Medical Complaint Form, Contact Investigation Form: Non-TB Illness, and Contact Investigation Form

ICR 202003-0970-007

OMB: 0970-0509

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Modified
Supporting Statement A
2020-03-18
Supplementary Document
2018-01-30
ICR Details
0970-0509 202003-0970-007
Historical Active 201801-0970-014
HHS/ACF ORR
Medical Complaint Form, Contact Investigation Form: Non-TB Illness, and Contact Investigation Form
Revision of a currently approved collection   No
Emergency 03/19/2020
Approved without change 03/19/2020
Retrieve Notice of Action (NOA) 03/18/2020
  Inventory as of this Action Requested Previously Approved
09/30/2020 6 Months From Approved 05/31/2021
101,040 0 101,040
21,182 0 21,182
0 0 0

Pursuant to Exhibit 1, part A.2 of the Flores Settlement Agreement (Jenny Lisette Flores, et al., v. Janet Reno, Attorney General of the United States, et al., Case No. CV 85-4544-RJK (C.D. Cal. 1996), the Administration for Children and Families’ Office of Refugee Resettlement (ORR), on behalf of the Department of Health and Human Services (DHHS), is directed to provide unaccompanied children in their custody with medical, mental, and dental care until reunification with a qualified sponsor. Licensed care provider facilities, on behalf of ORR, are required to ensure that all children receive a complete medical examination within 48 business hours of admission including screening for infectious diseases and immunizations recommended by the U.S. Public Health Service (PHS), the Center for Disease Control and Prevention. Additional required services include routine medical and dental care, family planning services, and emergency healthcare. ORR requires care provider facilities to maintain records on each child to ensure that health-related evaluations, diagnosed illnesses/conditions, immunizations, and treatments are documented, monitored, and included in the child’s discharge packet at the time of reunification. ORR requires the Medical Complaint and Contact Investigation (Active/Suspect TB and Non-TB Illness) information collections to implement and maintain compliance with the Flores Settlement Agreement.
In response to the COVID-19 outbreak, the Office of Refugee Resettlement has added fields to the Medical Complaint form. To allow for immediate use, we request emergency approval for six months and will submit a full request to continue collection beyond six months. The specific changes include the addition two fields: the COVID-19 diagnosis and public health interventions.

None
None

Not associated with rulemaking

  85 FR 15476 03/18/2020
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 101,040 101,040 0 0 0 0
Annual Time Burden (Hours) 21,182 21,182 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$131,653
No
    Yes
    No
No
No
No
Uncollected
Molly Buck 202 205-4724 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/18/2020


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