Unaccompanied Refugee Minors Program Application, and Withdrawal of Application or Declination of Placement Form

ICR 202005-0970-013

OMB: 0970-0550

Federal Form Document

ICR Details
0970-0550 202005-0970-013
Unaccompanied Refugee Minors Program Application, and Withdrawal of Application or Declination of Placement Form
New collection (Request for a new OMB Control Number)   No
Approved without change 08/13/2020
Retrieve Notice of Action (NOA) 05/27/2020
  Inventory as of this Action Requested Previously Approved
08/31/2023 36 Months From Approved
380 0 0
531 0 0
0 0 0

The Refugee Act of 1980, Pub. L. No. 96-212, 8 U.S.C. 1522, amended the Immigration and Nationality Act to create a domestic refugee resettlement program that provides assistance and services to refugees resettling in the United States. With the enactment of this legislation, the Office of Refugee Resettlement (ORR) established comprehensive requirements for a State-administered refugee resettlement program including child welfare services to unaccompanied refugee minors. The Unaccompanied Refugee Minors (URM) Program currently operates in 15 States and provides the same range of child welfare benefits and services available to other foster children in those States as well as services required by ORR regulation and policy guidance. Originally, the URM Program provided services for refugee minors arriving from overseas unaccompanied by a parent or adult relative. Over the years Congress passed laws making other special populations already in the United States eligible for the URM Program. A completed URM Program Application must be submitted to ORR for eligibility determination, initiation of placement efforts, and approval to enter the URM Program. The URM Program Application is completed on behalf of unaccompanied minors in the United States who are applying for entry into the URM Program. Applications are completed by case managers, attorneys, or other representatives working with minors who are eligible for the URM Program. The application includes biographical data and comprehensive information on the minor and his/her needs (e.g., placement history, family reunification efforts, medical needs, mental and behavioral health needs, etc.). ORR uses the information collected to determine a minor’s eligibility for the URM Program, and to facilitate placement in the program. The application information is also used to provide a recommendation to the ORR Director to approve the minor to enter the URM Program. The Withdrawal of Application or Declination of Placement Form is completed when a minor who has submitted an application for the URM Program wishes to withdraw this application before approval to enter the program, or if the minor has been offered placement and wishes to decline the placement. This form serves as official record for ORR to cease placement efforts, or to offer the proposed placement to another eligible applicant. The forms included in this information collection request were previously approved under OMB #0970-0498. We are requesting approval for the forms under a new OMB number, specific to this collection of information. Minor changes are proposed in comparison to the previously approved version of the form.

US Code: 8 USC 1522(d) Name of Law: Refugee Act of 1980

Not associated with rulemaking

  85 FR 11997 02/28/2020
85 FR 31783 05/27/2020

  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 380 0 0 380 0 0
Annual Time Burden (Hours) 531 0 0 531 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Miscellaneous Actions
The proposed revisions to each form are minimal from the last OMB approval (previously approved under OMB #0970-0498, expiration 7/31/2020). Certain terms on the forms were changed to improve clarity for respondents. ORR is currently seeking a new OMB number specific to these forms, as they were previously approved as part of another information collection package for ORR’s Unaccompanied Alien Children’s program.

Molly Buck 202 205-4724 [email protected]


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.

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