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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Withdrawal of Application or Declination of Placement Form	Form	New	Available
Form 1 Unaccompanied Refugee Minors Program Application	Form	New	Available
Supporting Statement_URM Program Application Forms_2020_final.docx	Supporting Statement A	Uploaded 2020-05-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241922	Withdrawal of Application or Declination of Placement Form	Form	New
241921	Unaccompanied Refugee Minors Program Application	Form	New

ICR Details

OMB Control No: 0970-0550	ICR Reference No: 202005-0970-013
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: ORR
Title: Unaccompanied Refugee Minors Program Application, and Withdrawal of Application or Declination of Placement Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/13/2020
	Date Received in OIRA: 05/27/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2023	36 Months From Approved
Responses	380	0	0
Time Burden (Hours)	531	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: 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.

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

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 11997	02/28/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 31783	05/27/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Unaccompanied Refugee Minors Program Application	1	URM Program Application Form
Withdrawal of Application or Declination of Placement Form	1	Withdrawal of Application or Declination of Placement Form

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ICR Summary of Burden

table that charts list of burden

	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

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: 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.

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Annual Cost to Federal Government: $172,670

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/27/2020

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