Monitoring and Compliance for Office of Refugee Resettlement (ORR) Care Provider Facilities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form M-7D LTFC Remote Site Visit Guide	Form and Instruction	New	Available
Form Form M-7C LTFC Site Visit Guide	Form and Instruction	New	Repair queued
Form Form M-7C LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-7D LTFC Remote Site Visit Guide	Form and Instruction	New	Available
Form Form M-7C LTFC Site Visit Guide	Form and Instruction	New	Repair queued
Form Form M-7C LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Respondents	Form and Instruction	New	Repair queued
Form Form M-15 Monitoring Schedule	Form and Instruction	New	Available
Form Form M-15 Monitoring Schedule (Form M-15)	Form and Instruction	New	Repair queued
Form Form M-14 Monitoring Visit	Form and Instruction	New	Available
Form Form M-14 Monitoring Visit (Form M-14)	Form and Instruction	New	Repair queued
Form Form M-13E Case Coordinator Questionnaire	Form and Instruction	New	Repair queued
Form Form M-13E Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-13E Case Coordinator Questionnaire	Form and Instruction	New	Available
Form Form M-13E Case Coordinator Questionnaire (Form M-13E) - Respondents	Form and Instruction	New	Repair queued
Form Form M-13D LTFC Legal Service Provider Questionnaire	Form and Instruction	New	Available
Form Form M-13D Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-13D LTFC Legal Service Provider Questionnaire	Form and Instruction	New	Available
Form Form M-13D Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting	Form and Instruction	New	Repair queued
Form Form M-13C Legal Service Provider Questionnaire	Form and Instruction	New	Available
Form Form M-13C Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-13C Legal Service Provider Questionnaire	Form and Instruction	New	Available
Form Form M-13C Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form and Instruction	New	Repair queued
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire	Form and Instruction	New	Available
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire	Form and Instruction	New	Available
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents	Form and Instruction	New	Repair queued
Form Form M-13A 48 - HS PRS Program Director Questionnaire	Form and Instruction	New	Available
Form Form M-13A Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-13A HS PRS Program Director Questionnaire	Form and Instruction	New	Available
Form Form M-13A Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form and Instruction	New	Repair queued
Form Form M-12D Secure Client Questionnaire	Form and Instruction	New	Repair queued
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-12D Secure Client Questionnaire	Form and Instruction	New	Available
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction	New	Repair queued
Form Form M-12C LTFC Client Questionnaire	Form and Instruction	New	Available
Form Form M-12C Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-12C LTFC Client Questionnaire	Form and Instruction	New	Available
Form Form M-12C Long Term Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction	New	Repair queued
Form Form M-12B UAC Questionnaire - Ages 13 and Older	Form and Instruction	New	Available
Form Form M-12A UAC Questionnaire - Ages 6-12 Years Old	Form and Instruction	New	Available
Form Form M-12A UAC Questionnaires (Forms M-12A-B) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-12B UAC Questionnaire - Ages 13 and Older	Form and Instruction	New	Available
Form Form M-12A UAC Questionnaire - Ages 6-12 Years Old	Form and Instruction	New	Available
Form Form M-12A UAC Questionnaires (Forms M-12A-B) - Respondents	Form and Instruction	New	Repair queued
Form Form M-11O LTFC Foster Parent Questionnaire	Form and Instruction	New	Available
Form Form M-11O Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-11O LTFC Foster Parent Questionnaire	Form and Instruction	New	Available
Form Form M-11O Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form and Instruction	New	Available
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire	Form and Instruction	New	Available
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire	Form and Instruction	New	Available
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form and Instruction	New	Repair queued
Form Form M-11M Long Term Foster Care Home Finder Questionnaire	Form and Instruction	New	Repair queued
Form Form M-11M Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-11M Long Term Foster Care Home Finder Questionnaire	Form and Instruction	New	Repair queued
Form Form M-11M Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form and Instruction	New	Repair queued
Form Form M-11L Secure Detention Officer Questionnaire	Form and Instruction	New	Repair queued
Form Form M-11L Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-11L Secure Detention Officer Questionnaire	Form and Instruction	New	Available
Form Form M-11L Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form and Instruction	New	Repair queued
Form Form M-11K PSA Compliance Manager Questionnaire	Form and Instruction	New	Available
Form Form M-11J Youth Care Worker Questionnaire	Form and Instruction	New	Repair queued
Form Form M-11I Medical Coordinator Questionnaire	Form and Instruction	New	Available
Form Form M-11H LTFC Educational Staff Questionnaire	Form and Instruction	New	Available
Form Form M-11G Education Staff Questionnaire	Form and Instruction	New	Available
Form Form M-11G Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-11F LTFC Case Manager Questionnaire	Form and Instruction	New	Available
Form Form M-11E Case Manager Questionnaire	Form and Instruction	New	Available
Form Form M-11D LTFC Clinician Questionnaire	Form and Instruction	New	Available
Form Form M-11C Clinician Questionnaire	Form and Instruction	New	Available
Form Form M-11B LTFC Program Director Questionnaire	Form and Instruction	New	Repair queued
Form Form M-11A Program Director Questionnaire	Form and Instruction	New	Available
Form Form M-11K PSA Compliance Manager Questionnaire	Form and Instruction	New	Available
Form Form M-11J Youth Care Worker Questionnaire	Form and Instruction	New	Available
Form Form M-11I Medical Coordinator Questionnaire	Form and Instruction	New	Available
Form Form M-11H LTFC Educational Staff Questionnaire	Form and Instruction	New	Available
Form Form M-11G Education Staff Questionnaire	Form and Instruction	New	Available
Form Form M-11F LTFC Case Manager Questionnaire	Form and Instruction	New	Available
Form Form M-11E Case Manager Questionnaire	Form and Instruction	New	Available
Form Form M-11D LTFC Clinician Questionnaire	Form and Instruction	New	Available
Form Form M-11D Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	Repair queued
Form Form M-11C Clinician Questionnaire	Form and Instruction	New	Available
Form Form M-11B LTFC Program Director Questionnaire	Form and Instruction	New	Repair queued
Form Form M-11A Program Director Questionnaire	Form and Instruction	New	Available
Form Form M-10D Long Term Foster Care Foster Parent Checklist	Form and Instruction	New	Available
Form Form M-10D Long Term Foster Care Foster Parent Checklist (Form M-10D)	Form and Instruction	New	Available
Form Form M-10C Home Study and Post-Release Services Personnel File Checklist	Form and Instruction	New	Repair queued
Form Form M-10C Home Study and Post-Release Services Personnel File Checklist (Form M-10C)	Form and Instruction	New	Repair queued
Form Form M-10B Supplement to Personnel File Checklist	Form and Instruction	New	Available
Form Form M-10B Supplement to Personnel File Checklist (Form M-10B)	Form and Instruction	New	Available
Form Form M-10A Personnel File Checklist	Form and Instruction	New	Available
Form Form M-10A Personnel File Checklist (Form M-10A)	Form and Instruction	New	Available
Form Form M-9C Post-Release Services Home Observation	Form and Instruction	New	Repair queued
Form Form M-9C Post-Release Services Home Observation (Form M-9C)	Form and Instruction	New	Repair queued
Form Form M-9 Foster Home On Site Monitoring Checklist	Form and Instruction	New	Available
Form Form M-9 Foster Home On Site Monitoring Checklist (Form M-9B)	Form and Instruction	New	Repair queued
Form Form M-9A On Site Monitoring Checklist	Form and Instruction	New	Available
Form Form M-9A On Site Monitoring Checklist (Form M-9A)	Form and Instruction	New	Repair queued
Form Form M-8D Secure and Staff Secure Addendum to Case File Checklist	Form and Instruction	New	Available
Form Form M-8D Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-8D Secure and Staff Secure Addendum to Case File Checklist	Form and Instruction	New	Available
Form Form M-8D Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Respondents	Form and Instruction	New	Repair queued
Form Form M-8C Home Study and Post-Release Services Case File Checklist	Form and Instruction	New	Available
Form Form M-8C Home Study and Post-Release Services Case File Checklist (Form M-8C) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-8C Home Study and Post-Release Services Case File Checklist	Form and Instruction	New	Repair queued
Form Form M-8C Home Study and Post-Release Services Case File Checklist (Form M-8C) - Respondents	Form and Instruction	New	Available
Form Form M-8B Long Term Foster Care File Checklist	Form and Instruction	New	Available
Form Form M-8B Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-8B Long Term Foster Care File Checklist	Form and Instruction	New	Available
Form Form M-8B Long Term Foster Care File Checklist (Form M-8B) - Respondents	Form and Instruction	New	Repair queued
Form Form M-8A UAC Case File Checklist	Form and Instruction	New	Repair queued
Form Form M-8A UAC Case File Checklist (Form M-8A) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-8A UAC Case File Checklist	Form and Instruction	New	Available
Form Form M-8A UAC Case File Checklist (Form M-8A) - Respondents	Form and Instruction	New	Repair queued
Form Form M-7F Voluntary Agency Site Visit Guide	Form and Instruction	New	Available
Form Form M-7F Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-7F Voluntary Agency Site Visit Guide	Form and Instruction	New	Repair queued
Form Form M-7F Voluntary Agency Site Visit Guide (Form M-7F) - Respondents	Form and Instruction	New	Repair queued
Form Form M-7E HS PRS Site Visit Guide	Form and Instruction	New	Available
Form Form M-7E HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-7E HS PRS Site Visit Guide	Form and Instruction	New	Available
Form Form M-7E HS/PRS Site Visit Guide (Form M-7E) - Respondents	Form and Instruction	New	Repair queued
Form Form M-7B Remote Monitoring Site Visit Guide	Form and Instruction	New	Available
Form Form M-7A Site Visit Guide	Form and Instruction	New	Available
Form Form M-7A Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-7B Remote Monitoring Site Visit Guide	Form and Instruction	New	Available
Form Form M-7A Site Visit Guide	Form and Instruction	New	Available
Form Form M-7A Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form and Instruction	New	Repair queued
Form Form M-6D LTFC Remote Monitoring Notes	Form and Instruction	New	Available
Form Form M-6C LTFC Monitoring Notes	Form and Instruction	New	Repair queued
Form Form M-6C LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D)	Form and Instruction	New	Repair queued
Form Form M-6B Remote Monitoring Notes	Form and Instruction	New	Available
Form Form M-6A Monitoring Notes	Form and Instruction	New	Available
Form Form M-6A Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B)	Form and Instruction	New	Repair queued
Form Form M-5B Adult Incident Review	Form and Instruction	New	Available
Form Form M-5A UAC Incident Review	Form and Instruction	New	Available
Form Form M-5A Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	New	Repair queued
Form Form M-4B Checklist for a Child-Friendly Environment - Individual Foster Home	Form and Instruction	New	Repair queued
Form Form M-4A Checklist for a Child-Friendly Environment - Care Provider Facility	Form and Instruction	New	Available
Form Form M-4A Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form and Instruction	New	Repair queued
Form Form M-3B Out-of-Network Site Visit Report	Form and Instruction	New	Available
Form Form M-3B Out-of-Network Site Visit Report (Form M-3B)	Form and Instruction	New	Repair queued
Form Form M-3A FFS Compliance and Safety Site Visit Report	Form and Instruction	New	Repair queued
Form Form M-3A FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping	Form and Instruction	New	Repair queued
Form Form M-3A FFS Compliance and Safety Site Visit Report	Form and Instruction	New	Available
Form Form M-3A FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents	Form and Instruction	New	Repair queued
Form M-1 Corrective Action Report (Form M-1)	Form and Instruction	New	Available
Form M-1 Corrective Action Report (Form M-1) - Recordkeeping	Form and Instruction	New	Repair queued
Form M-1 Corrective Action Report (Form M-1)	Form and Instruction	New	Available
Form M-1 Corrective Action Report (Form M-1) - Respondents	Form and Instruction	New	Repair queued
Supporting Statement - Monitoring Compliance - Emergency Request.docx	Supporting Statement A	Uploaded 2021-02-12	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
245634	LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping	Form and Instruction	New	LTFC Remote Site Visit Guide
245634	LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping	Form and Instruction	New	LTFC Site Visit Guide
245634	LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping	Form and Instruction	New
245633	LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Respondents	Form and Instruction	New	LTFC Remote Site Visit Guide
245633	LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Respondents	Form and Instruction	New	LTFC Site Visit Guide
245633	LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Respondents	Form and Instruction	New
245632	Monitoring Schedule (Form M-15)	Form and Instruction	New	Monitoring Schedule
245632	Monitoring Schedule (Form M-15)	Form and Instruction	New
245631	Monitoring Visit (Form M-14)	Form and Instruction	New	Monitoring Visit
245631	Monitoring Visit (Form M-14)	Form and Instruction	New
245630	Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form and Instruction	New	Case Coordinator Questionnaire
245630	Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form and Instruction	New
245629	Case Coordinator Questionnaire (Form M-13E) - Respondents	Form and Instruction	New	Case Coordinator Questionnaire
245629	Case Coordinator Questionnaire (Form M-13E) - Respondents	Form and Instruction	New
245628	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form and Instruction	New	LTFC Legal Service Provider Questionnaire
245628	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form and Instruction	New
245627	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting	Form and Instruction	New	LTFC Legal Service Provider Questionnaire
245627	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting	Form and Instruction	New
245626	Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form and Instruction	New	Legal Service Provider Questionnaire
245626	Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form and Instruction	New
245625	Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form and Instruction	New	Legal Service Provider Questionnaire
245625	Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form and Instruction	New
245624	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping	Form and Instruction	New	Home Study and Post-Release Services Caseworker Questionnaire
245624	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping	Form and Instruction	New
245623	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents	Form and Instruction	New	Home Study and Post-Release Services Caseworker Questionnaire
245623	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents	Form and Instruction	New
245622	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form and Instruction	New	48 - HS PRS Program Director Questionnaire
245622	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form and Instruction	New
245621	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form and Instruction	New	HS PRS Program Director Questionnaire
245621	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form and Instruction	New
245619	Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form and Instruction	New	Secure Client Questionnaire
245619	Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form and Instruction	New
245618	Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction	New	Secure Client Questionnaire
245618	Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction	New
245617	Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form and Instruction	New	LTFC Client Questionnaire
245617	Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form and Instruction	New
245616	Long Term Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction	New	LTFC Client Questionnaire
245616	Long Term Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction	New
245615	UAC Questionnaires (Forms M-12A-B) - Recordkeeping	Form and Instruction	New	UAC Questionnaire - Ages 13 and Older
245615	UAC Questionnaires (Forms M-12A-B) - Recordkeeping	Form and Instruction	New	UAC Questionnaire - Ages 6-12 Years Old
245615	UAC Questionnaires (Forms M-12A-B) - Recordkeeping	Form and Instruction	New
245614	UAC Questionnaires (Forms M-12A-B) - Respondents	Form and Instruction	New	UAC Questionnaire - Ages 13 and Older
245614	UAC Questionnaires (Forms M-12A-B) - Respondents	Form and Instruction	New	UAC Questionnaire - Ages 6-12 Years Old
245614	UAC Questionnaires (Forms M-12A-B) - Respondents	Form and Instruction	New
245613	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form and Instruction	New	LTFC Foster Parent Questionnaire
245613	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form and Instruction	New
245612	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form and Instruction	New	LTFC Foster Parent Questionnaire
245612	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form and Instruction	New
245611	Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form and Instruction	New	Long Term Foster Care Independent Living Life Skills Staff Questionnaire
245611	Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form and Instruction	New
245610	Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form and Instruction	New	Long Term Foster Care Independent Living Life Skills Staff Questionnaire
245610	Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form and Instruction	New
245609	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form and Instruction	New	Long Term Foster Care Home Finder Questionnaire
245609	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form and Instruction	New
245608	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form and Instruction	New	Long Term Foster Care Home Finder Questionnaire
245608	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form and Instruction	New
245607	Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form and Instruction	New	Secure Detention Officer Questionnaire
245607	Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form and Instruction	New
245606	Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form and Instruction	New	Secure Detention Officer Questionnaire
245606	Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form and Instruction	New
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	PSA Compliance Manager Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	Youth Care Worker Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	Medical Coordinator Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	LTFC Educational Staff Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	Education Staff Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	LTFC Case Manager Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	Case Manager Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	LTFC Clinician Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	Clinician Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	LTFC Program Director Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	New	Program Director Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	PSA Compliance Manager Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	Youth Care Worker Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	Medical Coordinator Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	LTFC Educational Staff Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	Education Staff Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	LTFC Case Manager Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	Case Manager Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	LTFC Clinician Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	Clinician Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	LTFC Program Director Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	New	Program Director Questionnaire
245603	Long Term Foster Care Foster Parent Checklist (Form M-10D)	Form and Instruction	New	Long Term Foster Care Foster Parent Checklist
245603	Long Term Foster Care Foster Parent Checklist (Form M-10D)	Form and Instruction	New
245602	Home Study and Post-Release Services Personnel File Checklist (Form M-10C)	Form and Instruction	New	Home Study and Post-Release Services Personnel File Checklist
245602	Home Study and Post-Release Services Personnel File Checklist (Form M-10C)	Form and Instruction	New
245601	Supplement to Personnel File Checklist (Form M-10B)	Form and Instruction	New	Supplement to Personnel File Checklist
245601	Supplement to Personnel File Checklist (Form M-10B)	Form and Instruction	New
245600	Personnel File Checklist (Form M-10A)	Form and Instruction	New	Personnel File Checklist
245600	Personnel File Checklist (Form M-10A)	Form and Instruction	New
245599	Post-Release Services Home Observation (Form M-9C)	Form and Instruction	New	Post-Release Services Home Observation
245599	Post-Release Services Home Observation (Form M-9C)	Form and Instruction	New
245598	Foster Home On Site Monitoring Checklist (Form M-9B)	Form and Instruction	New	Foster Home On Site Monitoring Checklist
245598	Foster Home On Site Monitoring Checklist (Form M-9B)	Form and Instruction	New
245597	On Site Monitoring Checklist (Form M-9A)	Form and Instruction	New	On Site Monitoring Checklist
245597	On Site Monitoring Checklist (Form M-9A)	Form and Instruction	New
245596	Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Recordkeeping	Form and Instruction	New	Secure and Staff Secure Addendum to Case File Checklist
245596	Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Recordkeeping	Form and Instruction	New
245595	Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Respondents	Form and Instruction	New	Secure and Staff Secure Addendum to Case File Checklist
245595	Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Respondents	Form and Instruction	New
245594	Home Study and Post-Release Services Case File Checklist (Form M-8C) - Recordkeeping	Form and Instruction	New	Home Study and Post-Release Services Case File Checklist
245594	Home Study and Post-Release Services Case File Checklist (Form M-8C) - Recordkeeping	Form and Instruction	New
245593	Home Study and Post-Release Services Case File Checklist (Form M-8C) - Respondents	Form and Instruction	New	Home Study and Post-Release Services Case File Checklist
245593	Home Study and Post-Release Services Case File Checklist (Form M-8C) - Respondents	Form and Instruction	New
245592	Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping	Form and Instruction	New	Long Term Foster Care File Checklist
245592	Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping	Form and Instruction	New
245591	Long Term Foster Care File Checklist (Form M-8B) - Respondents	Form and Instruction	New	Long Term Foster Care File Checklist
245591	Long Term Foster Care File Checklist (Form M-8B) - Respondents	Form and Instruction	New
245590	UAC Case File Checklist (Form M-8A) - Recordkeeping	Form and Instruction	New	UAC Case File Checklist
245590	UAC Case File Checklist (Form M-8A) - Recordkeeping	Form and Instruction	New
245589	UAC Case File Checklist (Form M-8A) - Respondents	Form and Instruction	New	UAC Case File Checklist
245589	UAC Case File Checklist (Form M-8A) - Respondents	Form and Instruction	New
245588	Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping	Form and Instruction	New	Voluntary Agency Site Visit Guide
245588	Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping	Form and Instruction	New
245587	Voluntary Agency Site Visit Guide (Form M-7F) - Respondents	Form and Instruction	New	Voluntary Agency Site Visit Guide
245587	Voluntary Agency Site Visit Guide (Form M-7F) - Respondents	Form and Instruction	New
245586	HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping	Form and Instruction	New	HS PRS Site Visit Guide
245586	HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping	Form and Instruction	New
245585	HS/PRS Site Visit Guide (Form M-7E) - Respondents	Form and Instruction	New	HS PRS Site Visit Guide
245585	HS/PRS Site Visit Guide (Form M-7E) - Respondents	Form and Instruction	New
245584	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form and Instruction	New	Remote Monitoring Site Visit Guide
245584	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form and Instruction	New	Site Visit Guide
245584	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form and Instruction	New
245583	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form and Instruction	New	Remote Monitoring Site Visit Guide
245583	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form and Instruction	New	Site Visit Guide
245583	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form and Instruction	New
245582	LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D)	Form and Instruction	New	LTFC Remote Monitoring Notes
245582	LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D)	Form and Instruction	New	LTFC Monitoring Notes
245582	LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D)	Form and Instruction	New
245581	Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B)	Form and Instruction	New	Remote Monitoring Notes
245581	Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B)	Form and Instruction	New	Monitoring Notes
245581	Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B)	Form and Instruction	New
245580	Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	New	Adult Incident Review
245580	Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	New	UAC Incident Review
245580	Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	New
245579	Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form and Instruction	New	Checklist for a Child-Friendly Environment - Individual Foster Home
245579	Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form and Instruction	New	Checklist for a Child-Friendly Environment - Care Provider Facility
245579	Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form and Instruction	New
245577	Out-of-Network Site Visit Report (Form M-3B)	Form and Instruction	New	Out-of-Network Site Visit Report
245577	Out-of-Network Site Visit Report (Form M-3B)	Form and Instruction	New
245576	FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping	Form and Instruction	New	FFS Compliance and Safety Site Visit Report
245576	FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping	Form and Instruction	New
245575	FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents	Form and Instruction	New	FFS Compliance and Safety Site Visit Report
245575	FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents	Form and Instruction	New
245574	Corrective Action Report (Form M-1) - Recordkeeping	Form and Instruction	New	Corrective Action Report (Form M-1)
245574	Corrective Action Report (Form M-1) - Recordkeeping	Form and Instruction	New
245572	Corrective Action Report (Form M-1) - Respondents	Form and Instruction	New	Corrective Action Report (Form M-1)
245572	Corrective Action Report (Form M-1) - Respondents	Form and Instruction	New

ICR Details

OMB Control No: 0970-0564	ICR Reference No: 202102-0970-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: ORR
Title: Monitoring and Compliance for Office of Refugee Resettlement (ORR) Care Provider Facilities
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 02/16/2021
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/16/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/12/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	6 Months From Approved
Responses	9,364	0	0
Time Burden (Hours)	13,364	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: These instruments allow ORR to monitor its care provider facilities for compliance with Federal and State laws and regulations, licensing and accreditation standards, ORR policies and procedures, and child welfare standards.

Emergency Justfication: Consistent with the Paperwork Reduction Act of 1995, and OMB procedures, the Department requests approval for emergency processing for Monitoring and Compliance forms for the Unaccompanied Children program. On January 21, 2021, the Department published a Notice of Request for Public Comment for the forms, initiating a 60-day period for the public to submit comments on the information collection. The 60-day comment period ends on March 22, 2021. The monitoring and compliance forms are necessary for the program to meet its statutory obligations (Homeland Security Act, 6 U.S.C. 279). The Department requests emergency OMB approval pursuant to 5 CFR 1320.13 in order for the monitoring and compliance forms to be used by ORR field offices while public comment is being sought. The Department plans to complete the ongoing PRA process for the three-year approval of the monitoring and compliance forms since approval based on emergency processing under the PRA is only granted for a maximum of 180 days, until August 2021.

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Authorizing Statute(s): US Code: 6 USC 279 Name of Law: Homeland Security Act of 2002
   US Code: 8 USC 1232 Name of Law: Trafficking Victim Protection Reauthorization Act of 2008
  

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:
	86 FR 6340	01/21/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 60

table that charts list of burden

IC Title	Form No.	Form Name
Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form M-13E	Case Coordinator Questionnaire
Case Coordinator Questionnaire (Form M-13E) - Respondents	Form M-13E	Case Coordinator Questionnaire
Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form M-4A, Form M-4B	Checklist for a Child-Friendly Environment - Care Provider Facility ,   Checklist for a Child-Friendly Environment - Individual Foster Home
Corrective Action Report (Form M-1) - Recordkeeping	M-1	Corrective Action Report (Form M-1)
Corrective Action Report (Form M-1) - Respondents	M-1	Corrective Action Report (Form M-1)
FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping	Form M-3A	FFS Compliance and Safety Site Visit Report
FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents	Form M-3A	FFS Compliance and Safety Site Visit Report
Foster Home On Site Monitoring Checklist (Form M-9B)	Form M-9	Foster Home On Site Monitoring Checklist
HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping	Form M-7E	HS PRS Site Visit Guide
HS/PRS Site Visit Guide (Form M-7E) - Respondents	Form M-7E	HS PRS Site Visit Guide
Home Study and Post-Release Services Case File Checklist (Form M-8C) - Recordkeeping	Form M-8C	Home Study and Post-Release Services Case File Checklist
Home Study and Post-Release Services Case File Checklist (Form M-8C) - Respondents	Form M-8C	Home Study and Post-Release Services Case File Checklist
Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping	Form M-13B	Home Study and Post-Release Services Caseworker Questionnaire
Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents	Form M-13B	Home Study and Post-Release Services Caseworker Questionnaire
Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form M-13A	48 - HS PRS Program Director Questionnaire
Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form M-13A	HS PRS Program Director Questionnaire
Home Study and Post-Release Services Personnel File Checklist (Form M-10C)	Form M-10C	Home Study and Post-Release Services Personnel File Checklist
Incident Reviews (Forms M-5A to M-5B)	Form M-5A, Form M-5B	UAC Incident Review ,   Adult Incident Review
LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D)	Form M-6C, Form M-6D	LTFC Monitoring Notes ,   LTFC Remote Monitoring Notes
LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping	Form M-7C, Form M-7D	LTFC Site Visit Guide ,   LTFC Remote Site Visit Guide
LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Respondents	Form M-7C, Form M-7D	LTFC Site Visit Guide ,   LTFC Remote Site Visit Guide
Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form M-13C	Legal Service Provider Questionnaire
Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form M-13C	Legal Service Provider Questionnaire
Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form M-12C	LTFC Client Questionnaire
Long Term Foster Care Client Questionnaire (M-12C) - Respondents	Form M-12C	LTFC Client Questionnaire
Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping	Form M-8B	Long Term Foster Care File Checklist
Long Term Foster Care File Checklist (Form M-8B) - Respondents	Form M-8B	Long Term Foster Care File Checklist
Long Term Foster Care Foster Parent Checklist (Form M-10D)	Form M-10D	Long Term Foster Care Foster Parent Checklist
Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form M-11O	LTFC Foster Parent Questionnaire
Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form M-11O	LTFC Foster Parent Questionnaire
Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form M-11M	Long Term Foster Care Home Finder Questionnaire
Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form M-11M	Long Term Foster Care Home Finder Questionnaire
Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form M-11N	Long Term Foster Care Independent Living Life Skills Staff Questionnaire
Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form M-11N	Long Term Foster Care Independent Living Life Skills Staff Questionnaire
Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form M-13D	LTFC Legal Service Provider Questionnaire
Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting	Form M-13D	LTFC Legal Service Provider Questionnaire
Monitoring Schedule (Form M-15)	Form M-15	Monitoring Schedule
Monitoring Visit (Form M-14)	Form M-14	Monitoring Visit
Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B)	Form M-6A, Form M-6B	Monitoring Notes ,   Remote Monitoring Notes
On Site Monitoring Checklist (Form M-9A)	Form M-9A	On Site Monitoring Checklist
Out-of-Network Site Visit Report (Form M-3B)	Form M-3B	Out-of-Network Site Visit Report
Personnel File Checklist (Form M-10A)	Form M-10A	Personnel File Checklist
Post-Release Services Home Observation (Form M-9C)	Form M-9C	Post-Release Services Home Observation
Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form M-11C, Form M-11D, Form M-11E, Form M-11F, Form M-11H, Form M-11I, Form M-11J, Form M-11K, Form M-11G, Form M-11A, Form M-11B	Program Director Questionnaire ,   LTFC Program Director Questionnaire ,   Clinician Questionnaire ,   LTFC Clinician Questionnaire ,   Case Manager Questionnaire ,   LTFC Case Manager Questionnaire ,   Education Staff Questionnaire ,   LTFC Educational Staff Questionnaire ,   Medical Coordinator Questionnaire ,   Youth Care Worker Questionnaire ,   PSA Compliance Manager Questionnaire
Program Staff Questionnaires (Form M-11A-K) - Respondents	Form M-11G, Form M-11A, Form M-11B, Form M-11C, Form M-11D, Form M-11E, Form M-11F, Form M-11H, Form M-11I, Form M-11J, Form M-11K	Program Director Questionnaire ,   LTFC Program Director Questionnaire ,   Clinician Questionnaire ,   LTFC Clinician Questionnaire ,   Case Manager Questionnaire ,   LTFC Case Manager Questionnaire ,   Education Staff Questionnaire ,   LTFC Educational Staff Questionnaire ,   Medical Coordinator Questionnaire ,   Youth Care Worker Questionnaire ,   PSA Compliance Manager Questionnaire
Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form M-12D	Secure Client Questionnaire
Secure Client Questionnaire (Form M-12D) - Respondents	Form M-12D	Secure Client Questionnaire
Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form M-11L	Secure Detention Officer Questionnaire
Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form M-11L	Secure Detention Officer Questionnaire
Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Recordkeeping	Form M-8D	Secure and Staff Secure Addendum to Case File Checklist
Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Respondents	Form M-8D	Secure and Staff Secure Addendum to Case File Checklist
Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form M-7A, Form M-7B	Site Visit Guide ,   Remote Monitoring Site Visit Guide
Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form M-7B, Form M-7A	Site Visit Guide ,   Remote Monitoring Site Visit Guide
Supplement to Personnel File Checklist (Form M-10B)	Form M-10B	Supplement to Personnel File Checklist
UAC Case File Checklist (Form M-8A) - Recordkeeping	Form M-8A	UAC Case File Checklist
UAC Case File Checklist (Form M-8A) - Respondents	Form M-8A	UAC Case File Checklist
UAC Questionnaires (Forms M-12A-B) - Recordkeeping	Form M-12A, Form M-12B	UAC Questionnaire - Ages 6-12 Years Old ,   UAC Questionnaire - Ages 13 and Older
UAC Questionnaires (Forms M-12A-B) - Respondents	Form M-12A, Form M-12B	UAC Questionnaire - Ages 6-12 Years Old ,   UAC Questionnaire - Ages 13 and Older
Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping	Form M-7F	Voluntary Agency Site Visit Guide
Voluntary Agency Site Visit Guide (Form M-7F) - Respondents	Form M-7F	Voluntary Agency Site Visit Guide

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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	9,364	0	0	9,364	0	0
Annual Time Burden (Hours)	13,364	0	0	13,364	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: This is a new information collection request.

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Annual Cost to Federal Government: $498,366

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.     Yes

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: 02/12/2021

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