Form M-13C Form M-13C Legal Service Provider Questionnaire

1 | Page

OMB 0970-#### [valid through MM/DD/YYYY]

(Revised: 4/29/2020)

Stakeholder Questionnaire – Legal Service Provider

Interview Details

Program name:
Level of Care:
Stakeholder’s Name:
Date/Time of Interview:
Type of Interview (phone and/or face-to-face):
Interview Completed by:

Note: Before beginning the interview and/or providing this questionnaire to stakeholders, provide a brief introduction, including monitor role and purpose of monitoring visit, overview/purpose of interview, and clarify any questions. See Introduction Prompt for Stakeholders for additional guidance as needed.

Notes

Are you provided with everything you need to be able to conduct KYRs. Are there any programmatic barriers that prevent KYR presentations from being provided? Are you provided with adequate space to conduct KYRs presentations?
Are you provided with everything you need to conduct legal screenings? A private place to do legal screenings?
How are you informed of new arrivals/discharges? Are you informed in a timely manner?
How is the communication with program staff? Which staff members do you have regular interaction and/or communication?
Are you made aware of incidents that may impact an UAC legal case (ex. Age outs, runaways, SIRs, etc.)? How are you made aware of incidents?
Do you have issues/concerns to share with us?

Additional Notes

Enter Additional Notes.

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow ORR Monitoring Team staff to interview and document responses from legal service providers during biennial site visits. Public reporting burden for this collection of information is estimated to average 1.0 hour per response (plus an additional 1.0 hour if the site visit is performed by a contractor monitor), including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information please contact [email protected].