Checklist for a Child-Friendly Environment (Form M-4A to M4B)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0564 can be found here:

Documents and Forms

Document Name Document Type
Form Form M-4A Checklist for a Child-Friendly Environment (Form M-4A to M4B) Form and Instruction
Form M-4A Checklist for a Child-Friendly Environment - Care Provid 04 - Checklist for a Child-Friendly Environment - Care Provider Facility (Form M-4A).pdf Form and Instruction
Form M-4A Checklist for a Child-Friendly Environment - Care Provid 04 - Checklist for a Child-Friendly Environment - Care Provider Facility (Form M-4A).pdf Form and Instruction
Form M-4B Checklist for a Child-Friendly Environment - Individual 05 - Checklist for a Child-Friendly Environment - Individual Foster Home (Form M-4B).pdf Form and Instruction
Form M-4B Checklist for a Child-Friendly Environment - Individual 05 - Checklist for a Child-Friendly Environment - Individual Foster Home (Form M-4B).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form M-4A	Checklist for a Child-Friendly Environment - Care Provider Facility	04 - Checklist for a Child-Friendly Environment - Care Provider Facility (Form M-4A).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	Form M-4B	Checklist for a Child-Friendly Environment - Individual Foster Home	05 - Checklist for a Child-Friendly Environment - Individual Foster Home (Form M-4B).pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 216	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,592	2,592
Annual IC Time Burden (Hours)	648	648
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.