Office of the Immigration and Detention Ombudsman (OIDO) Intake Form

Forms and Documents

Document Name	Status
Form DHS Form 405 DHS Form 405 Form and Instruction	Modified
OIDO CMD PIA - Final (06-21-21) (3).pdf Supplementary Document	2021-10-25
Supporting Statement_OIDO Case Intake Form.docx Supporting Statement A	2021-10-25
2021-23137.pdf Supplementary Document	2021-10-25
2021-17002.pdf Supplementary Document	2021-08-10
E9-20159.pdf Supplementary Document	2021-06-14
2017-12262.pdf Supplementary Document	2021-06-14
OIDO Case Intake Form - Emergency Clearance Memo_6.10.21_eh.pdf Supplementary Document	2021-06-11
PLAW-116publ93 (3).pdf Supplementary Document	2021-06-11

IC Document Collections

IC ID	Document Title	Status
247872	DHS Form 405 Form and Instruction	Modified

ICR Details

OMB Control No: 1601-0030	ICR Reference No: 202107-1601-002
Status: Received in OIRA	Previous ICR Reference No: 202106-1601-003
Agency/Subagency: DHS/OS	Agency Tracking No:
Title: Office of the Immigration and Detention Ombudsman (OIDO) Intake Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/25/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2021
Responses	30,000	30,000
Time Burden (Hours)	30,000	30,000
Cost Burden (Dollars)	1,650	1,650

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Abstract: The Department of Homeland Security’s (DHS) Office of the Immigration Detention Ombudsman (OIDO) is an independent office tasked with resolving individual complaints from or about individuals in immigration detention regarding the potential violation of immigration detention standards or other potential misconduct. OIDO was established by Congress (Sec. 106 of the Consolidated Appropriations Act, 2020, Public Law 116-93). Its intake form is intended for use by individuals wishing to submit a complaint to OIDO. Information collected will provide the office with details about the allegations the submitter seeks to have OIDO address. The information collected on this form will allow OIDO to identify: (1) the individual submitting the complaint and their contact information; (2) the detained individual who is the subject of the complaint; (3) the government-owned or contracted facility where the individual is or was detained and for how long; and (4) relevant details about the complaint. All of this information will be used by OIDO to investigate, resolve, and if appropriate, provide redress.

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Authorizing Statute(s): PL: Pub.L. 116 - 93 106 Name of Law: Consolidated Appropriations Act 2020
  

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 43671	08/10/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 58921	10/25/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
DHS Form 405	DHS Form 405	DHS Form 405

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ICR Summary of Burden

	Total Request	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	30,000	30,000	0	0	0	0
Annual Time Burden (Hours)	30,000	30,000	0	0	0	0
Annual Cost Burden (Dollars)	1,650	1,650	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $2,000,000

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: 10/25/2021

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