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	Modified	Available
Form Form M-7C LTFC Site Visit Guide	Form and Instruction	Modified	Available
Form Form M-7C LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-7D LTFC Remote Site Visit Guide	Form and Instruction	Modified	Repair queued
Form Form M-7C LTFC Site Visit Guide	Form and Instruction	Modified	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	Modified	Repair queued
Form Form M-15 Monitoring Schedule	Form and Instruction	Modified	Available
Form Form M-15 Monitoring Schedule (Form M-15)	Form and Instruction	Modified	Repair queued
Form Form M-14 Monitoring Visit	Form and Instruction	Modified	Available
Form Form M-14 Monitoring Visit (Form M-14)	Form and Instruction	Modified	Repair queued
Form Form M-13E Case Coordinator Questionnaire	Form and Instruction	Modified	Available
Form Form M-13E Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-13E Case Coordinator Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-13E Case Coordinator Questionnaire (Form M-13E) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-13D LTFC Legal Service Provider Questionnaire	Form and Instruction	Modified	Available
Form Form M-13D Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-13D LTFC Legal Service Provider Questionnaire	Form and Instruction	Modified	Available
Form Form M-13D Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting	Form and Instruction	Modified	Repair queued
Form Form M-13C Legal Service Provider Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-13C Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-13C Legal Service Provider Questionnaire	Form and Instruction	Modified	Available
Form Form M-13C Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire	Form and Instruction	Modified	Available
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire	Form and Instruction	Modified	Available
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-13A 48 - HS PRS Program Director Questionnaire	Form and Instruction	Modified	Available
Form Form M-13A Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-13A HS PRS Program Director Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-13A Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-12D Secure Client Questionnaire	Form and Instruction	Modified	Available
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-12D Secure Client Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-12C LTFC Client Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-12C Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-12C LTFC Client Questionnaire	Form and Instruction	Modified	Available
Form Form M-12C Long Term Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-12Es UC Questionnaire - Ages 5 and Under - Spanish	Form and Instruction	Modified	Repair queued
Form Form M-12Bs UC Questionnaire - Ages 13 and Older - Spanish	Form and Instruction	Modified	Repair queued
Form Form M-12As UC Questionnaire - Ages 6-12 Years Old - Spanish	Form and Instruction	Modified	Repair queued
Form Form M-12E UC Questionnaire - Ages 5 and Under - English	Form and Instruction	Modified	Repair queued
Form Form M-12B UC Questionnaire - Ages 13 and Older - English	Form and Instruction	Modified	Available
Form Form M-12A UC Questionnaire - Ages 6-12 Years Old - English	Form and Instruction	Modified	Available
Form Form M-12A UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-12Es UC Questionnaire - Ages 5 and Under - Spanish	Form and Instruction	Modified	Available
Form Form M-12Bs UC Questionnaire - Ages 13 and Older - Spanish	Form and Instruction	Modified	Available
Form Form M-12As UC Questionnaire - Ages 6-12 Years Old - Spanish	Form and Instruction	Modified	Repair queued
Form Form M-12E UC Questionnaire - Ages 5 and Under - English	Form and Instruction	Modified	Available
Form Form M-12B UC Questionnaire - Ages 13 and Older - English	Form and Instruction	Modified	Available
Form Form M-12A UC Questionnaire - Ages 6-12 Years Old - English	Form and Instruction	Modified	Available
Form Form M-12A UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-11O LTFC Foster Parent Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-11O Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-11O LTFC Foster Parent Questionnaire	Form and Instruction	Modified	Available
Form Form M-11O Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire	Form and Instruction	Modified	Available
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-11M Long Term Foster Care Home Finder Questionnaire	Form and Instruction	Modified	Available
Form Form M-11M Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-11M Long Term Foster Care Home Finder Questionnaire	Form and Instruction	Modified	Available
Form Form M-11M Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-11L Secure Detention Officer Questionnaire	Form and Instruction	Modified	Available
Form Form M-11L Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-11L Secure Detention Officer Questionnaire	Form and Instruction	Modified	Available
Form Form M-11L Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-11K PSA Compliance Manager Questionnaire	Form and Instruction	Modified	Available
Form Form M-11J Youth Care Worker Questionnaire	Form and Instruction	Modified	Available
Form Form M-11I Medical Coordinator Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-11H LTFC Educational Staff Questionnaire	Form and Instruction	Modified	Available
Form Form M-11G Education Staff Questionnaire	Form and Instruction	Modified	Available
Form Form M-11F LTFC Case Manager Questionnaire	Form and Instruction	Modified	Available
Form Form M-11E Case Manager Questionnaire	Form and Instruction	Modified	Available
Form Form M-11D LTFC Clinician Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-11C Clinician Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-11B LTFC Program Director Questionnaire	Form and Instruction	Modified	Available
Form Form M-11A Program Director Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-11A Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-11K PSA Compliance Manager Questionnaire	Form and Instruction	Modified	Available
Form Form M-11J Youth Care Worker Questionnaire	Form and Instruction	Modified	Available
Form Form M-11I Medical Coordinator Questionnaire	Form and Instruction	Modified	Available
Form Form M-11H LTFC Educational Staff Questionnaire	Form and Instruction	Modified	Available
Form Form M-11G Education Staff Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-11F LTFC Case Manager Questionnaire	Form and Instruction	Modified	Available
Form Form M-11E Case Manager Questionnaire	Form and Instruction	Modified	Available
Form Form M-11D LTFC Clinician Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-11C Clinician Questionnaire	Form and Instruction	Modified	Available
Form Form M-11B LTFC Program Director Questionnaire	Form and Instruction	Modified	Available
Form Form M-11A Program Director Questionnaire	Form and Instruction	Modified	Repair queued
Form Form M-11A Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-10D Long Term Foster Care Foster Parent Checklist	Form and Instruction	Modified	Available
Form Form M-10D Long Term Foster Care Foster Parent Checklist (Form M-10D)	Form and Instruction	Modified	Repair queued
Form Form M-10C Home Study and Post-Release Services Personnel File Checklist	Form and Instruction	Modified	Repair queued
Form Form M-10C Home Study and Post-Release Services Personnel File Checklist (Form M-10C)	Form and Instruction	Modified	Repair queued
Form Form M-10B Supplement to Personnel File Checklist	Form and Instruction	Modified	Repair queued
Form Form M-10B Supplement to Personnel File Checklist (Form M-10B)	Form and Instruction	Modified	Repair queued
Form Form M-10A Personnel File Checklist	Form and Instruction	Modified	Available
Form Form M-10A Personnel File Checklist (Form M-10A)	Form and Instruction	Modified	Repair queued
Form Form M-9C Post-Release Services Home Observation	Form and Instruction	Removed	Available
Form Form M-9C Post-Release Services Home Observation (Form M-9C)	Form and Instruction	Removed	Repair queued
Form Form M-9 Foster Home On Site Monitoring Checklist	Form and Instruction	Removed	Available
Form Form M-9 Foster Home On Site Monitoring Checklist (Form M-9B)	Form and Instruction	Removed	Repair queued
Form Form M-9A On Site Monitoring Checklist	Form and Instruction	Removed	Available
Form Form M-9A On Site Monitoring Checklist (Form M-9A)	Form and Instruction	Removed	Available
Form Form M-8D Secure and Staff Secure Addendum to Case File Checklist	Form and Instruction	Removed	Available
Form Form M-8D Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Recordkeeping	Form and Instruction	Removed	Available
Form Form M-8D Secure and Staff Secure Addendum to Case File Checklist	Form and Instruction	Removed	Available
Form Form M-8D Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Respondents	Form and Instruction	Removed	Repair queued
Form Form M-8C Home Study and Post-Release Services Case File Checklist	Form and Instruction	Removed	Repair queued
Form Form M-8C Home Study and Post-Release Services Case File Checklist (Form M-8C) - Recordkeeping	Form and Instruction	Removed	Repair queued
Form Form M-8C Home Study and Post-Release Services Case File Checklist	Form and Instruction	Removed	Available
Form Form M-8C Home Study and Post-Release Services Case File Checklist (Form M-8C) - Respondents	Form and Instruction	Removed	Repair queued
Form Form M-8B Long Term Foster Care File Checklist	Form and Instruction	Removed	Available
Form Form M-8B Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping	Form and Instruction	Removed	Repair queued
Form Form M-8B Long Term Foster Care File Checklist	Form and Instruction	Removed	Repair queued
Form Form M-8B Long Term Foster Care File Checklist (Form M-8B) - Respondents	Form and Instruction	Removed	Repair queued
Form Form M-8A UAC Case File Checklist	Form and Instruction	Removed	Available
Form Form M-8A UAC Case File Checklist (Form M-8A) - Recordkeeping	Form and Instruction	Removed	Repair queued
Form Form M-8A UAC Case File Checklist	Form and Instruction	Removed	Repair queued
Form Form M-8A UAC Case File Checklist (Form M-8A) - Respondents	Form and Instruction	Removed	Repair queued
Form Form M-7F Voluntary Agency Site Visit Guide	Form and Instruction	Modified	Available
Form Form M-7F Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-7F Voluntary Agency Site Visit Guide	Form and Instruction	Modified	Repair queued
Form Form M-7F Voluntary Agency Site Visit Guide (Form M-7F) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-7E HS PRS Site Visit Guide	Form and Instruction	Modified	Repair queued
Form Form M-7E HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form Form M-7E HS PRS Site Visit Guide	Form and Instruction	Modified	Available
Form Form M-7E HS/PRS Site Visit Guide (Form M-7E) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-7B Remote Monitoring Site Visit Guide	Form and Instruction	Modified	Available
Form Form M-7A Site Visit Guide	Form and Instruction	Modified	Repair queued
Form Form M-7A Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form and Instruction	Modified	Available
Form Form M-7B Remote Monitoring Site Visit Guide	Form and Instruction	Modified	Repair queued
Form Form M-7A Site Visit Guide	Form and Instruction	Modified	Available
Form Form M-7A Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form and Instruction	Modified	Repair queued
Form Form M-6D LTFC Remote Monitoring Notes	Form and Instruction	Removed	Repair queued
Form Form M-6C LTFC Monitoring Notes	Form and Instruction	Removed	Available
Form Form M-6C LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D)	Form and Instruction	Removed	Repair queued
Form Form M-6B Remote Monitoring Notes	Form and Instruction	Removed	Available
Form Form M-6A Monitoring Notes	Form and Instruction	Removed	Repair queued
Form Form M-6A Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B)	Form and Instruction	Removed	Repair queued
Form Form M-5B Adult Incident Review	Form and Instruction	Modified	Available
Form Form M-5A UC Incident Review	Form and Instruction	Modified	Repair queued
Form Form M-5A Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	Modified	Repair queued
Form Form M-4B Checklist for a Child-Friendly Environment - Individual Foster Home	Form and Instruction	Modified	Available
Form Form M-4A Checklist for a Child-Friendly Environment - Care Provider Facility	Form and Instruction	Modified	Repair queued
Form Form M-4A Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form and Instruction	Modified	Repair queued
Form Form M-3B Out-of-Network Site Visit Report	Form and Instruction	Modified	Available
Form Form M-3B Out-of-Network Site Visit Report (Form M-3B)	Form and Instruction	Modified	Repair queued
Form Form M-3A FFS Compliance and Safety Site Visit Report	Form and Instruction	Removed	Repair queued
Form Form M-3A FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping	Form and Instruction	Removed	Repair queued
Form Form M-3A FFS Compliance and Safety Site Visit Report	Form and Instruction	Modified	Available
Form Form M-3A FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents	Form and Instruction	Modified	Repair queued
Form M-1 Corrective Action Report (Form M-1)	Form and Instruction	Modified	Available
Form M-1 Corrective Action Report (Form M-1) - Recordkeeping	Form and Instruction	Modified	Repair queued
Form M-1 Corrective Action Report (Form M-1)	Form and Instruction	Modified	Available
Form M-1 Corrective Action Report (Form M-1) - Respondents	Form and Instruction	Modified	Repair queued
Attachment A - Monitoring and Compliance Responses (08.31.21) FINAL.docx	Supplementary Document	Uploaded 2021-08-31	Repair queued
Supporting Statement - Monitoring Compliance (08.26.21).docx	Supporting Statement A	Uploaded 2021-08-26	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	Modified	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	Modified	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	Modified
245633	LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Respondents	Form and Instruction	Modified	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	Modified	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	Modified
245632	Monitoring Schedule (Form M-15)	Form and Instruction	Modified	Monitoring Schedule
245632	Monitoring Schedule (Form M-15)	Form and Instruction	Modified
245631	Monitoring Visit (Form M-14)	Form and Instruction	Modified	Monitoring Visit
245631	Monitoring Visit (Form M-14)	Form and Instruction	Modified
245630	Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form and Instruction	Modified	Case Coordinator Questionnaire
245630	Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form and Instruction	Modified
245629	Case Coordinator Questionnaire (Form M-13E) - Respondents	Form and Instruction	Modified	Case Coordinator Questionnaire
245629	Case Coordinator Questionnaire (Form M-13E) - Respondents	Form and Instruction	Modified
245628	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form and Instruction	Modified	LTFC Legal Service Provider Questionnaire
245628	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form and Instruction	Modified
245627	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting	Form and Instruction	Modified	LTFC Legal Service Provider Questionnaire
245627	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting	Form and Instruction	Modified
245626	Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form and Instruction	Modified	Legal Service Provider Questionnaire
245626	Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form and Instruction	Modified
245625	Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form and Instruction	Modified	Legal Service Provider Questionnaire
245625	Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form and Instruction	Modified
245624	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping	Form and Instruction	Modified	Home Study and Post-Release Services Caseworker Questionnaire
245624	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping	Form and Instruction	Modified
245623	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents	Form and Instruction	Modified	Home Study and Post-Release Services Caseworker Questionnaire
245623	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents	Form and Instruction	Modified
245622	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form and Instruction	Modified	48 - HS PRS Program Director Questionnaire
245622	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form and Instruction	Modified
245621	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form and Instruction	Modified	HS PRS Program Director Questionnaire
245621	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form and Instruction	Modified
245619	Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form and Instruction	Modified	Secure Client Questionnaire
245619	Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form and Instruction	Modified
245618	Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction	Modified	Secure Client Questionnaire
245618	Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction	Modified
245617	Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form and Instruction	Modified	LTFC Client Questionnaire
245617	Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form and Instruction	Modified
245616	Long Term Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction	Modified	LTFC Client Questionnaire
245616	Long Term Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction	Modified
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Modified	UC Questionnaire - Ages 5 and Under - Spanish
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Modified	UC Questionnaire - Ages 13 and Older - Spanish
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Modified	UC Questionnaire - Ages 6-12 Years Old - Spanish
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Modified	UC Questionnaire - Ages 5 and Under - English
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Modified	UC Questionnaire - Ages 13 and Older - English
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Modified	UC Questionnaire - Ages 6-12 Years Old - English
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Modified
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Modified	UC Questionnaire - Ages 5 and Under - Spanish
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Modified	UC Questionnaire - Ages 13 and Older - Spanish
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Modified	UC Questionnaire - Ages 6-12 Years Old - Spanish
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Modified	UC Questionnaire - Ages 5 and Under - English
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Modified	UC Questionnaire - Ages 13 and Older - English
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Modified	UC Questionnaire - Ages 6-12 Years Old - English
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Modified
245613	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form and Instruction	Modified	LTFC Foster Parent Questionnaire
245613	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form and Instruction	Modified
245612	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form and Instruction	Modified	LTFC Foster Parent Questionnaire
245612	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form and Instruction	Modified
245611	Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form and Instruction	Modified	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	Modified
245610	Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form and Instruction	Modified	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	Modified
245609	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form and Instruction	Modified	Long Term Foster Care Home Finder Questionnaire
245609	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form and Instruction	Modified
245608	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form and Instruction	Modified	Long Term Foster Care Home Finder Questionnaire
245608	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form and Instruction	Modified
245607	Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form and Instruction	Modified	Secure Detention Officer Questionnaire
245607	Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form and Instruction	Modified
245606	Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form and Instruction	Modified	Secure Detention Officer Questionnaire
245606	Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form and Instruction	Modified
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	PSA Compliance Manager Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	Youth Care Worker Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	Medical Coordinator Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	LTFC Educational Staff Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	Education Staff Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	LTFC Case Manager Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	Case Manager Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	LTFC Clinician Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	Clinician Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	LTFC Program Director Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified	Program Director Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Modified
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	PSA Compliance Manager Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	Youth Care Worker Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	Medical Coordinator Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	LTFC Educational Staff Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	Education Staff Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	LTFC Case Manager Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	Case Manager Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	LTFC Clinician Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	Clinician Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	LTFC Program Director Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified	Program Director Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Modified
245603	Long Term Foster Care Foster Parent Checklist (Form M-10D)	Form and Instruction	Modified	Long Term Foster Care Foster Parent Checklist
245603	Long Term Foster Care Foster Parent Checklist (Form M-10D)	Form and Instruction	Modified
245602	Home Study and Post-Release Services Personnel File Checklist (Form M-10C)	Form and Instruction	Modified	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	Modified
245601	Supplement to Personnel File Checklist (Form M-10B)	Form and Instruction	Modified	Supplement to Personnel File Checklist
245601	Supplement to Personnel File Checklist (Form M-10B)	Form and Instruction	Modified
245600	Personnel File Checklist (Form M-10A)	Form and Instruction	Modified	Personnel File Checklist
245600	Personnel File Checklist (Form M-10A)	Form and Instruction	Modified
245599	Post-Release Services Home Observation (Form M-9C)	Form and Instruction	Removed	Post-Release Services Home Observation
245599	Post-Release Services Home Observation (Form M-9C)	Form and Instruction	Removed
245598	Foster Home On Site Monitoring Checklist (Form M-9B)	Form and Instruction	Removed	Foster Home On Site Monitoring Checklist
245598	Foster Home On Site Monitoring Checklist (Form M-9B)	Form and Instruction	Removed
245597	On Site Monitoring Checklist (Form M-9A)	Form and Instruction	Removed	On Site Monitoring Checklist
245597	On Site Monitoring Checklist (Form M-9A)	Form and Instruction	Removed
245596	Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Recordkeeping	Form and Instruction	Removed	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	Removed
245595	Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Respondents	Form and Instruction	Removed	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	Removed
245594	Home Study and Post-Release Services Case File Checklist (Form M-8C) - Recordkeeping	Form and Instruction	Removed	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	Removed
245593	Home Study and Post-Release Services Case File Checklist (Form M-8C) - Respondents	Form and Instruction	Removed	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	Removed
245592	Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping	Form and Instruction	Removed	Long Term Foster Care File Checklist
245592	Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping	Form and Instruction	Removed
245591	Long Term Foster Care File Checklist (Form M-8B) - Respondents	Form and Instruction	Removed	Long Term Foster Care File Checklist
245591	Long Term Foster Care File Checklist (Form M-8B) - Respondents	Form and Instruction	Removed
245590	UAC Case File Checklist (Form M-8A) - Recordkeeping	Form and Instruction	Removed	UAC Case File Checklist
245590	UAC Case File Checklist (Form M-8A) - Recordkeeping	Form and Instruction	Removed
245589	UAC Case File Checklist (Form M-8A) - Respondents	Form and Instruction	Removed	UAC Case File Checklist
245589	UAC Case File Checklist (Form M-8A) - Respondents	Form and Instruction	Removed
245588	Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping	Form and Instruction	Modified	Voluntary Agency Site Visit Guide
245588	Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping	Form and Instruction	Modified
245587	Voluntary Agency Site Visit Guide (Form M-7F) - Respondents	Form and Instruction	Modified	Voluntary Agency Site Visit Guide
245587	Voluntary Agency Site Visit Guide (Form M-7F) - Respondents	Form and Instruction	Modified
245586	HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping	Form and Instruction	Modified	HS PRS Site Visit Guide
245586	HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping	Form and Instruction	Modified
245585	HS/PRS Site Visit Guide (Form M-7E) - Respondents	Form and Instruction	Modified	HS PRS Site Visit Guide
245585	HS/PRS Site Visit Guide (Form M-7E) - Respondents	Form and Instruction	Modified
245584	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form and Instruction	Modified	Remote Monitoring Site Visit Guide
245584	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form and Instruction	Modified	Site Visit Guide
245584	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form and Instruction	Modified
245583	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form and Instruction	Modified	Remote Monitoring Site Visit Guide
245583	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form and Instruction	Modified	Site Visit Guide
245583	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form and Instruction	Modified
245582	LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D)	Form and Instruction	Removed	LTFC Remote Monitoring Notes
245582	LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D)	Form and Instruction	Removed	LTFC Monitoring Notes
245582	LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D)	Form and Instruction	Removed
245581	Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B)	Form and Instruction	Removed	Remote Monitoring Notes
245581	Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B)	Form and Instruction	Removed	Monitoring Notes
245581	Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B)	Form and Instruction	Removed
245580	Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	Modified	Adult Incident Review
245580	Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	Modified	UC Incident Review
245580	Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	Modified
245579	Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form and Instruction	Modified	Checklist for a Child-Friendly Environment - Individual Foster Home
245579	Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form and Instruction	Modified	Checklist for a Child-Friendly Environment - Care Provider Facility
245579	Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form and Instruction	Modified
245577	Out-of-Network Site Visit Report (Form M-3B)	Form and Instruction	Modified	Out-of-Network Site Visit Report
245577	Out-of-Network Site Visit Report (Form M-3B)	Form and Instruction	Modified
245576	FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping	Form and Instruction	Removed	FFS Compliance and Safety Site Visit Report
245576	FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping	Form and Instruction	Removed
245575	FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents	Form and Instruction	Modified	FFS Compliance and Safety Site Visit Report
245575	FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents	Form and Instruction	Modified
245574	Corrective Action Report (Form M-1) - Recordkeeping	Form and Instruction	Modified	Corrective Action Report (Form M-1)
245574	Corrective Action Report (Form M-1) - Recordkeeping	Form and Instruction	Modified
245572	Corrective Action Report (Form M-1) - Respondents	Form and Instruction	Modified	Corrective Action Report (Form M-1)
245572	Corrective Action Report (Form M-1) - Respondents	Form and Instruction	Modified

ICR Details

OMB Control No: 0970-0564	ICR Reference No: 202108-0970-016
Status: Historical Active	Previous ICR Reference No: 202107-0970-004
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: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/26/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/31/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2024	36 Months From Approved	10/31/2021
Responses	8,342	0	9,364
Time Burden (Hours)	11,031	0	13,364
Cost Burden (Dollars)	0	0	0

---

Abstract: This information collection request consists of several forms that allow the Unaccompanied Children (UC) Program 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. Two instruments will be incorporated into ORR’s new case management system, UC Path. Details about requested revisions, including removal of 11 instruments from the collection are included within Supporting Statement A. Note that ORR replaced the term “unaccompanied alien child (UC)” with “unaccompanied child (UC)” throughout the instruments in this collection. The screenshots of UC Path instruments included in this request do not reflect this change, however, because it has not yet been developed in the system. The revision in terminology will be made before the system is launched.

---

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

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 6340	01/21/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 48707	08/31/2021
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 46

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-4B, Form M-4A	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	UC 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-11G, Form M-11D, Form M-11A, Form M-11B, Form M-11C, 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
Program Staff Questionnaires (Form M-11A-K) - Respondents	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-11G, 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-7A, Form M-7B	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
UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form M-12E, Form M-12A, Form M-12B, Form M-12As, Form M-12Bs, Form M-12Es	UC Questionnaire - Ages 6-12 Years Old - English ,   UC Questionnaire - Ages 13 and Older - English ,   UC Questionnaire - Ages 5 and Under - English ,   UC Questionnaire - Ages 6-12 Years Old - Spanish ,   UC Questionnaire - Ages 13 and Older - Spanish ,   UC Questionnaire - Ages 5 and Under - Spanish
UC Questionnaires (Forms M-12A-B, E) - Respondents	Form M-12A , Form M-12B, Form M-12E, Form M-12As, Form M-12Bs, Form M-12Es	UC Questionnaire - Ages 6-12 Years Old - English ,   UC Questionnaire - Ages 13 and Older - English ,   UC Questionnaire - Ages 5 and Under - English ,   UC Questionnaire - Ages 6-12 Years Old - Spanish ,   UC Questionnaire - Ages 13 and Older - Spanish ,   UC Questionnaire - Ages 5 and Under - Spanish
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

---

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	8,342	9,364	0	-1,022	0	0
Annual Time Burden (Hours)	11,031	13,364	0	-2,333	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes to burden result from the following adjustments: • Shelter Site Visit Guide (Form M-7A) – The average burden minutes per response was increased from 12 hours to 13 hours for respondents and from 28 hours to 29 hours for federal and contractor monitors. • Removal of the following instruments from the information collection. These instruments will be completed by federal staff as part of their normal job duties and by less than 10 contractor staff. Therefore, they are no longer subject to PRA requirements. o Monitoring Notes (Form M-6A) o Remote Monitoring Notes (Form M-6B) o Long Term Foster Care Monitoring Notes (Form M-6C) o Long Term Foster Care Remote Monitoring Notes (Form M-6D) o UC Case File Checklist (Form M-8A) o Long Term Foster Care Case File Checklist (Form M-8B) o Home Study and Post-Release Services Case File Checklist (Form M-8C) o Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) o On Site Monitoring Checklist (Form M-9A) o Foster Home On Site Monitoring Checklist (Form M-9B) o Post-Release Services Home Observation (Form M-9C)

---

Annual Cost to Federal Government: $854,348

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

---

Common Form ICR:  No

---

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: 08/31/2021

---