Mental Health Care Services for Unaccompanied Children

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form MH-7 Mental Health Task (Form MH-7)	Form and Instruction	New	Repair queued
Form Form MH-6 Mental Health Service Report (Form MH-6)	Form and Instruction	New	Repair queued
Form Form MH-5 Mental Health Referral (Form MH-5)	Form and Instruction	New	Repair queued
Form Form MH-4 Clinical Contact Log (Form MH-4)	Form and Instruction	New	Repair queued
Form Form MH-3 Mental Health Group Event (Form MH-3)	Form and Instruction	New	Repair queued
Form Form MH-2 Columbia SSRS Risk Assessment (Form MH-2)	Form and Instruction	New	Repair queued
Form Form MH-1 Initial Mental Health Evaluation (Form MH-1)	Form and Instruction	New	Repair queued
SSA Attachment A_0970-NEW_Mental Health_001_2021 09 27 FINAL.docx	Supplementary Document	Uploaded 2021-09-28	Repair queued
SSA_0970-NEW_Mental Health_001_2021 09 27 FINAL.docx	Supporting Statement A	Uploaded 2021-09-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
249547	Mental Health Task (Form MH-7)	Form and Instruction	New
249546	Mental Health Service Report (Form MH-6)	Form and Instruction	New
249545	Mental Health Referral (Form MH-5)	Form and Instruction	New
249544	Clinical Contact Log (Form MH-4)	Form and Instruction	New
249543	Mental Health Group Event (Form MH-3)	Form and Instruction	New
249542	Columbia SSRS Risk Assessment (Form MH-2)	Form and Instruction	New
249541	Initial Mental Health Evaluation (Form MH-1)	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202109-0970-021
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: ORR
Title: Mental Health Care Services for Unaccompanied Children
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/30/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	2,528,496	0
Time Burden (Hours)	471,366	0
Cost Burden (Dollars)	0	0

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Abstract: ORR’s UC Program provides care and custody for UC until they can be safely released to a sponsor, repatriated to their home country, or obtain legal status. ORR funds residential care provider facilities that provide temporary housing and other services to UC in ORR custody. Care provider facilities are State- licensed, with the exception of temporary influx care facilities, and must meet ORR requirements to ensure a high-level quality of care. Services provided at care provider facilities include, but are not limited to, education, recreation, vocational training, acculturation, nutrition, medical, mental health, legal, and case management. ORR is submitting several instruments directly related to the care of UC for processing pursuant to the Paperwork Reduction Act. These instruments allow ORR to provide mental health care services to UC.

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

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 1114	01/07/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 54199	09/30/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Clinical Contact Log (Form MH-4)	Form MH-4	Clinical Contact Log
Columbia SSRS Risk Assessment (Form MH-2)	Form MH-2	Columbia SSRS Risk Assessment
Initial Mental Health Evaluation (Form MH-1)	Form MH-1	Initial Mental Health Evaluation
Mental Health Group Event (Form MH-3)	Form MH-3	Mental Health Group Event
Mental Health Referral (Form MH-5)	Form MH-5	Mental Health Referral
Mental Health Service Report (Form MH-6)	Form MH-6	Mental Health Service Report
Mental Health Task (Form MH-7)	Form MH-7	Mental Health Task

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ICR Summary of Burden

table that charts list 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	2,528,496	0	0	2,528,496	0	0
Annual Time Burden (Hours)	471,366	0	0	471,366	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 request for a new OMB # for information collection activities that allow ORR to provide mental health care services to UC.

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Annual Cost to Federal Government: $4,672,410

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: 09/30/2021

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