Unaccompanied Refugee Minors Program Application

Unaccompanied Refugee Minors Program Application, and Withdrawal of Application or Declination of Placement Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0550 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Unaccompanied Refugee Minors Program Application Form
1 URM Program Application Form URM Application Form_CLEAN_rev 6.2022.pdf Form
1 URM Program Application Form URM Application Form_CLEAN_rev 6.2022.pdf Form

Information Collection (IC) Details

IC Title:	Unaccompanied Refugee Minors Program Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	URM Program Application Form	URM Application Form_CLEAN_rev 6.2022.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: 350	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	525	525
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.