Form P-17 Influx Transfer Manual and Prescreen Criteria Review

Influx Transfer Manual and Prescreen Criteria Review (Form P-17)

Options for all dropdown fields in
the Manual Review section are:
• Pass
• Fail

Options for all dropdown fields in
the Prescreen Criteria section are:
• Pass
• Fail

OMB 0970-0554 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to evaluate each UAC’s eligibility to be
transferred to an influx care facility. Care provider staff review and update information on daily during times of influx. Public reporting burden for this collection of information is
estimated to average 0.5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.
This is a mandatory collection of information (Homeland Security Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection
of information please contact [email protected].
P-17 [Rev. MM/DD/YYYY]