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-13E-UF Unlicensed Facility Case Coordinator Questionnaire	Form and Instruction	New	Available
Form Form M-13E-UF Unlicensed Facility Case Coordinator Questionnaire	Form and Instruction	New	Available
Form Form M-13C-UF Legal Service Provider Questionnaire	Form and Instruction	New	Available
Form Form M-13C-UF Legal Service Provider Questionnaire	Form and Instruction	New	Available
Form Form M-12Es-UF UC Questionnaire - Ages 5 and Under Spanish	Form and Instruction	New	Available
Form Form M-12E-UF UC Questionnaire - Ages 5 and Under - English	Form and Instruction	New	Available
Form Form M-12Bs-UF UC Questionnaire - Ages 13 and Older Spanish	Form and Instruction	New	Available
Form Form M-12B-UF UC Questionnaire - Ages 13 and Older English	Form and Instruction	New	Available
Form Form M-12As-UF UC Questionnaire - Ages 6-12 Years Old Spanish	Form and Instruction	New	Available
Form Form M-12A-UF UC Questionnaire - Ages 6-12 Years Old English	Form and Instruction	New	Available
Form Form M-12Es-UF UC Questionnaire - Ages 5 and Under Spanish	Form and Instruction	New	Available
Form Form M-12E-UF UC Questionnaire - Ages 5 and Under - English	Form and Instruction	New	Available
Form Form M-12Bs-UF UC Questionnaire - Ages 13 and Older Spanish	Form and Instruction	New	Repair queued
Form Form M-12B-UF UC Questionnaire - Ages 13 and Older English	Form and Instruction	New	Available
Form Form M-12As-UF UC Questionnaire - Ages 6-12 Years Old Spanish	Form and Instruction	New	Available
Form Form M-12A-UF UC Questionnaire - Ages 6-12 Years Old English	Form and Instruction	New	Available
Form Form M-11P-UF Interpreter Questionnaire	Form and Instruction	New	Available
Form Form M-11P-UF Interpreter Questionnaire	Form and Instruction	New	Available
Form Form M-11K-UF PSA Compliance Manager Questionnaire	Form and Instruction	New	Available
Form Form M-11J-UF Youth Care Worker Questionnaire	Form and Instruction	New	Available
Form Form M-11I-UF Medical Coordinator Questionnaire	Form and Instruction	New	Available
Form Form M-11G-UF Education Staff Questionnaire	Form and Instruction	New	Available
Form Form M-11E-UF Case Manager Questionnaire	Form and Instruction	New	Available
Form Form M-11C-UF Clinician Questionnaire	Form and Instruction	New	Available
Form Form M-11A-UF Program Director Questionnaire	Form and Instruction	New	Available
Form Form M-11K-UF PSA Compliance Manager Questionnaire	Form and Instruction	New	Available
Form Form M-11J-UF Youth Care Worker Questionnaire	Form and Instruction	New	Available
Form Form M-11I-UF Medical Coordinator Questionnaire	Form and Instruction	New	Repair queued
Form Form M-11G-UF Education Staff Questionnaire	Form and Instruction	New	Available
Form Form M-11E-UF Case Manager Questionnaire	Form and Instruction	New	Available
Form Form M-11C-UF Clinician Questionnaire	Form and Instruction	New	Available
Form Form M-11A-UF Program Director Questionnaire	Form and Instruction	New	Available
Form Form M-11P Interpreter Questionnaire	Form and Instruction	New	Available
Form Form M-10A-UF Unlicensed Facility Personnel File Checklist	Form and Instruction	New	Available
Form Form M-9A-UF Unlicensed Facility On-Site Monitoring Checklist	Form and Instruction	New	Available
Form Form M-6A-UF Unlicensed Facility Monitoring Notes	Form and Instruction	New	Available
Form Form M-8A-UF Unlicensed Facility UC Case File Checklist	Form and Instruction	New	Available
Form Form M-8A-UF Unlicensed Facility UC Case File Checklist	Form and Instruction	New	Available
Form Form M-7A-UF Unlicensed Facility Site Visit Guide	Form and Instruction	New	Available
Form Form M-7A-UF Unlicensed Facility Site Visit Guide	Form and Instruction	New	Available
Form Form M-7D LTFC Remote Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7C LTFC Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7D LTFC Remote Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7C LTFC Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-15 Monitoring Schedule	Form and Instruction	Unchanged	Available
Form Form M-14 Monitoring Visit	Form and Instruction	Unchanged	Available
Form Form M-13E Case Coordinator Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13E Case Coordinator Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13D LTFC Legal Service Provider Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13D LTFC Legal Service Provider Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13C Legal Service Provider Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13C Legal Service Provider Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13A 48 - HS PRS Program Director Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13A HS PRS Program Director Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-12D Secure Client Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-12D Secure Client Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-12C LTFC Client Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-12C LTFC Client Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-12Es UC Questionnaire - Ages 5 and Under - Spanish	Form and Instruction	Unchanged	Available
Form Form M-12Bs UC Questionnaire - Ages 13 and Older - Spanish	Form and Instruction	Unchanged	Available
Form Form M-12As UC Questionnaire - Ages 6-12 Years Old - Spanish	Form and Instruction	Unchanged	Repair queued
Form Form M-12E UC Questionnaire - Ages 5 and Under - English	Form and Instruction	Unchanged	Available
Form Form M-12B UC Questionnaire - Ages 13 and Older - English	Form and Instruction	Unchanged	Available
Form Form M-12A UC Questionnaire - Ages 6-12 Years Old - English	Form and Instruction	Unchanged	Available
Form Form M-12Es UC Questionnaire - Ages 5 and Under - Spanish	Form and Instruction	Unchanged	Available
Form Form M-12Bs UC Questionnaire - Ages 13 and Older - Spanish	Form and Instruction	Unchanged	Available
Form Form M-12As UC Questionnaire - Ages 6-12 Years Old - Spanish	Form and Instruction	Unchanged	Available
Form Form M-12E UC Questionnaire - Ages 5 and Under - English	Form and Instruction	Unchanged	Available
Form Form M-12B UC Questionnaire - Ages 13 and Older - English	Form and Instruction	Unchanged	Available
Form Form M-12A UC Questionnaire - Ages 6-12 Years Old - English	Form and Instruction	Unchanged	Available
Form Form M-11O LTFC Foster Parent Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11O LTFC Foster Parent Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11M Long Term Foster Care Home Finder Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11M Long Term Foster Care Home Finder Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11L Secure Detention Officer Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11L Secure Detention Officer Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11K PSA Compliance Manager Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11J Youth Care Worker Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11I Medical Coordinator Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11H LTFC Educational Staff Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11G Education Staff Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11F LTFC Case Manager Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11E Case Manager Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11D LTFC Clinician Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11C Clinician Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11B LTFC Program Director Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11A Program Director Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11K PSA Compliance Manager Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11J Youth Care Worker Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11I Medical Coordinator Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11H LTFC Educational Staff Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11G Education Staff Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11F LTFC Case Manager Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11E Case Manager Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11D LTFC Clinician Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11C Clinician Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11B LTFC Program Director Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11A Program Director Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-10D Long Term Foster Care Foster Parent Checklist	Form and Instruction	Unchanged	Available
Form Form M-10C Home Study and Post-Release Services Personnel File Checklist	Form and Instruction	Unchanged	Available
Form Form M-10B Supplement to Personnel File Checklist	Form and Instruction	Unchanged	Available
Form Form M-10A Personnel File Checklist	Form and Instruction	Unchanged	Available
Form Form M-7F Voluntary Agency Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7F Voluntary Agency Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7E HS PRS Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7E HS PRS Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7B Remote Monitoring Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7A Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7B Remote Monitoring Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7A Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-5B Adult Incident Review	Form and Instruction	Unchanged	Available
Form Form M-5A UC Incident Review	Form and Instruction	Unchanged	Available
Form Form M-4B Checklist for a Child-Friendly Environment - Individual Foster Home	Form and Instruction	Unchanged	Available
Form Form M-4A Checklist for a Child-Friendly Environment - Care Provider Facility	Form and Instruction	Unchanged	Available
Form Form M-3B Out-of-Network Site Visit Report	Form and Instruction	Unchanged	Available
Form Form M-3A FFS Compliance and Safety Site Visit Report	Form and Instruction	Unchanged	Available
Form M-1 Corrective Action Report (Form M-1)	Form and Instruction	Unchanged	Available
Form M-1 Corrective Action Report (Form M-1)	Form and Instruction	Unchanged	Available
Expedited Review FRN Monitoring and Compliance_0970-0564_10.26.22.pdf	Supplementary Document	Uploaded 2022-11-09	Available
Emergency SSA_0970-0564_Monitoring and Compliance_005_2022 11 09.docx	Supporting Statement A	Uploaded 2022-11-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
256795	Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping	Form and Instruction	New	Unlicensed Facility Case Coordinator Questionnaire
256793	Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent	Form and Instruction	New	Unlicensed Facility Case Coordinator Questionnaire
256792	Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping	Form and Instruction	New	Legal Service Provider Questionnaire
256791	Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent	Form and Instruction	New	Legal Service Provider Questionnaire
256790	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	New	UC Questionnaire - Ages 5 and Under Spanish
256790	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	New	UC Questionnaire - Ages 5 and Under - English
256790	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	New	UC Questionnaire - Ages 13 and Older Spanish
256790	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	New	UC Questionnaire - Ages 13 and Older English
256790	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	New	UC Questionnaire - Ages 6-12 Years Old Spanish
256790	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	New	UC Questionnaire - Ages 6-12 Years Old English
256789	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	New	UC Questionnaire - Ages 5 and Under Spanish
256789	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	New	UC Questionnaire - Ages 5 and Under - English
256789	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	New	UC Questionnaire - Ages 13 and Older Spanish
256789	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	New	UC Questionnaire - Ages 13 and Older English
256789	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	New	UC Questionnaire - Ages 6-12 Years Old Spanish
256789	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	New	UC Questionnaire - Ages 6-12 Years Old English
256788	Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping	Form and Instruction	New	Interpreter Questionnaire
256787	Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents	Form and Instruction	New	Interpreter Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	New	PSA Compliance Manager Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	New	Youth Care Worker Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	New	Medical Coordinator Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	New	Education Staff Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	New	Case Manager Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	New	Clinician Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	New	Program Director Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	New	PSA Compliance Manager Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	New	Youth Care Worker Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	New	Medical Coordinator Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	New	Education Staff Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	New	Case Manager Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	New	Clinician Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	New	Program Director Questionnaire
256784	Interpreter Questionnaire (Form M-11P)	Form and Instruction	New	Interpreter Questionnaire
256783	Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping	Form and Instruction	New	Unlicensed Facility Personnel File Checklist
256782	Unlicensed Facility On-Site Monitoring Checklist (Form M-9A-UF) - Recordkeeping	Form and Instruction	New	Unlicensed Facility On-Site Monitoring Checklist
256781	Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping	Form and Instruction	New	Unlicensed Facility Monitoring Notes
256780	Unlicensed Facility UC Case File Checklist (Form M-8A-UF) - Recordkeeping	Form and Instruction	New	Unlicensed Facility UC Case File Checklist
256779	Unlicensed Facility UC Case File Checklist (Form M-8A-UF) - Respondents	Form and Instruction	New	Unlicensed Facility UC Case File Checklist
256778	Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping	Form and Instruction	New	Unlicensed Facility Site Visit Guide
256777	Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents	Form and Instruction	New	Unlicensed Facility Site Visit Guide
245634	LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping	Form and Instruction	Unchanged	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	Unchanged	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	Unchanged	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	Unchanged	LTFC Site Visit Guide
245632	Monitoring Schedule (Form M-15)	Form and Instruction	Unchanged	Monitoring Schedule
245631	Monitoring Visit (Form M-14)	Form and Instruction	Unchanged	Monitoring Visit
245630	Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form and Instruction	Unchanged	Case Coordinator Questionnaire
245629	Case Coordinator Questionnaire (Form M-13E) - Respondents	Form and Instruction	Unchanged	Case Coordinator Questionnaire
245628	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form and Instruction	Unchanged	LTFC Legal Service Provider Questionnaire
245627	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting	Form and Instruction	Unchanged	LTFC Legal Service Provider Questionnaire
245626	Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form and Instruction	Unchanged	Legal Service Provider Questionnaire
245625	Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form and Instruction	Unchanged	Legal Service Provider Questionnaire
245624	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping	Form and Instruction	Unchanged	Home Study and Post-Release Services Caseworker Questionnaire
245623	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents	Form and Instruction	Unchanged	Home Study and Post-Release Services Caseworker Questionnaire
245622	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form and Instruction	Unchanged	48 - HS PRS Program Director Questionnaire
245621	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form and Instruction	Unchanged	HS PRS Program Director Questionnaire
245619	Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form and Instruction	Unchanged	Secure Client Questionnaire
245618	Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction	Unchanged	Secure Client Questionnaire
245617	Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form and Instruction	Unchanged	LTFC Client Questionnaire
245616	Long Term Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction	Unchanged	LTFC Client Questionnaire
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 5 and Under - Spanish
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 13 and Older - Spanish
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 6-12 Years Old - Spanish
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 5 and Under - English
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 13 and Older - English
245615	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 6-12 Years Old - English
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 5 and Under - Spanish
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 13 and Older - Spanish
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 6-12 Years Old - Spanish
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 5 and Under - English
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 13 and Older - English
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 6-12 Years Old - English
245613	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form and Instruction	Unchanged	LTFC Foster Parent Questionnaire
245612	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form and Instruction	Unchanged	LTFC Foster Parent Questionnaire
245611	Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form and Instruction	Unchanged	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	Unchanged	Long Term Foster Care Independent Living Life Skills Staff Questionnaire
245609	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form and Instruction	Unchanged	Long Term Foster Care Home Finder Questionnaire
245608	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form and Instruction	Unchanged	Long Term Foster Care Home Finder Questionnaire
245607	Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form and Instruction	Unchanged	Secure Detention Officer Questionnaire
245606	Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form and Instruction	Unchanged	Secure Detention Officer Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	PSA Compliance Manager Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	Youth Care Worker Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	Medical Coordinator Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	LTFC Educational Staff Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	Education Staff Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	LTFC Case Manager Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	Case Manager Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	LTFC Clinician Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	Clinician Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	LTFC Program Director Questionnaire
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	Program Director Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	PSA Compliance Manager Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	Youth Care Worker Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	Medical Coordinator Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	LTFC Educational Staff Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	Education Staff Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	LTFC Case Manager Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	Case Manager Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	LTFC Clinician Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	Clinician Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	LTFC Program Director Questionnaire
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	Program Director Questionnaire
245603	Long Term Foster Care Foster Parent Checklist (Form M-10D)	Form and Instruction	Unchanged	Long Term Foster Care Foster Parent Checklist
245602	Home Study and Post-Release Services Personnel File Checklist (Form M-10C)	Form and Instruction	Unchanged	Home Study and Post-Release Services Personnel File Checklist
245601	Supplement to Personnel File Checklist (Form M-10B)	Form and Instruction	Unchanged	Supplement to Personnel File Checklist
245600	Personnel File Checklist (Form M-10A)	Form and Instruction	Unchanged	Personnel File Checklist
245588	Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping	Form and Instruction	Unchanged	Voluntary Agency Site Visit Guide
245587	Voluntary Agency Site Visit Guide (Form M-7F) - Respondents	Form and Instruction	Unchanged	Voluntary Agency Site Visit Guide
245586	HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping	Form and Instruction	Unchanged	HS PRS Site Visit Guide
245585	HS/PRS Site Visit Guide (Form M-7E) - Respondents	Form and Instruction	Unchanged	HS PRS Site Visit Guide
245584	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form and Instruction	Unchanged	Remote Monitoring Site Visit Guide
245584	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form and Instruction	Unchanged	Site Visit Guide
245583	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form and Instruction	Unchanged	Remote Monitoring Site Visit Guide
245583	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form and Instruction	Unchanged	Site Visit Guide
245580	Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	Unchanged	Adult Incident Review
245580	Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	Unchanged	UC Incident Review
245579	Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form and Instruction	Unchanged	Checklist for a Child-Friendly Environment - Individual Foster Home
245579	Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form and Instruction	Unchanged	Checklist for a Child-Friendly Environment - Care Provider Facility
245577	Out-of-Network Site Visit Report (Form M-3B)	Form and Instruction	Unchanged	Out-of-Network Site Visit Report
245575	FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents	Form and Instruction	Unchanged	FFS Compliance and Safety Site Visit Report
245574	Corrective Action Report (Form M-1) - Recordkeeping	Form and Instruction	Unchanged	Corrective Action Report (Form M-1)
245572	Corrective Action Report (Form M-1) - Respondents	Form and Instruction	Unchanged	Corrective Action Report (Form M-1)

ICR Details

OMB Control No: 0970-0564	ICR Reference No: 202211-0970-002
Status: Historical Active	Previous ICR Reference No: 202112-0970-003
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: Emergency	Approval Requested By: 11/10/2022
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/09/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/09/2022
Terms of Clearance: OMB is approving this Emergency ICR with the understanding that within 6 months from the approval date, ACF will complete a 60d and 30d public comment request to support the approval of the ICR ahead of the expiration date.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2023	6 Months From Approved	10/31/2024
Responses	19,728	0	8,342
Time Burden (Hours)	35,506	0	11,031
Cost Burden (Dollars)	0	0	0

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Abstract: The 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. Generally, care provider facilities are State-licensed (with the exception of facilities located in states that are unwilling to license them and temporary emergency 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 uses several instruments directly related to the care of UC. The instruments in this information collection allow the 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.

Emergency Justfication: The Administration for Children and Families (ACF) is requesting emergency review and approval of this information collection by OMB, as authorized under 44 U.S.C. 3507(subsection j). The proposed forms are necessary to allow the Office of Refugee Resettlement (ORR) 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. The information collected is essential to the mission of the agency and an unanticipated event has occurred that could reasonably result in public harm if normal Paperwork Reduction Act (PRA) clearance procedures are followed. Recent legislation in Texas (Proclamation by the Governor of the State of Texas, May 31, 2021) and Florida (Emergency Rule 65CER21-3, December 10, 2021) has resulted in a large number of ORR facilities no longer being licensed by the states. To help mitigate the issue, ORR plans to perform quarterly monitoring visits to Texas and Florida programs. In order to implement the quarterly monitoring, ORR needs to add alternate versions of 15 forms in this information collection and reinstate three forms. See sections A1, A2, and A15 in Supporting Statement A for additional details.

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Authorizing Statute(s): US Code: 8 USC 1232 Name of Law: Trafficking Victim Protection Reauthorization Act of 2008
   PL: Pub.L. 113 - 4 1101(c) Name of Law: Violence Against Women Reauthorization Act of 2013
   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:
	87 FR 64798	10/26/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 64

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-4A, Form M-4B	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) - Respondents	Form M-3A	FFS Compliance and Safety Site Visit Report
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 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
Interpreter Questionnaire (Form M-11P)	Form M-11P	Interpreter Questionnaire
LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping	Form M-7D, Form M-7C	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 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
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
Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form M-11H, Form M-11G, Form M-11D, Form M-11A, Form M-11B, Form M-11C, Form M-11E, Form M-11F, 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-11G, Form M-11C, Form M-11A, Form M-11B, Form M-11D, 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
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
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
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
Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping	Form M-10A-UF	Unlicensed Facility Personnel File Checklist
Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping	Form M-13E-UF	Unlicensed Facility Case Coordinator Questionnaire
Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent	Form M-13E-UF	Unlicensed Facility Case Coordinator Questionnaire
Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping	Form M-11P-UF	Interpreter Questionnaire
Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents	Form M-11P-UF	Interpreter Questionnaire
Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping	Form M-13C-UF	Legal Service Provider Questionnaire
Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent	Form M-13C-UF	Legal Service Provider Questionnaire
Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping	Form M-6A-UF	Unlicensed Facility Monitoring Notes
Unlicensed Facility On-Site Monitoring Checklist (Form M-9A-UF) - Recordkeeping	Form M-9A-UF	Unlicensed Facility On-Site Monitoring Checklist
Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form M-11A-UF, Form M-11C-UF, Form M-11E-UF, Form M-11G-UF, Form M-11I-UF, Form M-11J-UF, Form M-11K-UF	Program Director Questionnaire ,   Clinician Questionnaire ,   Case Manager Questionnaire ,   Education Staff Questionnaire ,   Medical Coordinator Questionnaire ,   Youth Care Worker Questionnaire ,   PSA Compliance Manager Questionnaire
Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form M-11A-UF, Form M-11C-UF, Form M-11E-UF, Form M-11G-UF, Form M-11I-UF, Form M-11J-UF, Form M-11K-UF	Program Director Questionnaire ,   Clinician Questionnaire ,   Case Manager Questionnaire ,   Education Staff Questionnaire ,   Medical Coordinator Questionnaire ,   Youth Care Worker Questionnaire ,   PSA Compliance Manager Questionnaire
Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping	Form M-7A-UF	Unlicensed Facility Site Visit Guide
Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents	Form M-7A-UF	Unlicensed Facility Site Visit Guide
Unlicensed Facility UC Case File Checklist (Form M-8A-UF) - Recordkeeping	Form M-8A-UF	Unlicensed Facility UC Case File Checklist
Unlicensed Facility UC Case File Checklist (Form M-8A-UF) - Respondents	Form M-8A-UF	Unlicensed Facility UC Case File Checklist
Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form M-12Bs-UF, Form M-12A-UF, Form M-12As-UF, Form M-12B-UF, Form M-12E-UF, Form M-12Es-UF	UC Questionnaire - Ages 6-12 Years Old English ,   UC Questionnaire - Ages 6-12 Years Old Spanish ,   UC Questionnaire - Ages 13 and Older English ,   UC Questionnaire - Ages 13 and Older Spanish ,   UC Questionnaire - Ages 5 and Under - English ,   UC Questionnaire - Ages 5 and Under Spanish
Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form M-12A-UF, Form M-12As-UF, Form M-12B-UF, Form M-12Bs-UF, Form M-12E-UF, Form M-12Es-UF	UC Questionnaire - Ages 6-12 Years Old English ,   UC Questionnaire - Ages 6-12 Years Old Spanish ,   UC Questionnaire - Ages 13 and Older English ,   UC Questionnaire - Ages 13 and Older Spanish ,   UC Questionnaire - Ages 5 and Under - English ,   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

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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	19,728	8,342	0	11,386	0	0
Annual Time Burden (Hours)	35,506	11,031	0	24,475	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: ORR added Interpreter Questionnaire (Form M-11P), which is currently approved under OMB #0970-0558, to this information collection. ORR added forms that were previously approved by OMB but were removed from the information collection due to the number of respondents. Differences between the previously approved versions and the current versions that will be used by contractor monitors are as noted in section A15 of Supporting Statement A. ORR added alternate versions of forms already approved under this information collection. Differences between the already approved versions and the alternate versions that will be used by contractor monitors are detailed in section A15 of Supporting Statement A. Unlicensed programs will continue to receive comprehensive biennial monitoring visits pursuant to UC Policy Guide Section 5.5.1 during which the full original versions of these forms will be used. Quarterly monitoring visits will mainly focus on health and safety. To align with that purpose and help streamline forms that will be administered more often than their full version counterparts, adjustments made to the alternate versions removed some items related to program management. Other adjustments were made for clarity or to align with current ORR policy and procedures. Quarterly monitoring visits will continue to monitor for the same areas related to child welfare practices and provision of services as biennial monitoring visits.

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Annual Cost to Federal Government: $859,105

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: 11/09/2022

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