A-9 Event Report

Event (Form A-9)
Data Entry Window

OMB 0970-#### [valid through MM/DD/YYYY]

Yellow highlight = New field
Blue highlight = Field moved from
body of incident report to Event.

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this
information collection is to allow ORR care provider programs to document events occurring in and outside of ORR
care that must be reported to ORR. Public reporting burden for this collection of information is estimated to average
0.17 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].
UAC-A-9 [Rev. MM/DD/YYYY]

Event Page

OMB 0970-#### [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 allow ORR care provider programs to document events
occurring in and outside of ORR care that must be reported to ORR. Public reporting burden for this collection of information is estimated to average 0.17 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].