Monitoring and Compliance for Office of Refugee Resettlement (ORR) Care Provider Facilities

ICR 202305-0970-015

OMB: 0970-0564

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0970-0564 can be found here:

2024-03-22 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
Form Form M-17H PSA Audit Corrective Action Report (Form M-17H) - Recordkeeping Form and Instruction	New
Form Form M-17H PSA Audit Corrective Action Report (Form M-17H) - Respondent Form and Instruction	New
Form Form M-17G Interview Guide: Unaccompanied Child (Form M-17G) - Recordkeeping Form and Instruction	New
Form Form M-17G Interview Guide: Unaccompanied Child (Form M-17G) - Respondent Form and Instruction	New
Form Form M-17F Interview Guide: Specialized Staff (Form M-17F) - Recordkeeping Form and Instruction	New
Form Form M-17F Interview Guide: Specialized Staff (Form M-17F) - Respondent Form and Instruction	New
Form Form M-17E Interview Guide: PSA Compliance Manager (Form M-17E) - Recordkeeping Form and Instruction	New
Form Form M-17E Interview Guide: PSA Compliance Manager (Form M-17E) - Respondent Form and Instruction	New
Form Form M-17D Interview Guide: Program Director (Form M-17D) - Recordkeeping Form and Instruction	New
Form Form M-17D Interview Guide: Program Director (Form M-17D) - Respondent Form and Instruction	New
Form Form M-17C Interview Guide: Random Sample of Staff Interview (Form M-17C) - Recordkeeping Form and Instruction	New
Form Form M-17C Interview Guide: Random Sample of Staff Interview (Form M-17C) - Respondent Form and Instruction	New
Form Form M-17B Instructions for Site Visit and Facility Tour (Form M-17B) - Recordkieeping Form and Instruction	New
Form Form M-17B Instructions for Site Visit and Facility Tour (Form M-17B) - Respondent Form and Instruction	New
Form Form M-17A Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Recordkeeping Form and Instruction	New
Form Form M-17A Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Respondent Form and Instruction	New
Form Form M-10E Influx Care Facility Personnel File Checklist (Form M-10E) - Recordkeeping Form and Instruction	New
Form M-9B-UF Unlicensed Facility Foster Home Onsite Monitoring Checklist (M-9B-UF) - Recordkeeping Form and Instruction	New
Form Form M-8D-UF Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Recordkeeping Form and Instruction	New
Form Form M-8D-UF Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Respondents Form and Instruction	New
Form Form M-8B-UF Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Recordkeeping Form and Instruction	New
Form Form M-8B-UF Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Respondents Form and Instruction	New
Form Form M-7G Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Recordkeeping Form and Instruction	New
Form Form M-7G Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Respondents Form and Instruction	New
Form Form M-6E-UF Influx Care Facility Monitoring Notes (Form M-6E-UF) - Recordkeeping Form and Instruction	New
Form Form M-6C-UF Unlicensed Facility Foster Care Monitoring Notes (Form M-6C-UF) - Recordkeeping Form and Instruction	New
Form Form M-13E-UF Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping Form and Instruction	Modified
Form Form M-13E-UF Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent Form and Instruction	Modified
Form Form M-13C-UF Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping Form and Instruction	Modified
Form Form M-13C-UF Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent Form and Instruction	Modified
Form Form M-12A-UF Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping Form and Instruction	Modified
Form Form M-12A-UF Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents Form and Instruction	Modified
Form Form M-11P-UF Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping Form and Instruction	Modified
Form Form M-11P-UF Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents Form and Instruction	Modified
Form Form M-11A-UF Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping Form and Instruction	Modified
Form Form M-11A-UF Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents Form and Instruction	Modified
Form Form M-11P Interpreter Questionnaire (Form M-11P) Form and Instruction	Modified
Form Form M-10A-UF Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping Form and Instruction	Modified
Form Form M-9A-UF Unlicensed Facility OnSite Monitoring Checklist (Form M-9A-UF) - Recordkeeping Form and Instruction	Modified
Form Form M-6A-UF Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping Form and Instruction	Modified
Form Form M-8A-UF Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Recordkeeping Form and Instruction	Modified
Form Form M-8A-UF Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Respondents Form and Instruction	Modified
Form Form M-7A-UF Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping Form and Instruction	Modified
Form Form M-7A-UF Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents Form and Instruction	Modified
Form Form M-7C Foster Care Site Visit Guide (Forms M-7C) - Recordkeeping Form and Instruction	Modified
Form Form M-7C Foster Care Site Visit Guide (Forms M-7C) - Respondents Form and Instruction	Modified
Form Form M-15 Monitoring Schedule (Form M-15) Form and Instruction	Modified
Form Form M-14 Monitoring Visit (Form M-14) - Recordkeeping Form and Instruction	Modified
Form Form M-13E Case Coordinator Questionnaire (Form M-13E) - Recordkeeping Form and Instruction	Modified
Form Form M-13E Case Coordinator Questionnaire (Form M-13E) - Respondents Form and Instruction	Modified
Form Form M-13D Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping Form and Instruction	Modified
Form Form M-13D Foster Care Legal Service Provider Questionnaire (Form M-13D) - Respondents Form and Instruction	Modified
Form Form M-13C Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping Form and Instruction	Modified
Form Form M-13C Legal Service Provider Questionnaire (Form M-13C) - Respondents Form and Instruction	Modified
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping Form and Instruction	Modified
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents Form and Instruction	Modified
Form Form M-13A Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping Form and Instruction	Modified
Form Form M-13A Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents Form and Instruction	Modified
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Recordkeeping Form and Instruction	Modified
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Respondents Form and Instruction	Modified
Form Form M-12C Foster Care Client Questionnaire (M-12C) - Recordkeeping Form and Instruction	Modified
Form Form M-12C Foster Care Client Questionnaire (M-12C) - Respondents Form and Instruction	Modified
Form Form M-12A Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping Form and Instruction	Modified
Form Form M-12A Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents Form and Instruction	Modified
Form Form M-11O Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping Form and Instruction	Modified
Form Form M-11O Foster Care Foster Parent Questionnaire (form M-11O) - Respondents Form and Instruction	Modified
Form Form M-11N Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping Form and Instruction	Modified
Form Form M-11N Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents Form and Instruction	Modified
Form Form M-11M Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping Form and Instruction	Modified
Form Form M-11M Foster Care Home Finder Questionnaire (Form M-11M) - Respondents Form and Instruction	Modified
Form Form M-11L Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping Form and Instruction	Modified
Form Form M-11L Secure Detention Officer Questionnaire (Form M-11L) - Respondents Form and Instruction	Modified
Form Form M-11A Program Staff Questionnaires (Form M-11A-K) - Recordkeeping Form and Instruction	Modified
Form Form M-11A Program Staff Questionnaires (Form M-11A-K) - Respondents Form and Instruction	Modified
Form Form M-10D Foster Care Foster Parent Checklist (Form M-10D) - Recordkeeping Form and Instruction	Modified
Form Form M-10C Home Study and Post-Release Services Personnel File Checklist (Form M-10C) - Recordkeeping Form and Instruction	Modified
Form Form M-10B Supplement to Personnel File Checklist (Form M-10B) - Recordkeeping Form and Instruction	Modified
Form Form M-10A Personnel File Checklist (Form M-10A) - Recordkeeping Form and Instruction	Modified
Form Form M-7F Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping Form and Instruction	Removed
Form Form M-7F Voluntary Agency Site Visit Guide (Form M-7F) - Respondents Form and Instruction	Removed
Form Form M-7E Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Recordkeeping Form and Instruction	Modified
Form Form M-7E Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Respondents Form and Instruction	Modified
Form Form M-7A Site Visit Guides (Forms M-7A) - Recordkeeping Form and Instruction	Modified
Form Form M-7A Site Visit Guides (Forms M-7A) - Respondents Form and Instruction	Modified
Form Form M-5A Incident Reviews (Forms M-5A to M-5B) Form and Instruction	Modified
Form Form M-4A Checklist for a Child-Friendly Environment (Form M-4a to M-4B) Form and Instruction	Modified
Form Form M-3B Out-of-Network Site Visit Report (Form M-3B) Form and Instruction	Modified
Form Form M-3A FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents Form and Instruction	Modified
Form M-1 Corrective Action Report (Form M-1) - Recordkeeping Form and Instruction	Modified
Form M-1 Corrective Action Report (Form M-1) - Respondents Form and Instruction	Modified
SSA Attachment A_0970-0564_Monitoring and Compliance_005_2023 05 25.docx Supplementary Document	2023-05-30
Extension SSA_0970-0564_Monitoring and Compliance_005_2023 05 25 CLEAN.docx Supporting Statement A	2023-05-30

IC Document Collections

IC ID	Document Title	Status
260450	PSA Audit Corrective Action Report (Form M-17H) - Recordkeeping Form and Instruction	New
260449	PSA Audit Corrective Action Report (Form M-17H) - Respondent Form and Instruction	New
260448	Interview Guide: Unaccompanied Child (Form M-17G) - Recordkeeping Form and Instruction	New
260447	Interview Guide: Unaccompanied Child (Form M-17G) - Respondent Form and Instruction	New
260446	Interview Guide: Specialized Staff (Form M-17F) - Recordkeeping Form and Instruction	New
260445	Interview Guide: Specialized Staff (Form M-17F) - Respondent Form and Instruction	New
260444	Interview Guide: PSA Compliance Manager (Form M-17E) - Recordkeeping Form and Instruction	New
260442	Interview Guide: PSA Compliance Manager (Form M-17E) - Respondent Form and Instruction	New
260441	Interview Guide: Program Director (Form M-17D) - Recordkeeping Form and Instruction	New
260439	Interview Guide: Program Director (Form M-17D) - Respondent Form and Instruction	New
260438	Interview Guide: Random Sample of Staff Interview (Form M-17C) - Recordkeeping Form and Instruction	New
260437	Interview Guide: Random Sample of Staff Interview (Form M-17C) - Respondent Form and Instruction	New
260436	Instructions for Site Visit and Facility Tour (Form M-17B) - Recordkieeping Form and Instruction	New
260435	Instructions for Site Visit and Facility Tour (Form M-17B) - Respondent Form and Instruction	New
260434	Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Recordkeeping Form and Instruction	New
260433	Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Respondent Form and Instruction	New
260432	Influx Care Facility Personnel File Checklist (Form M-10E) - Recordkeeping Form and Instruction	New
260431	Unlicensed Facility Foster Home Onsite Monitoring Checklist (M-9B-UF) - Recordkeeping Form and Instruction	New
260430	Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Recordkeeping Form and Instruction	New
260429	Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Respondents Form and Instruction	New
260428	Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Recordkeeping Form and Instruction	New
260427	Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Respondents Form and Instruction	New
260425	Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Recordkeeping Form and Instruction	New
260424	Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Respondents Form and Instruction	New
260423	Influx Care Facility Monitoring Notes (Form M-6E-UF) - Recordkeeping Form and Instruction	New
260422	Unlicensed Facility Foster Care Monitoring Notes (Form M-6C-UF) - Recordkeeping Form and Instruction	New
256795	Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping Form and Instruction	Modified
256793	Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent Form and Instruction	Modified
256792	Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping Form and Instruction	Modified
256791	Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent Form and Instruction	Modified
256790	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping Form and Instruction	Modified
256789	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents Form and Instruction	Modified
256788	Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping Form and Instruction	Modified
256787	Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents Form and Instruction	Modified
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping Form and Instruction	Modified
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents Form and Instruction	Modified
256784	Interpreter Questionnaire (Form M-11P) Form and Instruction	Modified
256783	Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping Form and Instruction	Modified
256782	Unlicensed Facility OnSite Monitoring Checklist (Form M-9A-UF) - Recordkeeping Form and Instruction	Modified
256781	Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping Form and Instruction	Modified
256780	Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Recordkeeping Form and Instruction	Modified
256779	Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Respondents Form and Instruction	Modified
256778	Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping Form and Instruction	Modified
256777	Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents Form and Instruction	Modified
245634	Foster Care Site Visit Guide (Forms M-7C) - Recordkeeping Form and Instruction	Modified
245633	Foster Care Site Visit Guide (Forms M-7C) - Respondents Form and Instruction	Modified
245632	Monitoring Schedule (Form M-15) Form and Instruction	Modified
245631	Monitoring Visit (Form M-14) - Recordkeeping Form and Instruction	Modified
245630	Case Coordinator Questionnaire (Form M-13E) - Recordkeeping Form and Instruction	Modified
245629	Case Coordinator Questionnaire (Form M-13E) - Respondents Form and Instruction	Modified
245628	Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping Form and Instruction	Modified
245627	Foster Care Legal Service Provider Questionnaire (Form M-13D) - Respondents Form and Instruction	Modified
245626	Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping Form and Instruction	Modified
245625	Legal Service Provider Questionnaire (Form M-13C) - Respondents Form and Instruction	Modified
245624	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping Form and Instruction	Modified
245623	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents Form and Instruction	Modified
245622	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping Form and Instruction	Modified
245621	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents Form and Instruction	Modified
245619	Secure Client Questionnaire (Form M-12D) - Recordkeeping Form and Instruction	Modified
245618	Secure Client Questionnaire (Form M-12D) - Respondents Form and Instruction	Modified
245617	Foster Care Client Questionnaire (M-12C) - Recordkeeping Form and Instruction	Modified
245616	Foster Care Client Questionnaire (M-12C) - Respondents Form and Instruction	Modified
245615	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping Form and Instruction	Modified
245614	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents Form and Instruction	Modified
245613	Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping Form and Instruction	Modified
245612	Foster Care Foster Parent Questionnaire (form M-11O) - Respondents Form and Instruction	Modified
245611	Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping Form and Instruction	Modified
245610	Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents Form and Instruction	Modified
245609	Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping Form and Instruction	Modified
245608	Foster Care Home Finder Questionnaire (Form M-11M) - Respondents Form and Instruction	Modified
245607	Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping Form and Instruction	Modified
245606	Secure Detention Officer Questionnaire (Form M-11L) - Respondents Form and Instruction	Modified
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping Form and Instruction	Modified
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents Form and Instruction	Modified
245603	Foster Care Foster Parent Checklist (Form M-10D) - Recordkeeping Form and Instruction	Modified
245602	Home Study and Post-Release Services Personnel File Checklist (Form M-10C) - Recordkeeping Form and Instruction	Modified
245601	Supplement to Personnel File Checklist (Form M-10B) - Recordkeeping Form and Instruction	Modified
245600	Personnel File Checklist (Form M-10A) - Recordkeeping Form and Instruction	Modified
245588	Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping Form and Instruction	Removed
245587	Voluntary Agency Site Visit Guide (Form M-7F) - Respondents Form and Instruction	Removed
245586	Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Recordkeeping Form and Instruction	Modified
245585	Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Respondents Form and Instruction	Modified
245584	Site Visit Guides (Forms M-7A) - Recordkeeping Form and Instruction	Modified
245583	Site Visit Guides (Forms M-7A) - Respondents Form and Instruction	Modified
245580	Incident Reviews (Forms M-5A to M-5B) Form and Instruction	Modified
245579	Checklist for a Child-Friendly Environment (Form M-4a to M-4B) Form and Instruction	Modified
245577	Out-of-Network Site Visit Report (Form M-3B) Form and Instruction	Modified
245575	FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents Form and Instruction	Modified
245574	Corrective Action Report (Form M-1) - Recordkeeping Form and Instruction	Modified
245572	Corrective Action Report (Form M-1) - Respondents Form and Instruction	Modified

ICR Details