Information Collection

Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping

IC 256790 under ICR 202305-0970-015 · OMB 0970-0564.

⚠️ Notice: This information collection may be referencing outdated material.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

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form M-12A-UF Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction
Form M-12A-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12A-UF UC Questionnaire - Ages 6-12 Years Old English.docx	Form and Instruction
Form M-12A-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12A-UF UC Questionnaire - Ages 6-12 Years Old English.docx	Form and Instruction
Form M-12As-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12As-UF UC Questionnaire - Ages 6-12 Years Old Spanish.docx	Form and Instruction
Form M-12As-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12As-UF UC Questionnaire - Ages 6-12 Years Old Spanish.docx	Form and Instruction
Form M-12B-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12B-UF UC Questionnaire - Ages 13 and Older English.docx	Form and Instruction
Form M-12B-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12B-UF UC Questionnaire - Ages 13 and Older English.docx	Form and Instruction
Form M-12Bs-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12Bs-UF UC Questionnaire - Ages 13 and Older Spanish.docx	Form and Instruction
Form M-12Bs-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12Bs-UF UC Questionnaire - Ages 13 and Older Spanish.docx	Form and Instruction
Form M-12E-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12E-UF UC Questionnaire - Ages 5 and Under - English.docx	Form and Instruction
Form M-12E-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12E-UF UC Questionnaire - Ages 5 and Under - English.docx	Form and Instruction
Form M-12Es-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12Es-UF UC Questionnaire - Ages 5 and Under Spanish.docx	Form and Instruction
Form M-12Es-UF Unlicensed Facility Unaccompanied Child Questionnaire - M-12Es-UF UC Questionnaire - Ages 5 and Under Spanish.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form M-12A-UF	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old English	M-12A-UF UC Questionnaire - Ages 6-12 Years Old English.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Form M-12As-UF	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old Spanish	M-12As-UF UC Questionnaire - Ages 6-12 Years Old Spanish.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Form M-12B-UF	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older English	M-12B-UF UC Questionnaire - Ages 13 and Older English.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Form M-12Bs-UF	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older Spanish	M-12Bs-UF UC Questionnaire - Ages 13 and Older Spanish.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Form M-12E-UF	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under - English	M-12E-UF UC Questionnaire - Ages 5 and Under - English.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Form M-12Es-UF	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under Spanish	M-12Es-UF UC Questionnaire - Ages 5 and Under Spanish.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: ORR Unaccompanied Refugee Minors Records

FR Citation: 81 FR 46682

Number of Respondents: 18

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,116	1,116
Annual IC Time Burden (Hours)	558	558
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.