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-17H PSA Audit Corrective Action Report	Form and Instruction	Unchanged	Available
Form Form M-17H PSA Audit Corrective Action Report (Form M-17H) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-17H PSA Audit Corrective Action Report	Form and Instruction	Unchanged	Available
Form Form M-17H PSA Audit Corrective Action Report (Form M-17H) - Respondent	Form and Instruction	Unchanged	Repair queued
Form Form M-17G Interview Guide: Unaccompanied Child	Form and Instruction	Unchanged	Available
Form Form M-17G Interview Guide: Unaccompanied Child (Form M-17G) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-17G Interview Guide: Unaccompanied Child	Form and Instruction	Unchanged	Available
Form Form M-17G Interview Guide: Unaccompanied Child (Form M-17G) - Respondent	Form and Instruction	Unchanged	Repair queued
Form Form M-17F Interview Guide: Specialized Staff	Form and Instruction	Unchanged	Available
Form Form M-17F Interview Guide: Specialized Staff (Form M-17F) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-17F Interview Guide: Specialized Staff	Form and Instruction	Unchanged	Available
Form Form M-17F Interview Guide: Specialized Staff (Form M-17F) - Respondent	Form and Instruction	Unchanged	Repair queued
Form Form M-17E Interview Guide: PSA Compliance Manager	Form and Instruction	Unchanged	Available
Form Form M-17E Interview Guide: PSA Compliance Manager (Form M-17E) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-17E Interview Guide: PSA Compliance Manager	Form and Instruction	Unchanged	Available
Form Form M-17E Interview Guide: PSA Compliance Manager (Form M-17E) - Respondent	Form and Instruction	Unchanged	Repair queued
Form Form M-17D Interview Guide: Program Director	Form and Instruction	Unchanged	Available
Form Form M-17D Interview Guide: Program Director (Form M-17D) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-17D Interview Guide: Program Director	Form and Instruction	Unchanged	Available
Form Form M-17D Interview Guide: Program Director (Form M-17D) - Respondent	Form and Instruction	Unchanged	Repair queued
Form Form M-17C Interview Guide: Random Sample of Staff Interview	Form and Instruction	Unchanged	Available
Form Form M-17C Interview Guide: Random Sample of Staff Interview (Form M-17C) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-17C Interview Guide: Random Sample of Staff Interview	Form and Instruction	Unchanged	Available
Form Form M-17C Interview Guide: Random Sample of Staff Interview (Form M-17C) - Respondent	Form and Instruction	Unchanged	Repair queued
Form Form M-17B Instructions for Site Visit and Facility Tour	Form and Instruction	Unchanged	Available
Form Form M-17B Instructions for Site Visit and Facility Tour (Form M-17B) - Recordkieeping	Form and Instruction	Unchanged	Repair queued
Form Form M-17B Instructions for Site Visit and Facility Tour	Form and Instruction	Unchanged	Available
Form Form M-17B Instructions for Site Visit and Facility Tour (Form M-17B) - Respondent	Form and Instruction	Unchanged	Repair queued
Form Form M-17A Preaudit Questionnaire and Audit Documentation Requested Checklist	Form and Instruction	Unchanged	Available
Form Form M-17A Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-17A Preaudit Questionnaire and Audit Documentation Requested Checklist	Form and Instruction	Unchanged	Available
Form Form M-17A Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Respondent	Form and Instruction	Unchanged	Repair queued
Form Form M-10E Influx Care Facility Personnel File Checklist	Form and Instruction	Unchanged	Available
Form Form M-10E Influx Care Facility Personnel File Checklist (Form M-10E) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form M-9B-UF Unlicensed Facility Foster Home Onsite Monitoring Checklist	Form and Instruction	Unchanged	Available
Form M-9B-UF Unlicensed Facility Foster Home Onsite Monitoring Checklist (M-9B-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-8D-UF Unlicensed Facility Staff Secure Addendum to Case File Checklist	Form and Instruction	Unchanged	Available
Form Form M-8D-UF Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-8D-UF Unlicensed Facility Staff Secure Addendum to Case File Checklist	Form and Instruction	Unchanged	Available
Form Form M-8D-UF Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-8B-UF Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist	Form and Instruction	Unchanged	Available
Form Form M-8B-UF Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-8B-UF Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist	Form and Instruction	Unchanged	Available
Form Form M-8B-UF Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-7G Influx Care Facility Monitoring Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7G Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-7G Influx Care Facility Monitoring Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7G Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-6E-UF Influx Care Facility Monitoring Notes	Form and Instruction	Unchanged	Available
Form Form M-6E-UF Influx Care Facility Monitoring Notes (Form M-6E-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-6C-UF Unlicensed Facility Foster Care Monitoring Notes	Form and Instruction	Unchanged	Available
Form Form M-6C-UF Unlicensed Facility Foster Care Monitoring Notes (Form M-6C-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-13E-UF Unlicensed Facility Case Coordinator Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13E-UF Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-13E-UF Unlicensed Facility Case Coordinator Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13E-UF Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent	Form and Instruction	Unchanged	Repair queued
Form Form M-13C-UF Legal Service Provider Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13C-UF Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-13C-UF Legal Service Provider Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13C-UF Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent	Form and Instruction	Unchanged	Repair queued
Form Form M-12Es-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under Spanish	Form and Instruction	Unchanged	Available
Form Form M-12E-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under - English	Form and Instruction	Unchanged	Available
Form Form M-12Bs-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older Spanish	Form and Instruction	Unchanged	Available
Form Form M-12B-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older English	Form and Instruction	Unchanged	Available
Form Form M-12As-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old Spanish	Form and Instruction	Unchanged	Available
Form Form M-12A-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old English	Form and Instruction	Unchanged	Available
Form Form M-12A-UF Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-12Es-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under Spanish	Form and Instruction	Unchanged	Available
Form Form M-12E-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under - English	Form and Instruction	Unchanged	Available
Form Form M-12Bs-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older Spanish	Form and Instruction	Unchanged	Available
Form Form M-12B-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older English	Form and Instruction	Unchanged	Available
Form Form M-12As-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old Spanish	Form and Instruction	Unchanged	Available
Form Form M-12A-UF Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old English	Form and Instruction	Unchanged	Available
Form Form M-12A-UF Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-11P-UF Interpreter Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11P-UF Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-11P-UF Interpreter Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11P-UF Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-11K-UF PSA Compliance Manager Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11J-UF Youth Care Worker Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11I-UF Medical Coordinator Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11G-UF Education Staff Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11E-UF Case Manager Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11C-UF Clinician Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11A-UF Program Director Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11A-UF Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-11K-UF PSA Compliance Manager Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11J-UF Youth Care Worker Questionnaire	Form and Instruction	Unchanged	Repair queued
Form Form M-11I-UF Medical Coordinator Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11G-UF Education Staff Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11E-UF Case Manager Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11C-UF Clinician Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11A-UF Program Director Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11A-UF Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-11P Interpreter Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11P Interpreter Questionnaire (Form M-11P)	Form and Instruction	Unchanged	Repair queued
Form Form M-10A-UF Unlicensed Facility Personnel File Checklist	Form and Instruction	Unchanged	Available
Form Form M-10A-UF Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-9A-UF Unlicensed Facility On-Site Monitoring Checklist	Form and Instruction	Unchanged	Available
Form Form M-9A-UF Unlicensed Facility OnSite Monitoring Checklist (Form M-9A-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-6A-UF Unlicensed Facility Monitoring Notes	Form and Instruction	Unchanged	Available
Form Form M-6A-UF Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-8A-UF Unlicensed Facility Unaccompanied Child Case File Checklist	Form and Instruction	Unchanged	Available
Form Form M-8A-UF Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-8A-UF Unlicensed Facility Unaccompanied Child Case File Checklist	Form and Instruction	Unchanged	Available
Form Form M-8A-UF Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-7A-UF Unlicensed Facility Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7A-UF Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-7A-UF Unlicensed Facility Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7A-UF Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-7C FC Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7C Foster Care Site Visit Guide (Forms M-7C) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-7C FC Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7C Foster Care Site Visit Guide (Forms M-7C) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-15 Monitoring Schedule	Form and Instruction	Unchanged	Available
Form Form M-15 Monitoring Schedule (Form M-15)	Form and Instruction	Unchanged	Repair queued
Form Form M-14 Monitoring Visit	Form and Instruction	Unchanged	Available
Form Form M-14 Monitoring Visit (Form M-14) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-13E Case Coordinator Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13E Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-13E Case Coordinator Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13E Case Coordinator Questionnaire (Form M-13E) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-13D FC Legal Service Provider Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13D Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-13D FC Legal Service Provider Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13D Foster Care Legal Service Provider Questionnaire (Form M-13D) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-13C Legal Service Provider Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13C Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-13C Legal Service Provider Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13C Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form and Instruction	Unchanged	Repair queued
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 M-13B) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
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 M-13B) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-13A 48 - HS PRS Program Director Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13A Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-13A HS PRS Program Director Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-13A Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-12D Secure Client Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-12D Secure Client Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-12C FC Client Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-12C Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-12C FC Client Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-12C Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-12Es UC Questionnaire - Ages 5 and Under - Spanish	Form and Instruction	Unchanged	Repair queued
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-12A Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
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-12A Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-11O Foster Parent Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11O Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-11O Foster Parent Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11O Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-11N Foster Care Independent Living Life Skills Staff Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11N Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-11N Foster Care Independent Living Life Skills Staff Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11N Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-11M Foster Care Home Finder Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11M Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-11M Foster Care Home Finder Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11M Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-11L Secure Detention Officer Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11L Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-11L Secure Detention Officer Questionnaire	Form and Instruction	Unchanged	Available
Form Form M-11L Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form and Instruction	Unchanged	Repair queued
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-11A Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
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-11A Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-10D Foster Care Foster Parent Checklist	Form and Instruction	Unchanged	Available
Form Form M-10D Foster Care Foster Parent Checklist (Form M-10D) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-10C Home Study and Post-Release Services Personnel File Checklist	Form and Instruction	Unchanged	Available
Form Form M-10C Home Study and Post-Release Services Personnel File Checklist (Form M-10C) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-10B Supplement to Personnel File Checklist	Form and Instruction	Unchanged	Available
Form Form M-10B Supplement to Personnel File Checklist (Form M-10B) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-10A Personnel File Checklist	Form and Instruction	Unchanged	Available
Form Form M-10A Personnel File Checklist (Form M-10A) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-7E HS PRS Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7E Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form Form M-7E HS PRS Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7E Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-7A Suppleme Supplemental Personnel and Volunteer List.xlsx	Form and Instruction	Unchanged	Available
Form Form M-7A Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7A Site Visit Guides (Forms M-7A) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form M-7A Supplement Supplemental Personnel and Volunteer List	Form and Instruction	Unchanged	Available
Form Form M-7A Site Visit Guide	Form and Instruction	Unchanged	Available
Form Form M-7A Site Visit Guides (Forms M-7A) - Respondents	Form and Instruction	Unchanged	Repair queued
Form Form M-5B Adult Incident Review	Form and Instruction	Unchanged	Available
Form Form M-5A Incident Review	Form and Instruction	Unchanged	Available
Form Form M-5A Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	Unchanged	Repair queued
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-4A Checklist for a Child-Friendly Environment (Form M-4a to M-4B)	Form and Instruction	Unchanged	Repair queued
Form Form M-3B Out-of-Network Site Visit Report	Form and Instruction	Unchanged	Available
Form Form M-3B Out-of-Network Site Visit Report (Form M-3B)	Form and Instruction	Unchanged	Repair queued
Form Form M-3A FFS Compliance and Safety Site Visit Report	Form and Instruction	Modified	Available
Form Form M-3A FFS Site Visit Form (Form M-3A) - Respondents	Form and Instruction	Modified	Repair queued
Form M-1 Corrective Action Report (Form M-1)	Form and Instruction	Unchanged	Available
Form M-1 Corrective Action Report (Form M-1) - Recordkeeping	Form and Instruction	Unchanged	Repair queued
Form M-1 Corrective Action Report (Form M-1)	Form and Instruction	Unchanged	Available
Form M-1 Corrective Action Report (Form M-1) - Respondents	Form and Instruction	Unchanged	Repair queued
Attachment 1 - FFS Site Visit Form Revisions_2024 03 22.xlsx	Supplementary Document	Uploaded 2024-03-22	Available
Attachment 1 - FFS Site Visit Form Revisions_2024 03 22.xlsx	Supplementary Document	Uploaded 2024-03-22	Repair queued
NonSub Memo_0970-0564_Monitoring and Compliance_006_2024 03 22.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-03-22	Available
NonSub Memo_0970-0564_Monitoring and Compliance_006_2024 03 22.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-03-22	Repair queued
SSA Attachment A_0970-0564_Monitoring and Compliance_005_2023 05 25.docx	Supplementary Document	Uploaded 2023-05-30	Available
SSA Attachment A_0970-0564_Monitoring and Compliance_005_2023 05 25.docx	Supplementary Document	Uploaded 2023-05-30	Repair queued
Extension SSA_0970-0564_Monitoring and Compliance_005_2023 05 25 CLEAN.docx	Supporting Statement A	Uploaded 2023-05-30	Available
Extension SSA_0970-0564_Monitoring and Compliance_005_2023 05 25 CLEAN.docx	Supporting Statement A	Uploaded 2023-05-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260450	PSA Audit Corrective Action Report (Form M-17H) - Recordkeeping	Form and Instruction	Unchanged	PSA Audit Corrective Action Report
260450	PSA Audit Corrective Action Report (Form M-17H) - Recordkeeping	Form and Instruction	Unchanged
260449	PSA Audit Corrective Action Report (Form M-17H) - Respondent	Form and Instruction	Unchanged	PSA Audit Corrective Action Report
260449	PSA Audit Corrective Action Report (Form M-17H) - Respondent	Form and Instruction	Unchanged
260448	Interview Guide: Unaccompanied Child (Form M-17G) - Recordkeeping	Form and Instruction	Unchanged	Interview Guide: Unaccompanied Child
260448	Interview Guide: Unaccompanied Child (Form M-17G) - Recordkeeping	Form and Instruction	Unchanged
260447	Interview Guide: Unaccompanied Child (Form M-17G) - Respondent	Form and Instruction	Unchanged	Interview Guide: Unaccompanied Child
260447	Interview Guide: Unaccompanied Child (Form M-17G) - Respondent	Form and Instruction	Unchanged
260446	Interview Guide: Specialized Staff (Form M-17F) - Recordkeeping	Form and Instruction	Unchanged	Interview Guide: Specialized Staff
260446	Interview Guide: Specialized Staff (Form M-17F) - Recordkeeping	Form and Instruction	Unchanged
260445	Interview Guide: Specialized Staff (Form M-17F) - Respondent	Form and Instruction	Unchanged	Interview Guide: Specialized Staff
260445	Interview Guide: Specialized Staff (Form M-17F) - Respondent	Form and Instruction	Unchanged
260444	Interview Guide: PSA Compliance Manager (Form M-17E) - Recordkeeping	Form and Instruction	Unchanged	Interview Guide: PSA Compliance Manager
260444	Interview Guide: PSA Compliance Manager (Form M-17E) - Recordkeeping	Form and Instruction	Unchanged
260442	Interview Guide: PSA Compliance Manager (Form M-17E) - Respondent	Form and Instruction	Unchanged	Interview Guide: PSA Compliance Manager
260442	Interview Guide: PSA Compliance Manager (Form M-17E) - Respondent	Form and Instruction	Unchanged
260441	Interview Guide: Program Director (Form M-17D) - Recordkeeping	Form and Instruction	Unchanged	Interview Guide: Program Director
260441	Interview Guide: Program Director (Form M-17D) - Recordkeeping	Form and Instruction	Unchanged
260439	Interview Guide: Program Director (Form M-17D) - Respondent	Form and Instruction	Unchanged	Interview Guide: Program Director
260439	Interview Guide: Program Director (Form M-17D) - Respondent	Form and Instruction	Unchanged
260438	Interview Guide: Random Sample of Staff Interview (Form M-17C) - Recordkeeping	Form and Instruction	Unchanged	Interview Guide: Random Sample of Staff Interview
260438	Interview Guide: Random Sample of Staff Interview (Form M-17C) - Recordkeeping	Form and Instruction	Unchanged
260437	Interview Guide: Random Sample of Staff Interview (Form M-17C) - Respondent	Form and Instruction	Unchanged	Interview Guide: Random Sample of Staff Interview
260437	Interview Guide: Random Sample of Staff Interview (Form M-17C) - Respondent	Form and Instruction	Unchanged
260436	Instructions for Site Visit and Facility Tour (Form M-17B) - Recordkieeping	Form and Instruction	Unchanged	Instructions for Site Visit and Facility Tour
260436	Instructions for Site Visit and Facility Tour (Form M-17B) - Recordkieeping	Form and Instruction	Unchanged
260435	Instructions for Site Visit and Facility Tour (Form M-17B) - Respondent	Form and Instruction	Unchanged	Instructions for Site Visit and Facility Tour
260435	Instructions for Site Visit and Facility Tour (Form M-17B) - Respondent	Form and Instruction	Unchanged
260434	Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Recordkeeping	Form and Instruction	Unchanged	Preaudit Questionnaire and Audit Documentation Requested Checklist
260434	Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Recordkeeping	Form and Instruction	Unchanged
260433	Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Respondent	Form and Instruction	Unchanged	Preaudit Questionnaire and Audit Documentation Requested Checklist
260433	Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Respondent	Form and Instruction	Unchanged
260432	Influx Care Facility Personnel File Checklist (Form M-10E) - Recordkeeping	Form and Instruction	Unchanged	Influx Care Facility Personnel File Checklist
260432	Influx Care Facility Personnel File Checklist (Form M-10E) - Recordkeeping	Form and Instruction	Unchanged
260431	Unlicensed Facility Foster Home Onsite Monitoring Checklist (M-9B-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Foster Home Onsite Monitoring Checklist
260431	Unlicensed Facility Foster Home Onsite Monitoring Checklist (M-9B-UF) - Recordkeeping	Form and Instruction	Unchanged
260430	Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Staff Secure Addendum to Case File Checklist
260430	Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Recordkeeping	Form and Instruction	Unchanged
260429	Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Respondents	Form and Instruction	Unchanged	Unlicensed Facility Staff Secure Addendum to Case File Checklist
260429	Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Respondents	Form and Instruction	Unchanged
260428	Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist
260428	Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Recordkeeping	Form and Instruction	Unchanged
260427	Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Respondents	Form and Instruction	Unchanged	Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist
260427	Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Respondents	Form and Instruction	Unchanged
260425	Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Recordkeeping	Form and Instruction	Unchanged	Influx Care Facility Monitoring Site Visit Guide
260425	Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Recordkeeping	Form and Instruction	Unchanged
260424	Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Respondents	Form and Instruction	Unchanged	Influx Care Facility Monitoring Site Visit Guide
260424	Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Respondents	Form and Instruction	Unchanged
260423	Influx Care Facility Monitoring Notes (Form M-6E-UF) - Recordkeeping	Form and Instruction	Unchanged	Influx Care Facility Monitoring Notes
260423	Influx Care Facility Monitoring Notes (Form M-6E-UF) - Recordkeeping	Form and Instruction	Unchanged
260422	Unlicensed Facility Foster Care Monitoring Notes (Form M-6C-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Foster Care Monitoring Notes
260422	Unlicensed Facility Foster Care Monitoring Notes (Form M-6C-UF) - Recordkeeping	Form and Instruction	Unchanged
256795	Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Case Coordinator Questionnaire
256795	Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping	Form and Instruction	Unchanged
256793	Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent	Form and Instruction	Unchanged	Unlicensed Facility Case Coordinator Questionnaire
256793	Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent	Form and Instruction	Unchanged
256792	Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping	Form and Instruction	Unchanged	Legal Service Provider Questionnaire
256792	Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping	Form and Instruction	Unchanged
256791	Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent	Form and Instruction	Unchanged	Legal Service Provider Questionnaire
256791	Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent	Form and Instruction	Unchanged
256790	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under Spanish
256790	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under - English
256790	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older Spanish
256790	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older English
256790	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old Spanish
256790	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old English
256790	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form and Instruction	Unchanged
256789	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under Spanish
256789	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under - English
256789	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older Spanish
256789	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older English
256789	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old Spanish
256789	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old English
256789	Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents	Form and Instruction	Unchanged
256788	Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping	Form and Instruction	Unchanged	Interpreter Questionnaire
256788	Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping	Form and Instruction	Unchanged
256787	Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents	Form and Instruction	Unchanged	Interpreter Questionnaire
256787	Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents	Form and Instruction	Unchanged
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	Unchanged	PSA Compliance Manager Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	Unchanged	Youth Care Worker Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	Unchanged	Medical Coordinator Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	Unchanged	Education Staff Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	Unchanged	Case Manager Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	Unchanged	Clinician Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	Unchanged	Program Director Questionnaire
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form and Instruction	Unchanged
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	Unchanged	PSA Compliance Manager Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	Unchanged	Youth Care Worker Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	Unchanged	Medical Coordinator Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	Unchanged	Education Staff Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	Unchanged	Case Manager Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	Unchanged	Clinician Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	Unchanged	Program Director Questionnaire
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents	Form and Instruction	Unchanged
256784	Interpreter Questionnaire (Form M-11P)	Form and Instruction	Unchanged	Interpreter Questionnaire
256784	Interpreter Questionnaire (Form M-11P)	Form and Instruction	Unchanged
256783	Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Personnel File Checklist
256783	Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping	Form and Instruction	Unchanged
256782	Unlicensed Facility OnSite Monitoring Checklist (Form M-9A-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility On-Site Monitoring Checklist
256782	Unlicensed Facility OnSite Monitoring Checklist (Form M-9A-UF) - Recordkeeping	Form and Instruction	Unchanged
256781	Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Monitoring Notes
256781	Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping	Form and Instruction	Unchanged
256780	Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Case File Checklist
256780	Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Recordkeeping	Form and Instruction	Unchanged
256779	Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Respondents	Form and Instruction	Unchanged	Unlicensed Facility Unaccompanied Child Case File Checklist
256779	Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Respondents	Form and Instruction	Unchanged
256778	Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping	Form and Instruction	Unchanged	Unlicensed Facility Site Visit Guide
256778	Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping	Form and Instruction	Unchanged
256777	Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents	Form and Instruction	Unchanged	Unlicensed Facility Site Visit Guide
256777	Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents	Form and Instruction	Unchanged
245634	Foster Care Site Visit Guide (Forms M-7C) - Recordkeeping	Form and Instruction	Unchanged	FC Site Visit Guide
245634	Foster Care Site Visit Guide (Forms M-7C) - Recordkeeping	Form and Instruction	Unchanged
245633	Foster Care Site Visit Guide (Forms M-7C) - Respondents	Form and Instruction	Unchanged	FC Site Visit Guide
245633	Foster Care Site Visit Guide (Forms M-7C) - Respondents	Form and Instruction	Unchanged
245632	Monitoring Schedule (Form M-15)	Form and Instruction	Unchanged	Monitoring Schedule
245632	Monitoring Schedule (Form M-15)	Form and Instruction	Unchanged
245631	Monitoring Visit (Form M-14) - Recordkeeping	Form and Instruction	Unchanged	Monitoring Visit
245631	Monitoring Visit (Form M-14) - Recordkeeping	Form and Instruction	Unchanged
245630	Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form and Instruction	Unchanged	Case Coordinator Questionnaire
245630	Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form and Instruction	Unchanged
245629	Case Coordinator Questionnaire (Form M-13E) - Respondents	Form and Instruction	Unchanged	Case Coordinator Questionnaire
245629	Case Coordinator Questionnaire (Form M-13E) - Respondents	Form and Instruction	Unchanged
245628	Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form and Instruction	Unchanged	FC Legal Service Provider Questionnaire
245628	Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form and Instruction	Unchanged
245627	Foster Care Legal Service Provider Questionnaire (Form M-13D) - Respondents	Form and Instruction	Unchanged	FC Legal Service Provider Questionnaire
245627	Foster Care Legal Service Provider Questionnaire (Form M-13D) - Respondents	Form and Instruction	Unchanged
245626	Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form and Instruction	Unchanged	Legal Service Provider Questionnaire
245626	Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form and Instruction	Unchanged
245625	Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form and Instruction	Unchanged	Legal Service Provider Questionnaire
245625	Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form and Instruction	Unchanged
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
245624	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping	Form and Instruction	Unchanged
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
245623	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents	Form and Instruction	Unchanged
245622	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form and Instruction	Unchanged	48 - HS PRS Program Director Questionnaire
245622	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form and Instruction	Unchanged
245621	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form and Instruction	Unchanged	HS PRS Program Director Questionnaire
245621	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form and Instruction	Unchanged
245619	Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form and Instruction	Unchanged	Secure Client Questionnaire
245619	Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form and Instruction	Unchanged
245618	Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction	Unchanged	Secure Client Questionnaire
245618	Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction	Unchanged
245617	Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form and Instruction	Unchanged	FC Client Questionnaire
245617	Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form and Instruction	Unchanged
245616	Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction	Unchanged	FC Client Questionnaire
245616	Foster Care Client Questionnaire (M-12C) - Respondents	Form and Instruction	Unchanged
245615	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 5 and Under - Spanish
245615	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 13 and Older - Spanish
245615	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 6-12 Years Old - Spanish
245615	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 5 and Under - English
245615	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 13 and Older - English
245615	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping	Form and Instruction	Unchanged	UC Questionnaire - Ages 6-12 Years Old - English
245615	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping	Form and Instruction	Unchanged
245614	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 5 and Under - Spanish
245614	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 13 and Older - Spanish
245614	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 6-12 Years Old - Spanish
245614	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 5 and Under - English
245614	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 13 and Older - English
245614	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents	Form and Instruction	Unchanged	UC Questionnaire - Ages 6-12 Years Old - English
245614	Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents	Form and Instruction	Unchanged
245613	Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form and Instruction	Unchanged	Foster Parent Questionnaire
245613	Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form and Instruction	Unchanged
245612	Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form and Instruction	Unchanged	Foster Parent Questionnaire
245612	Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form and Instruction	Unchanged
245611	Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form and Instruction	Unchanged	Foster Care Independent Living Life Skills Staff Questionnaire
245611	Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form and Instruction	Unchanged
245610	Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form and Instruction	Unchanged	Foster Care Independent Living Life Skills Staff Questionnaire
245610	Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form and Instruction	Unchanged
245609	Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form and Instruction	Unchanged	Foster Care Home Finder Questionnaire
245609	Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form and Instruction	Unchanged
245608	Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form and Instruction	Unchanged	Foster Care Home Finder Questionnaire
245608	Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form and Instruction	Unchanged
245607	Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form and Instruction	Unchanged	Secure Detention Officer Questionnaire
245607	Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form and Instruction	Unchanged
245606	Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form and Instruction	Unchanged	Secure Detention Officer Questionnaire
245606	Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form and Instruction	Unchanged
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
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form and Instruction	Unchanged
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
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents	Form and Instruction	Unchanged
245603	Foster Care Foster Parent Checklist (Form M-10D) - Recordkeeping	Form and Instruction	Unchanged	Foster Care Foster Parent Checklist
245603	Foster Care Foster Parent Checklist (Form M-10D) - Recordkeeping	Form and Instruction	Unchanged
245602	Home Study and Post-Release Services Personnel File Checklist (Form M-10C) - Recordkeeping	Form and Instruction	Unchanged	Home Study and Post-Release Services Personnel File Checklist
245602	Home Study and Post-Release Services Personnel File Checklist (Form M-10C) - Recordkeeping	Form and Instruction	Unchanged
245601	Supplement to Personnel File Checklist (Form M-10B) - Recordkeeping	Form and Instruction	Unchanged	Supplement to Personnel File Checklist
245601	Supplement to Personnel File Checklist (Form M-10B) - Recordkeeping	Form and Instruction	Unchanged
245600	Personnel File Checklist (Form M-10A) - Recordkeeping	Form and Instruction	Unchanged	Personnel File Checklist
245600	Personnel File Checklist (Form M-10A) - Recordkeeping	Form and Instruction	Unchanged
245586	Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Recordkeeping	Form and Instruction	Unchanged	HS PRS Site Visit Guide
245586	Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Recordkeeping	Form and Instruction	Unchanged
245585	Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Respondents	Form and Instruction	Unchanged	HS PRS Site Visit Guide
245585	Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Respondents	Form and Instruction	Unchanged
245584	Site Visit Guides (Forms M-7A) - Recordkeeping	Form and Instruction	Unchanged	Supplemental Personnel and Volunteer List.xlsx
245584	Site Visit Guides (Forms M-7A) - Recordkeeping	Form and Instruction	Unchanged	Site Visit Guide
245584	Site Visit Guides (Forms M-7A) - Recordkeeping	Form and Instruction	Unchanged
245583	Site Visit Guides (Forms M-7A) - Respondents	Form and Instruction	Unchanged	Supplemental Personnel and Volunteer List
245583	Site Visit Guides (Forms M-7A) - Respondents	Form and Instruction	Unchanged	Site Visit Guide
245583	Site Visit Guides (Forms M-7A) - Respondents	Form and Instruction	Unchanged
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	Incident Review
245580	Incident Reviews (Forms M-5A to M-5B)	Form and Instruction	Unchanged
245579	Checklist for a Child-Friendly Environment (Form M-4a to M-4B)	Form and Instruction	Unchanged	Checklist for a Child-Friendly Environment - Individual Foster Home
245579	Checklist for a Child-Friendly Environment (Form M-4a to M-4B)	Form and Instruction	Unchanged	Checklist for a Child-Friendly Environment - Care Provider Facility
245579	Checklist for a Child-Friendly Environment (Form M-4a to M-4B)	Form and Instruction	Unchanged
245577	Out-of-Network Site Visit Report (Form M-3B)	Form and Instruction	Unchanged	Out-of-Network Site Visit Report
245577	Out-of-Network Site Visit Report (Form M-3B)	Form and Instruction	Unchanged
245575	FFS Site Visit Form (Form M-3A) - Respondents	Form and Instruction	Modified	FFS Compliance and Safety Site Visit Report
245575	FFS Site Visit Form (Form M-3A) - Respondents	Form and Instruction	Modified
245574	Corrective Action Report (Form M-1) - Recordkeeping	Form and Instruction	Unchanged	Corrective Action Report (Form M-1)
245574	Corrective Action Report (Form M-1) - Recordkeeping	Form and Instruction	Unchanged
245572	Corrective Action Report (Form M-1) - Respondents	Form and Instruction	Unchanged	Corrective Action Report (Form M-1)
245572	Corrective Action Report (Form M-1) - Respondents	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0970-0564	ICR Reference No: 202403-0970-014
Status: Active	Previous ICR Reference No: 202305-0970-015
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: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/28/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/22/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026	11/30/2026	11/30/2026
Responses	26,109	0	26,109
Time Burden (Hours)	43,311	0	43,311
Cost Burden (Dollars)	0	0	0

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Abstract: The Monitoring and Compliance for ORR Care Provider Facilities information collection consists of several forms that allow the 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 collection was last approved by OMB on November 3, 2023 and expires on November 30, 2026. ORR is proposing revisions to one form in this collection, the FFS Compliance and Safety Site Visit Report (Form M-3A). This form is completed by ORR Federal Field Specialists (FFS) to document site visit observations and interview responses. Currently, the form is completed in Microsoft Forms. ORR proposes moving the form onto a different digital platform that will enhance the functionality of the form and improve user experience.

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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:
	88 FR 16986	03/21/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 34858	05/31/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 88

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 M-4B)	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 Site Visit Form (Form M-3A) - Respondents	Form M-3A	FFS Compliance and Safety Site Visit Report
Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form M-12C	FC Client Questionnaire
Foster Care Client Questionnaire (M-12C) - Respondents	Form M-12C	FC Client Questionnaire
Foster Care Foster Parent Checklist (Form M-10D) - Recordkeeping	Form M-10D	Foster Care Foster Parent Checklist
Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form M-11O	Foster Parent Questionnaire
Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form M-11O	Foster Parent Questionnaire
Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form M-11M	Foster Care Home Finder Questionnaire
Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form M-11M	Foster Care Home Finder Questionnaire
Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form M-11N	Foster Care Independent Living Life Skills Staff Questionnaire
Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form M-11N	Foster Care Independent Living Life Skills Staff Questionnaire
Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form M-13D	FC Legal Service Provider Questionnaire
Foster Care Legal Service Provider Questionnaire (Form M-13D) - Respondents	Form M-13D	FC Legal Service Provider Questionnaire
Foster Care Site Visit Guide (Forms M-7C) - Recordkeeping	Form M-7C	FC Site Visit Guide
Foster Care Site Visit Guide (Forms M-7C) - Respondents	Form M-7C	FC 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) - Recordkeeping	Form M-10C	Home Study and Post-Release Services Personnel File Checklist
Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Recordkeeping	Form M-7E	HS PRS Site Visit Guide
Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Respondents	Form M-7E	HS PRS Site Visit Guide
Incident Reviews (Forms M-5A to M-5B)	Form M-5A, Form M-5B	Incident Review ,   Adult Incident Review
Influx Care Facility Monitoring Notes (Form M-6E-UF) - Recordkeeping	Form M-6E-UF	Influx Care Facility Monitoring Notes
Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Recordkeeping	Form M-7G	Influx Care Facility Monitoring Site Visit Guide
Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Respondents	Form M-7G	Influx Care Facility Monitoring Site Visit Guide
Influx Care Facility Personnel File Checklist (Form M-10E) - Recordkeeping	Form M-10E	Influx Care Facility Personnel File Checklist
Instructions for Site Visit and Facility Tour (Form M-17B) - Recordkieeping	Form M-17B	Instructions for Site Visit and Facility Tour
Instructions for Site Visit and Facility Tour (Form M-17B) - Respondent	Form M-17B	Instructions for Site Visit and Facility Tour
Interpreter Questionnaire (Form M-11P)	Form M-11P	Interpreter Questionnaire
Interview Guide: PSA Compliance Manager (Form M-17E) - Recordkeeping	Form M-17E	Interview Guide: PSA Compliance Manager
Interview Guide: PSA Compliance Manager (Form M-17E) - Respondent	Form M-17E	Interview Guide: PSA Compliance Manager
Interview Guide: Program Director (Form M-17D) - Recordkeeping	Form M-17D	Interview Guide: Program Director
Interview Guide: Program Director (Form M-17D) - Respondent	Form M-17D	Interview Guide: Program Director
Interview Guide: Random Sample of Staff Interview (Form M-17C) - Recordkeeping	Form M-17C	Interview Guide: Random Sample of Staff Interview
Interview Guide: Random Sample of Staff Interview (Form M-17C) - Respondent	Form M-17C	Interview Guide: Random Sample of Staff Interview
Interview Guide: Specialized Staff (Form M-17F) - Recordkeeping	Form M-17F	Interview Guide: Specialized Staff
Interview Guide: Specialized Staff (Form M-17F) - Respondent	Form M-17F	Interview Guide: Specialized Staff
Interview Guide: Unaccompanied Child (Form M-17G) - Recordkeeping	Form M-17G	Interview Guide: Unaccompanied Child
Interview Guide: Unaccompanied Child (Form M-17G) - Respondent	Form M-17G	Interview Guide: Unaccompanied Child
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
Monitoring Schedule (Form M-15)	Form M-15	Monitoring Schedule
Monitoring Visit (Form M-14) - Recordkeeping	Form M-14	Monitoring Visit
Out-of-Network Site Visit Report (Form M-3B)	Form M-3B	Out-of-Network Site Visit Report
PSA Audit Corrective Action Report (Form M-17H) - Recordkeeping	Form M-17H	PSA Audit Corrective Action Report
PSA Audit Corrective Action Report (Form M-17H) - Respondent	Form M-17H	PSA Audit Corrective Action Report
Personnel File Checklist (Form M-10A) - Recordkeeping	Form M-10A	Personnel File Checklist
Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Recordkeeping	Form M-17A	Preaudit Questionnaire and Audit Documentation Requested Checklist
Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Respondent	Form M-17A	Preaudit Questionnaire and Audit Documentation Requested Checklist
Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	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, Form M-11H	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-11B, Form M-11C, Form M-11A, 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 Guides (Forms M-7A) - Recordkeeping	Form M-7A, Form M-7A Supplement	Site Visit Guide ,   Supplemental Personnel and Volunteer List.xlsx
Site Visit Guides (Forms M-7A) - Respondents	Form M-7A, M-7A Supplement	Site Visit Guide ,   Supplemental Personnel and Volunteer List
Supplement to Personnel File Checklist (Form M-10B) - Recordkeeping	Form M-10B	Supplement to Personnel File Checklist
Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - 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
Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - 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 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 Foster Care Monitoring Notes (Form M-6C-UF) - Recordkeeping	Form M-6C-UF	Unlicensed Facility Foster Care Monitoring Notes
Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Recordkeeping	Form M-8B-UF	Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist
Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Respondents	Form M-8B-UF	Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist
Unlicensed Facility Foster Home Onsite Monitoring Checklist (M-9B-UF) - Recordkeeping	M-9B-UF	Unlicensed Facility Foster Home Onsite Monitoring Checklist
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 OnSite Monitoring Checklist (Form M-9A-UF) - Recordkeeping	Form M-9A-UF	Unlicensed Facility On-Site Monitoring Checklist
Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping	Form M-10A-UF	Unlicensed Facility Personnel File Checklist
Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping	Form M-11E-UF, Form M-11A-UF, Form M-11C-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 Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Recordkeeping	Form M-8D-UF	Unlicensed Facility Staff Secure Addendum to Case File Checklist
Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Respondents	Form M-8D-UF	Unlicensed Facility Staff Secure Addendum to Case File Checklist
Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Recordkeeping	Form M-8A-UF	Unlicensed Facility Unaccompanied Child Case File Checklist
Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Respondents	Form M-8A-UF	Unlicensed Facility Unaccompanied Child Case File Checklist
Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping	Form M-12A-UF, Form M-12Bs-UF, Form M-12As-UF, Form M-12B-UF, Form M-12E-UF, Form M-12Es-UF	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old English ,   Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old Spanish ,   Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older English ,   Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older Spanish ,   Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under - English ,   Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under Spanish
Unlicensed Facility Unaccompanied Child 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	Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old English ,   Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old Spanish ,   Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older English ,   Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older Spanish ,   Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under - English ,   Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under Spanish

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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	26,109	26,109	0	0	0	0
Annual Time Burden (Hours)	43,311	43,311	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,371,918

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: 03/22/2024

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