Information Collection

Secure Client Questionnaire (Form M-12D) - Respondents

IC 245618 under ICR 202403-0970-014 · OMB 0970-0564.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Respondents	Form and Instruction
Form M-12D Secure Client Questionnaire Secure UC Questionnaire (Form M-12D).docx	Form and Instruction
Form M-12D Secure Client Questionnaire Secure UC Questionnaire (Form M-12D).docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form M-12D	Secure Client Questionnaire	Secure UC Questionnaire (Form M-12D).docx		Yes	Yes	Fillable Fileable

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: 5

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	3	3
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.