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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 256789 under ICR 202403-0970-014 · OMB 0970-0564.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form Form M-12A-UF
Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents		 Form and Instruction
Form Form M-12A-UF
Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents		 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)

layout table

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-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


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,120 0 0 0 0 1,120
Annual IC Time Burden (Hours) 560 0 0 0 0 560
Annual IC Cost Burden (Dollars) 0 0 0 0 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.