Medical Assessment Form and Dental Assessment Form
No material or nonsubstantive change to a currently approved collection
No
Regular
10/07/2024
table that charts list comparision
Requested
Previously Approved
10/31/2026
10/31/2026
619,000
619,000
160,815
160,815
0
0
The Medical Assessment Form was approved by OMB on October 26, 2023, as part of the Medical Assessment Form and Dental Assessment Form information collection. The purpose of the Medical Assessment Form is to collect standardized health information on unaccompanied children during evaluations with generalist medical providers, pediatricians, and other medical specialty providers.
The following two Administration for Children and Families (ACF) Office of Refugee Resettlement (ORR) information collections capture health data on children in ORR care:
⢠Medical Assessment Form and Dental Assessment Form
⢠Mental Health Assessment Form and Public Health Investigation Form: Active TB, and Public Health Investigation Form: Non-TB Illness.
ORR has recently identified a specific need to share data collected on ORRâs health assessment forms that falls outside of the stated limitations with the Department of Homeland Security (DHS). The need to communicate with DHS occurs when a newly referred child arrives at an ORR facility ill or requires emergent/urgent healthcare services shortly after placement and ORR was not notified in advance. For DHS to investigate the event, ORR must share confidential and sensitive health information including the childâs alien number, name, signs/symptoms, diagnoses, and date of diagnosis. The goal of this data sharing effort is to identify areas of potential improvement in delivery of healthcare services and continuity of care for children transferred from DHS to HHS custody.
Currently, there is specific language in the Supporting Statements describing limitations on data sharing that limits ORRâs ability to fulfill this need. ORR has discussed the need to update this language with OMB and as a result ORR published a notice in the Federal Register (89 FR 54829) on July 2, 2024 announcing a 30-day period for the public to comment on the proposed changes. No comments were received, and we are now submitting the updated Supporting Statement A for final review and approval.
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:
(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;
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.
Dental Assessment Form - Recordkeeping Time