Incident Reporting for the Unaccompanied Alien Children Bureau

Forms and Documents

Document Name	Status
Form A-10 Program-Level Event Report (Form A-10) Form and Instruction	New
Form A-9E Behavioral Note (Form A-9E) Form and Instruction	New
Form A-9D Historical Disclosure (Form A-9D) Form and Instruction	New
Form A-9C Non-Emergency Significant Incident Report (Form A-9C) Form and Instruction	New
Form A-9B Emergency Significant Incident Report (Form A-9B) Form and Instruction	New
Form A-9A Child-Level Event (Form A-9A) Form and Instruction	New
SSA_0970-NEW_Incident Reporting_001_2025 04 17.docx Supporting Statement A	2025-04-17

IC Document Collections

IC ID	Document Title	Status
274958	Program-Level Event Report (Form A-10) Form and Instruction	New
274957	Behavioral Note (Form A-9E) Form and Instruction	New
274956	Historical Disclosure (Form A-9D) Form and Instruction	New
274955	Non-Emergency Significant Incident Report (Form A-9C) Form and Instruction	New
274954	Emergency Significant Incident Report (Form A-9B) Form and Instruction	New
274953	Child-Level Event (Form A-9A) Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202504-0970-017
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: ORR - UAC Bureau
Title: Incident Reporting for the Unaccompanied Alien Children Bureau
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/28/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	170,700	0
Time Burden (Hours)	123,612	0
Cost Burden (Dollars)	0	0

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Abstract: The ORR Unaccompanied Alien Children Bureau (UACB) provides care and custody for unaccompanied alien children until they can be safely released to a sponsor, repatriated to their home country, or obtain legal status. ORR funds residential care provider facilities that provide temporary housing and other services to children in ORR custody. Generally, care provider facilities are State- licensed (with the exception of those located in states unwilling to consider them for licensure and temporary influx care facilities) and must meet ORR requirements to ensure a high-level quality of care. Services provided at care provider facilities include, but are not limited to, education, recreation, vocational training, acculturation, nutrition, medical, mental health, legal, and case management. ORR uses several forms directly related to the care of unaccompanied alien children. The forms in this information collection allow ORR to ensure that serious issues are elevated to ORR and that all incidents, and responses to such incidents, are documented and resolved in a way that protects the interests of unaccompanied alien children. ORR is in the process of reorganizing its information collections to better manage its large portfolio of forms. As part of that reorganization effort, ORR is submitting this request to transfer six existing forms (with revisions) currently approved under OMB# 0970-0547 under a new OMB control number.

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Authorizing Statute(s): US Code: 6 USC 279 Name of Law: Homeland Security Act (HSA)
   US Code: 8 USC 1232 Name of Law: William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 (TVPRA)
  

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:
	89 FR 105610	12/27/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 22307	05/27/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Behavioral Note (Form A-9E)	A-9E	Behavioral Note
Child-Level Event (Form A-9A)	A-9A	Child-Level Event
Emergency Significant Incident Report (Form A-9B)	A-9B	Emergency Significant Incident Report
Historical Disclosure (Form A-9D)	A-9D	Historical Disclosure
Non-Emergency Significant Incident Report (Form A-9C)	A-9C	Non-Emergency Significant Incident Report
Program-Level Event Report (Form A-10)	A-10	Program-Level Event Report

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ICR Summary of Burden

	Total Request	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	170,700	0	0	170,700	0	0
Annual Time Burden (Hours)	123,612	0	0	123,612	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This request includes six forms that were previously approved under OMB #0970-0547. This request moves the forms under a new OMB number, with revisions. See section A15 of Supporting Statement A for details about proposed revisions.

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Annual Cost to Federal Government: $7,621,827

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: 05/28/2025

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