Information Collection

Non-Emergency Significant Incident Report (Form A-9C)

IC 274955 under ICR 202504-0970-017 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form A-9C Non-Emergency Significant Incident Report (Form A-9C)	Form and Instruction
Form A-9C Non-Emergency Significant Incident Report Non-Emergency Significant Incident Report (Form A-9C)	Form and Instruction
A-9C Non-Emergency Significant Incident Report Non-Emergency Significant Incident Report (Form A-9C)_2025 04 17.pdf	Form and Instruction
A-9C Non-Emergency Significant Incident Report Non-Emergency Significant Incident Report (Form A-9C)_2025 09 22 CLEAN.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 410, 411, 412 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	A-9C				Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: ORR Unaccompanied Children Bureau Administrative Program Records

FR Citation: 89 FR 100500

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18,600	18,600
Annual IC Time Burden (Hours)	27,900	27,900
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.

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