Information Collection Request

Unaccompanied Alien Children Bureau Administrative Activities

ICR 202505-0970-002 · OMB 0970-0547 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form A-9E Behavioral Note Form Removed Available
Form A-9E Behavioral Note (Form A-9E) Form Removed Repair queued
Form A-9D Historical Disclosure Form Removed Available
Form A-9D Historical Disclosure (Form A-9D) Form Removed Repair queued
Form Form A-7 Notification of Concern Addendum Form and Instruction Removed Available
Form Form A-7 Notification of Concern Form Removed Available
Form Form A-7 Notification of Concern (Form A-7) Form Removed Repair queued
Form A-5s Authorization for Release of Records - Spanish Form Modified Available
Form A-5 Authorization for Release of Records Form Modified Available
Form A-5 Authorization for Release of Records (Form A-5) - Record keeping Form Modified Repair queued
Form Form A-1A Care Provider Facility Tour Request Form Modified Available
Form Form A-1A Care Provider Facility Tour Request (Form A-1A) - Record Keeping Form Modified Repair queued
Form Form A-15 ORR Waiver Request Form Modified Available
Form Form A-15 ORR Waiver Request (Form A-15) Form Modified Repair queued
Form A-14 Key Personnel Minimum Qualifications Checklist and Attestation Form Modified Available
Form A-14 Key Personnel Minimum Qualifications Checklist and Attestation (Form A-14) Form Modified Repair queued
Form A-10 Program-Level Event Report and Addendum - UC Path Version Form Removed Available
Form A-10 Program-Level Event Report - UC Portal Version Form Removed Available
Form A-10 Program Level Event (Form A-10) Form Removed Repair queued
Form A-9C Emergency Significant Incident Report Addendum - UC Portal Version Form Removed Available
Form A-9C Emergency Significant Incident Report Addendum - UC Path Version Form Removed Available
Form A-9C Non-Emergency Significant Incident Report and Addendum (Form A-9C) Form Removed Repair queued
Form A-9B Emergency Significant Incident Report Form Removed Available
Form A-9B Emergency Significant Incident Report - UC Path Version Form Removed Available
Form A-9B Emergency Significant Incident Report (Form A-9B) Form Removed Missing upstream
Form A-9A Child-Level Event Form Removed Available
Form A-9A Child-Level Event (Form A-9A) Form Removed Repair queued
Form A-5s Authorization for Release of Records (Spanish) Form Modified Available
Form A-5 Authorization for Release of Records (English) Form Modified Available
Form A-5 Authorization for Release of Records (Form A-5) Form Modified Repair queued
Form A-4s Notice to Unaccompanied Alien Children for Class Counsel Visits - Spanish Form Modified Available
Form A-4 Notice to Unaccompanied Alien Children for Class Counsel Visits Form Modified Available
Form A-4 Notice to Unaccompanied Alien Children for Class Counsel Visits (Form A-4) Form Modified Repair queued
Form A-1A Care Provider Facility Tour Request Form Modified Available
Form A-1A Care Provider Facility Tour Request (Form A-1A) Form Modified Repair queued
SSA_0970-0547_Admin Activities _011_2025 04 17.docx Supporting Statement A Uploaded 2025-05-01 Repair queued
SSA_0970-0547_Admin Activities _011_2025 04 17.docx Supporting Statement A Uploaded 2025-05-01 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
260907 Behavioral Note (Form A-9E) Form RemovedBehavioral Note
260907 Behavioral Note (Form A-9E) Form Removed
260906 Historical Disclosure (Form A-9D) Form RemovedHistorical Disclosure
260906 Historical Disclosure (Form A-9D) Form Removed
249481 Notification of Concern (Form A-7) Form and Instruction RemovedNotification of Concern Addendum
249481 Notification of Concern (Form A-7) Form RemovedNotification of Concern
249481 Notification of Concern (Form A-7) Form Removed
249480 Authorization for Release of Records (Form A-5) - Record keeping Form ModifiedAuthorization for Release of Records - Spanish
249480 Authorization for Release of Records (Form A-5) - Record keeping Form ModifiedAuthorization for Release of Records
249480 Authorization for Release of Records (Form A-5) - Record keeping Form Modified
241082 Care Provider Facility Tour Request (Form A-1A) - Record Keeping Form ModifiedCare Provider Facility Tour Request
241082 Care Provider Facility Tour Request (Form A-1A) - Record Keeping Form Modified
241079 ORR Waiver Request (Form A-15) Form ModifiedORR Waiver Request
241079 ORR Waiver Request (Form A-15) Form Modified
241078 Key Personnel Minimum Qualifications Checklist and Attestation (Form A-14) Form ModifiedKey Personnel Minimum Qualifications Checklist and Attestation
241078 Key Personnel Minimum Qualifications Checklist and Attestation (Form A-14) Form Modified
241077 Program Level Event (Form A-10) Form RemovedProgram-Level Event Report and Addendum - UC Path Version
241077 Program Level Event (Form A-10) Form RemovedProgram-Level Event Report - UC Portal Version
241077 Program Level Event (Form A-10) Form Removed
241075 Non-Emergency Significant Incident Report and Addendum (Form A-9C) Form RemovedEmergency Significant Incident Report Addendum - UC Portal Version
241075 Non-Emergency Significant Incident Report and Addendum (Form A-9C) Form RemovedEmergency Significant Incident Report Addendum - UC Path Version
241075 Non-Emergency Significant Incident Report and Addendum (Form A-9C) Form Removed
241074 Emergency Significant Incident Report (Form A-9B) Form RemovedEmergency Significant Incident Report
241074 Emergency Significant Incident Report (Form A-9B) Form RemovedEmergency Significant Incident Report - UC Path Version
241074 Emergency Significant Incident Report (Form A-9B) Form Removed
241073 Child-Level Event (Form A-9A) Form RemovedChild-Level Event
241073 Child-Level Event (Form A-9A) Form Removed
241072 Authorization for Release of Records (Form A-5) Form ModifiedAuthorization for Release of Records (Spanish)
241072 Authorization for Release of Records (Form A-5) Form ModifiedAuthorization for Release of Records (English)
241072 Authorization for Release of Records (Form A-5) Form Modified
241070 Notice to Unaccompanied Alien Children for Class Counsel Visits (Form A-4) Form ModifiedNotice to Unaccompanied Alien Children for Class Counsel Visits - Spanish
241070 Notice to Unaccompanied Alien Children for Class Counsel Visits (Form A-4) Form ModifiedNotice to Unaccompanied Alien Children for Class Counsel Visits
241070 Notice to Unaccompanied Alien Children for Class Counsel Visits (Form A-4) Form Modified
241067 Care Provider Facility Tour Request (Form A-1A) Form ModifiedCare Provider Facility Tour Request
241067 Care Provider Facility Tour Request (Form A-1A) Form Modified
ICR Details
0970-0547 202505-0970-002
Historical Active 202409-0970-009
HHS/ACF ORR - UAC Bureau
Unaccompanied Alien Children Bureau Administrative Activities
Revision of a currently approved collection   No
Regular
Approved without change 06/30/2025
Retrieve Notice of Action (NOA) 05/28/2025
  Inventory as of this Action Requested Previously Approved
06/30/2028 36 Months From Approved 06/30/2025
22,790 0 188,089
11,804 0 173,941
0 0 0

The Office of Refugee Resettlement (ORR) Unaccompanied Alien Children (UAC) Bureau 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 perform UAC Bureau-related administrative activities, such as facilitating stakeholder visits to care provider facilities; obtaining consent from children to share their case file information; and processing requests and waivers for the hiring of key and non-key personnel at care provider facilities. This request is for revisions to five existing forms in this collection and to remove seven forms, which will be transferred under new Office of Management and Budget (OMB) control numbers (separate requests will be submitted for the new control numbers). Details about the changes are described in section A15 of Supporting Statement A.

US Code: 8 USC 1232 Name of Law: Trafficking Victim Protection Reauthorization Act of 2008
   US Code: 6 USC 279 Name of Law: Homeland Security Act (HSA)
   PL: Pub.L. 113 - 4 1101(c) Name of Law: Violence Against Women Reauthorization Act of 2013
  
None

Not associated with rulemaking

  89 FR 104187 12/20/2024
90 FR 22304 05/27/2025
No

7
IC Title Form No. Form Name
Authorization for Release of Records (Form A-5) A-5, A-5s Authorization for Release of Records (English) ,   Authorization for Release of Records (Spanish)
Authorization for Release of Records (Form A-5) - Record keeping A-5, A-5s Authorization for Release of Records ,   Authorization for Release of Records - Spanish
Behavioral Note (Form A-9E) A-9E Behavioral Note
Care Provider Facility Tour Request (Form A-1A) A-1A Care Provider Facility Tour Request
Care Provider Facility Tour Request (Form A-1A) - Record Keeping Form A-1A Care Provider Facility Tour Request
Child-Level Event (Form A-9A) A-9A Child-Level Event
Emergency Significant Incident Report (Form A-9B) A-9B, A-9B Emergency Significant Incident Report - UC Path Version ,   Emergency Significant Incident Report
Historical Disclosure (Form A-9D) A-9D Historical Disclosure
Key Personnel Minimum Qualifications Checklist and Attestation (Form A-14) A-14 Key Personnel Minimum Qualifications Checklist and Attestation
Non-Emergency Significant Incident Report and Addendum (Form A-9C) A-9C, A-9C Emergency Significant Incident Report Addendum - UC Path Version ,   Emergency Significant Incident Report Addendum - UC Portal Version
Notice to Unaccompanied Alien Children for Class Counsel Visits (Form A-4) A-4, A-4s Notice to Unaccompanied Alien Children for Class Counsel Visits ,   Notice to Unaccompanied Alien Children for Class Counsel Visits - Spanish
Notification of Concern (Form A-7) Form A-7, Form A-7 Notification of Concern ,   Notification of Concern Addendum
ORR Waiver Request (Form A-15) Form A-15 ORR Waiver Request
Program Level Event (Form A-10) A-10, A-10 Program-Level Event Report - UC Portal Version ,   Program-Level Event Report and Addendum - UC Path Version

  Total Approved 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 22,790 188,089 0 -165,299 0 0
Annual Time Burden (Hours) 11,804 173,941 0 -162,137 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
This request is for revisions to five existing forms in this collection and to remove seven forms, which will be transferred under new Office of Management and Budget (OMB) control numbers (separate requests will be submitted for the new control numbers). Details about the changes are described in section A15 of Supporting Statement A.

$11,421
No
    Yes
    No
No
No
No
No
Molly Buck 202 205-4724 [email protected]

  No

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.
05/28/2025