Unaccompanied Alien Children Bureau Administrative Activities

Forms and Documents

Document Name	Status
Form A-9E Behavioral Note (Form A-9E) Form	Removed
Form A-9D Historical Disclosure (Form A-9D) Form	Removed
Form Form A-7 Notification of Concern (Form A-7) Form	Removed
Form A-5 Authorization for Release of Records (Form A-5) - Record keeping Form	Modified
Form Form A-1A Care Provider Facility Tour Request (Form A-1A) - Record Keeping Form	Modified
Form Form A-15 ORR Waiver Request (Form A-15) Form	Modified
Form A-14 Key Personnel Minimum Qualifications Checklist and Attestation (Form A-14) Form	Modified
Form A-10 Program Level Event (Form A-10) Form	Removed
Form A-9C Non-Emergency Significant Incident Report and Addendum (Form A-9C) Form	Removed
Form A-9B Emergency Significant Incident Report (Form A-9B) Form	Removed
Form A-9A Child-Level Event (Form A-9A) Form	Removed
Form A-5 Authorization for Release of Records (Form A-5) Form	Modified
Form A-4 Notice to Unaccompanied Alien Children for Class Counsel Visits (Form A-4) Form	Modified
Form A-1A Care Provider Facility Tour Request (Form A-1A) Form	Modified
SSA_0970-0547_Admin Activities _011_2025 04 17.docx Supporting Statement A	2025-05-01

IC Document Collections

IC ID	Document Title	Status
260907	Behavioral Note (Form A-9E) Form	Removed
260906	Historical Disclosure (Form A-9D) Form	Removed
249481	Notification of Concern (Form A-7) Form	Removed
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	Modified
241079	ORR Waiver Request (Form A-15) Form	Modified
241078	Key Personnel Minimum Qualifications Checklist and Attestation (Form A-14) Form	Modified
241077	Program Level Event (Form A-10) Form	Removed
241075	Non-Emergency Significant Incident Report and Addendum (Form A-9C) Form	Removed
241074	Emergency Significant Incident Report (Form A-9B) Form	Removed
241073	Child-Level Event (Form A-9A) Form	Removed
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	Modified
241067	Care Provider Facility Tour Request (Form A-1A) Form	Modified

ICR Details

OMB Control No: 0970-0547	ICR Reference No: 202505-0970-002
Status: Received in OIRA	Previous ICR Reference No: 202409-0970-009
Agency/Subagency: HHS/ACF	Agency Tracking No: ORR - UAC Bureau
Title: Unaccompanied Alien Children Bureau Administrative Activities
Type of Information Collection: Revision of a currently approved collection	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	05/31/2025
Responses	22,790	188,089
Time Burden (Hours)	11,804	173,941
Cost Burden (Dollars)	0	0

---

Abstract: 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.

---

Authorizing Statute(s): US Code: 6 USC 279 Name of Law: Homeland Security Act (HSA)
   US Code: 8 USC 1232 Name of Law: Trafficking Victim Protection Reauthorization Act of 2008
   PL: Pub.L. 113 - 4 1101(c) Name of Law: Violence Against Women Reauthorization Act of 2013
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 104187	12/20/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 22304	05/27/2025
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 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-4s, A-4	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

---

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	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

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: 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.

---

Annual Cost to Federal Government: $11,421

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.     No

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

---

Common Form ICR:  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:

(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

---