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Notice to Unaccompanied Alien Children for Class Counsel Visits (Form A-4)
Unaccompanied Alien Children Bureau Administrative Activities
OMB: 0970-0547
IC ID: 241070
OMB.report
HHS/ACF
OMB 0970-0547
ICR 202505-0970-002
IC 241070
( )
Documents and Forms
Document Name
Document Type
Form A-4
Notice to Unaccompanied Alien Children for Class Counsel Visits (Form A-4)
Form
A-4 Notice to Unaccompanied Alien Children for Class Counsel
A-4 (ENG) Notice to UAC for Flores Visits_English_Revised_2025 04 17.pdf
Form
A-4s Notice to Unaccompanied Alien Children for Class Counsel
A-4 (ESP) Notice to UAC for Flores Visits_Spanish_Revised_2025 04 17.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Notice to Unaccompanied Alien Children for Class Counsel Visits (Form A-4)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
A-4
Notice to Unaccompanied Alien Children for Class Counsel Visits
A-4 (ENG) Notice to UAC for Flores Visits_English_Revised_2025 04 17.pdf
Yes
Yes
Fillable Fileable
Form
A-4s
Notice to Unaccompanied Alien Children for Class Counsel Visits - Spanish
A-4 (ESP) Notice to UAC for Flores Visits_Spanish_Revised_2025 04 17.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
09-80-0321 ORR Unaccompanied Children Bureau Administrative Program Records
FR Citation:
89 FR 100500
Number of Respondents:
20
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20
0
0
0
0
20
Annual IC Time Burden (Hours)
5
0
0
0
0
5
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.