Information Collection

Authorization for Release of Records (Form A-5) - Record keeping

IC 249480 under ICR 202505-0970-002 · OMB 0970-0547.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0547 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form A-5 Authorization for Release of Records (Form A-5) - Record keeping	Form
Form A-5 Authorization for Release of Records Authorization for Release of Records (Form A-5) - Record keeping	Form
Form A-5s Authorization for Release of Records - Spanish Authorization for Release of Records (Form A-5) - Record keeping	Form
A-5 Authorization for Release of Records A-5 (ENG) Authorization for Release of Records_English_Revised_2025 04 17.pdf	Form
A-5 Authorization for Release of Records A-5 (ENG) Authorization for Release of Records_English_Revised_2025 04 17.pdf	Form
A-5s Authorization for Release of Records - Spanish A-5 (ESP) Authorization for Release of Records_Spanish_Revised_2025 04 16.pdf	Form
A-5s Authorization for Release of Records - Spanish A-5 (ESP) Authorization for Release of Records_Spanish_Revised_2025 04 16.pdf	Form

IC Title:

Authorization for Release of Records (Form A-5) - Record keeping

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	A-5				Yes	Yes	Fillable Fileable
Form	A-5s				Yes	Yes	Fillable Fileable

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: 9,620

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	Previously Approved
Annual Number of Responses for this IC	9,620	5,516	4,104
Annual IC Time Burden (Hours)	4,810	3,442	1,368
Annual IC Cost Burden (Dollars)	0	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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