Information Collection

Care Provider Facility Tour Request (Form A-1A) - Record Keeping

IC 241082 under ICR 202510-0970-001 · OMB 0970-0547.

Documents and Forms

Document Name Document Type
Form Form A-1A Care Provider Facility Tour Request (Form A-1A) - Record Keeping Form
Form Form A-1A Care Provider Facility Tour Request Care Provider Facility Tour Request (Form A-1A) - Record Keeping Form
Form A-1A Care Provider Facility Tour Request A-1A Care Provider Facility Tour Request_Revised_2025 04 17.pdf Form
Form A-1A Care Provider Facility Tour Request A-1A Care Provider Facility Tour Request_Revised_2025 04 17.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Care Provider Facility Tour Request (Form A-1A) - Record Keeping	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	Form A-1A	Care Provider Facility Tour Request	A-1A Care Provider Facility Tour Request_Revised_2025 04 17.pdf		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: 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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	510	510
Annual IC Time Burden (Hours)	1,020	1,020
Annual IC Cost Burden (Dollars)	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.

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