Information Collection

Bed Configuration Module (Form P-12A)

IC 261943 under ICR 202512-0970-002 · OMB 0970-0554.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0554 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form P-12A Bed Configuration Module (Form P-12A)	Form and Instruction
Form P-12A Bed Configuration Module Bed Configuration Module (Form P-12A)	Form and Instruction
P-12A Bed Configuration Module P-12A Bed Configuration Module.pdf	Form and Instruction
P-12A Bed Configuration Module P-12A Bed Configuration Module.pdf	Form and Instruction
Supplemental - Bed Configuration Module Guide.pdf Supplemental - Bed Configuration Module Guide	IC Document
Supplemental - Bed Configuration Module Guide.pdf Supplemental - Bed Configuration Module Guide	IC Document

IC Title:

Bed Configuration Module (Form P-12A)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

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 and Instruction	P-12A				Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: 09-80-0321 ORR Division of Children's Services Records

FR Citation: 81 FR 46682

Number of Respondents: 220

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,640	2,640
Annual IC Time Burden (Hours)	449	449
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supplemental - Bed Configuration Module Guide		08/30/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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