Placement and Transfer of Unaccompanied Alien Children into ORR Care Provider Facilities

Forms and Documents

Document	Type	Status	Availability
Form P-12B Bed Assignment Capacity Overview Module	Form and Instruction	Modified	Repair queued
Form P-12B Bed Assignment Capacity Overview Module	Form and Instruction	Modified	Available
Form P-12A Bed Configuration Module	Form and Instruction	Modified	Repair queued
Form P-12A Bed Configuration Module	Form and Instruction	Modified	Repair queued
Form P-10B Placement Confirmation	Form and Instruction	Modified	Repair queued
Form P-10B Placement Confirmation	Form and Instruction	Modified	Available
Form P-18p Notice of Administrative Review - Pashto	Form	Removed	Repair queued
Form P-18p Notice of Administrative Review - Pashto	Form	Removed	Available
Form P-18d Notice of Administrative Review - Dari	Form	Removed	Repair queued
Form P-18d Notice of Administrative Review - Dari	Form	Removed	Available
Form P-18s Notice of Administrative Review - Spanish	Form	Removed	Repair queued
Form P-18s Notice of Administrative Review - Spanish	Form	Removed	Available
Form P-18 Notice of Administrative Review	Form	Removed	Available
Form P-18 Notice of Administrative Review	Form	Removed	Available
Form P-17 Influx Transfer Manual and Prescreen Criteria Review	Form and Instruction	Modified	Available
Form P-17 Influx Transfer Manual and Prescreen Criteria Review	Form and Instruction	Modified	Available
Form P-16 Influx Transfer Manifest	Form and Instruction	Modified	Repair queued
Form P-16 Influx Transfer Manifest	Form and Instruction	Modified	Available
Form P-15 Family Group Entity	Form and Instruction	Unchanged	Repair queued
Form P-15 Family Group Entity	Form and Instruction	Unchanged	Available
Form P-10B Placement Confirmation	Form and Instruction	Modified	Repair queued
Form P-10B Placement Confirmation	Form and Instruction	Modified	Available
Form P-10A Transfer Request	Form and Instruction	Modified	Available
Form P-10A Transfer Request	Form and Instruction	Modified	Available
Form P-14 ORR Transfer Notification - UC Path Version	Form and Instruction	Unchanged	Available
Form P-14 ORR Transfer Notification - UC Path Version	Form and Instruction	Unchanged	Available
Form P-13 UAC Profile - UAC Path	Form and Instruction	Modified	Repair queued
Form P-13 UAC Profile - UAC Path	Form and Instruction	Modified	Available
Form P-13 UAC Profile - UAC Portal	Form and Instruction	Modified	Repair queued
Form P-13 UAC Profile - UAC Portal	Form and Instruction	Modified	Available
Form P-12 UC Portal Capacity Report (Form P-12) - UC Portal	Form and Instruction	Unchanged	Repair queued
Form P-12 UC Portal Capacity Report (Form P-12) - UC Portal	Form and Instruction	Unchanged	Available
Form P-12C Program Entity	Form and Instruction	Unchanged	Repair queued
Form P-12C Program Entity	Form and Instruction	Unchanged	Available
Form P-11 Transfer Summary and Tracking - UAC Path Version	Form and Instruction	Modified	Available
Form P-11 Transfer Summary and Tracking - UAC Path Version	Form and Instruction	Modified	Available
Form P-10A Transfer Request	Form and Instruction	Modified	Repair queued
Form P-10A Transfer Request	Form and Instruction	Modified	Available
Form P-9B Medical Checklist for Influx Transfers	Form and Instruction	Unchanged	Available
Form P-9B Medical Checklist for Influx Transfers	Form and Instruction	Unchanged	Available
Form P-9A Medical Checklist for Transfers	Form and Instruction	Unchanged	Repair queued
Form P-9A Medical Checklist for Transfers	Form and Instruction	Unchanged	Available
Form P-8 Care Provider Checklist for Transfers to Influx Care Facilities	Form and Instruction	Unchanged	Repair queued
Form P-8 Care Provider Checklist for Transfers to Influx Care Facilities	Form and Instruction	Unchanged	Available
Form P-7 Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist)	Form and Instruction	Modified	Available
Form P-7 Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist)	Form and Instruction	Modified	Available
Form P-7 UAC Referral - Path Version	Form and Instruction	Modified	Repair queued
Form P-7 UAC Referral - Path Version	Form and Instruction	Modified	Available
Form P-5 Long Term Foster Care Placement Memo	Form and Instruction	Unchanged	Repair queued
Form P-5 Long Term Foster Care Placement Memo	Form and Instruction	Unchanged	Available
Form Form P-4 Notice of Placement in a Restrictive Setting	Form and Instruction	Modified	Repair queued
Form Form P-4 Notice of Placement in a Restrictive Setting	Form and Instruction	Modified	Available
Form P-2 Authorization for Medical, Dental, and Mental Health Care - UC Path Version	Form and Instruction	Modified	Available
Form P-2 Authorization for Medical, Dental, and Mental Health Care - UC Path Version	Form and Instruction	Modified	Available
Form P-1 Placement Authorization - UC Path Version	Form and Instruction	Unchanged	Repair queued
Form P-1 Placement Authorization - UC Path Version	Form and Instruction	Unchanged	Available
EPPC Comment on HHS ACF ORR Request for Comment on Extended Approval of Forms.pdf	Public Comments	Uploaded 2026-03-19	Repair queued
CWA comment on HHS-ACF-ORR global terminology update 3-18-2026 .pdf	Public Comments	Uploaded 2026-03-18	Repair queued
PC_202602-0970-007_030626_124024_1.pdf	Public Comments	Uploaded 2026-03-06	Repair queued
NonSub Change Request Template-Authorization for Medical, Dental, and Mental Health Care Package.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2026-02-19	Repair queued
NonSub Change Request Template-Authorization for Medical, Dental, and Mental Health Care Package.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2026-02-19	Repair queued
USCCB Comment on ORR changes to UC Forms P-4 and P-7 - FINAL.pdf	Public Comments	Uploaded 2025-12-01	Available
HHS-ACF Placement and Transfer of Unaccompanied Children.pdf	Public Comments	Uploaded 2025-12-01	Available
EPPC Comment on ACF UAC Placement Notice_11.21.25.pdf	Public Comments	Uploaded 2025-11-21	Available
CWA comment on HHS-ACF global terminology update 11-25-2025 .pdf	Public Comments	Uploaded 2025-11-25	Available
2025_12_01_Young Center Restrictive Placement Intake Comment.pdf	Public Comments	Uploaded 2025-12-01	Available
2026.01.20 Comment on Intakes Checklist.pdf	Public Comments	Uploaded 2026-01-20	Available
25 11 19 Final Comment on ORR Forms_National Center for Youth Law _email 11.19.25.pdf	Public Comments	Uploaded 2026-01-20	Available
Emergency SSA Attachment A_0970-0554_Placement and Transfer_2025 09 25.docx	Supplementary Document	Uploaded 2025-09-25	Repair queued
Emergency SSA Attachment A_0970-0554_Placement and Transfer_2025 09 25.docx	Supplementary Document	Uploaded 2025-09-25	Available
Extension SSA Attachment A_0970-0554_Placement & Transfer_011_2026 02 12.docx	Supplementary Document	Uploaded 2026-02-13	Repair queued
Extension SSA Attachment A_0970-0554_Placement & Transfer_011_2026 02 12.docx	Supplementary Document	Uploaded 2026-02-13	Available
Revision_1year ext_SSA_0970-0554_Placement and Transfer_011_2026 02 20 CLEAN.docx	Supporting Statement A	Uploaded 2026-02-20	Repair queued
Revision_1year ext_SSA_0970-0554_Placement and Transfer_011_2026 02 20 CLEAN.docx	Supporting Statement A	Uploaded 2026-02-20	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
261944	Bed Assignment and Capacity Overview Module (Form P-12B)	Form and Instruction	Modified	Bed Assignment Capacity Overview Module
261944	Bed Assignment and Capacity Overview Module (Form P-12B)	Form and Instruction	Modified	Bed Assignment Capacity Overview Module
261944	Bed Assignment and Capacity Overview Module (Form P-12B)	Form and Instruction	Modified
261943	Bed Configuration Module (Form P-12A)	Form and Instruction	Modified	Bed Configuration Module
261943	Bed Configuration Module (Form P-12A)	Form and Instruction	Modified	Bed Configuration Module
261943	Bed Configuration Module (Form P-12A)	Form and Instruction	Modified
261526	Placement Confirmation (Form P-10B) – Contractor Case Coordinator	Form and Instruction	Modified	Placement Confirmation
261526	Placement Confirmation (Form P-10B) – Contractor Case Coordinator	Form and Instruction	Modified	Placement Confirmation
261526	Placement Confirmation (Form P-10B) – Contractor Case Coordinator	Form and Instruction	Modified
256558	Notice of Administrative Review (Form P-18)	Form	Removed	Notice of Administrative Review - Pashto
256558	Notice of Administrative Review (Form P-18)	Form	Removed	Notice of Administrative Review - Pashto
256558	Notice of Administrative Review (Form P-18)	Form	Removed	Notice of Administrative Review - Dari
256558	Notice of Administrative Review (Form P-18)	Form	Removed	Notice of Administrative Review - Dari
256558	Notice of Administrative Review (Form P-18)	Form	Removed	Notice of Administrative Review - Spanish
256558	Notice of Administrative Review (Form P-18)	Form	Removed	Notice of Administrative Review - Spanish
256558	Notice of Administrative Review (Form P-18)	Form	Removed	Notice of Administrative Review
256558	Notice of Administrative Review (Form P-18)	Form	Removed	Notice of Administrative Review
256558	Notice of Administrative Review (Form P-18)	Form	Removed
249643	Influx Transfer Manual and Prescreen Criteria Review (Form P-17)	Form and Instruction	Modified	Influx Transfer Manual and Prescreen Criteria Review
249643	Influx Transfer Manual and Prescreen Criteria Review (Form P-17)	Form and Instruction	Modified	Influx Transfer Manual and Prescreen Criteria Review
249643	Influx Transfer Manual and Prescreen Criteria Review (Form P-17)	Form and Instruction	Modified
249642	Influx Transfer Manifest (Form P-16)	Form and Instruction	Modified	Influx Transfer Manifest
249642	Influx Transfer Manifest (Form P-16)	Form and Instruction	Modified	Influx Transfer Manifest
249642	Influx Transfer Manifest (Form P-16)	Form and Instruction	Modified
249641	Family Group Entity (Form P-15)	Form and Instruction	Unchanged	Family Group Entity
249641	Family Group Entity (Form P-15)	Form and Instruction	Unchanged	Family Group Entity
249641	Family Group Entity (Form P-15)	Form and Instruction	Unchanged
249640	Placement Confirmation (Form P-10B) – Grantee Case Manager	Form and Instruction	Modified	Placement Confirmation
249640	Placement Confirmation (Form P-10B) – Grantee Case Manager	Form and Instruction	Modified	Placement Confirmation
249640	Placement Confirmation (Form P-10B) – Grantee Case Manager	Form and Instruction	Modified
249639	Transfer Request (Form P-10A) – Contractor Case Coordinator	Form and Instruction	Modified	Transfer Request
249639	Transfer Request (Form P-10A) – Contractor Case Coordinator	Form and Instruction	Modified	Transfer Request
249639	Transfer Request (Form P-10A) – Contractor Case Coordinator	Form and Instruction	Modified
242799	ORR Transfer Notification - ORR Notification to ICE Chief Counsel of Transfer of UC and Request to Change Address/Venue (Form P-14)	Form and Instruction	Unchanged	ORR Transfer Notification - UC Path Version
242799	ORR Transfer Notification - ORR Notification to ICE Chief Counsel of Transfer of UC and Request to Change Address/Venue (Form P-14)	Form and Instruction	Unchanged	ORR Transfer Notification - UC Path Version
242799	ORR Transfer Notification - ORR Notification to ICE Chief Counsel of Transfer of UC and Request to Change Address/Venue (Form P-14)	Form and Instruction	Unchanged
242798	Unaccompanied [Alien] Child Profile (Form P-13)	Form and Instruction	Modified	UAC Profile - UAC Path
242798	Unaccompanied [Alien] Child Profile (Form P-13)	Form and Instruction	Modified	UAC Profile - UAC Path
242798	Unaccompanied [Alien] Child Profile (Form P-13)	Form and Instruction	Modified	UAC Profile - UAC Portal
242798	Unaccompanied [Alien] Child Profile (Form P-13)	Form and Instruction	Modified	UAC Profile - UAC Portal
242798	Unaccompanied [Alien] Child Profile (Form P-13)	Form and Instruction	Modified
242797	Program Entity (Form P-12C)	Form and Instruction	Unchanged	UC Portal Capacity Report (Form P-12) - UC Portal
242797	Program Entity (Form P-12C)	Form and Instruction	Unchanged	UC Portal Capacity Report (Form P-12) - UC Portal
242797	Program Entity (Form P-12C)	Form and Instruction	Unchanged	Program Entity
242797	Program Entity (Form P-12C)	Form and Instruction	Unchanged	Program Entity
242797	Program Entity (Form P-12C)	Form and Instruction	Unchanged
242796	Transfer Summary and Tracking (Form P-11)	Form and Instruction	Modified	Transfer Summary and Tracking - UAC Path Version
242796	Transfer Summary and Tracking (Form P-11)	Form and Instruction	Modified	Transfer Summary and Tracking - UAC Path Version
242796	Transfer Summary and Tracking (Form P-11)	Form and Instruction	Modified
242795	Transfer Request (Form P-10A) – Grantee Case Manager	Form and Instruction	Modified	Transfer Request
242795	Transfer Request (Form P-10A) – Grantee Case Manager	Form and Instruction	Modified	Transfer Request
242795	Transfer Request (Form P-10A) – Grantee Case Manager	Form and Instruction	Modified
242794	Medical Checklist for Transfers to Influx Care Facilities (Form P-9B)	Form and Instruction	Unchanged	Medical Checklist for Influx Transfers
242794	Medical Checklist for Transfers to Influx Care Facilities (Form P-9B)	Form and Instruction	Unchanged	Medical Checklist for Influx Transfers
242794	Medical Checklist for Transfers to Influx Care Facilities (Form P-9B)	Form and Instruction	Unchanged
242793	Medical Checklist for Non-Influx Transfers (Form P-9A)	Form and Instruction	Unchanged	Medical Checklist for Transfers
242793	Medical Checklist for Non-Influx Transfers (Form P-9A)	Form and Instruction	Unchanged	Medical Checklist for Transfers
242793	Medical Checklist for Non-Influx Transfers (Form P-9A)	Form and Instruction	Unchanged
242792	Care Provider Checklist for Transfers to Influx Care Facilities (Form P-8)	Form and Instruction	Unchanged	Care Provider Checklist for Transfers to Influx Care Facilities
242792	Care Provider Checklist for Transfers to Influx Care Facilities (Form P-8)	Form and Instruction	Unchanged	Care Provider Checklist for Transfers to Influx Care Facilities
242792	Care Provider Checklist for Transfers to Influx Care Facilities (Form P-8)	Form and Instruction	Unchanged
242791	Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist) (Form P-7)	Form and Instruction	Modified	Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist)
242791	Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist) (Form P-7)	Form and Instruction	Modified	Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist)
242791	Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist) (Form P-7)	Form and Instruction	Modified	UAC Referral - Path Version
242791	Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist) (Form P-7)	Form and Instruction	Modified	UAC Referral - Path Version
242791	Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist) (Form P-7)	Form and Instruction	Modified
242790	Long Term Foster Care Placement Memo (Form P-5)	Form and Instruction	Unchanged	Long Term Foster Care Placement Memo
242790	Long Term Foster Care Placement Memo (Form P-5)	Form and Instruction	Unchanged	Long Term Foster Care Placement Memo
242790	Long Term Foster Care Placement Memo (Form P-5)	Form and Instruction	Unchanged
242789	Notice of Placement in a Restrictive Setting (Form P-4)	Form and Instruction	Modified	Notice of Placement in a Restrictive Setting
242789	Notice of Placement in a Restrictive Setting (Form P-4)	Form and Instruction	Modified	Notice of Placement in a Restrictive Setting
242789	Notice of Placement in a Restrictive Setting (Form P-4)	Form and Instruction	Modified
242788	Authorization for Medical, Dental, and Mental Health Care (Form P-2)	Form and Instruction	Modified	Authorization for Medical, Dental, and Mental Health Care - UC Path Version
242788	Authorization for Medical, Dental, and Mental Health Care (Form P-2)	Form and Instruction	Modified	Authorization for Medical, Dental, and Mental Health Care - UC Path Version
242788	Authorization for Medical, Dental, and Mental Health Care (Form P-2)	Form and Instruction	Modified
242787	Placement Authorization (Form P-1)	Form and Instruction	Unchanged	Placement Authorization - UC Path Version
242787	Placement Authorization (Form P-1)	Form and Instruction	Unchanged	Placement Authorization - UC Path Version
242787	Placement Authorization (Form P-1)	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0970-0554	ICR Reference No: 202602-0970-007
Status: Active	Previous ICR Reference No: 202512-0970-002
Agency/Subagency: HHS/ACF	Agency Tracking No: ORR
Title: Placement and Transfer of Unaccompanied Alien Children into ORR Care Provider Facilities
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/20/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/20/2026
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2027	15 Months From Approved	04/30/2026
Responses	12,003,089	0	12,003,289
Time Burden (Hours)	5,950,799	0	5,950,965
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection was originally approved under emergency approval for six months, as authorized under 5 CFR 1320.13, because it is essential to the mission of the agency; the use of normal clearance procedures was reasonably likely to prevent or disrupt the collection of information; and public harm was reasonably likely to result if normal clearance procedures were followed. 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 license them 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 place unaccompanied alien children referred to ORR by federal agencies into care provider facilities and to transfer children within the ORR care provider network. This request is to continue data collection for all forms under this OMB number, including those approved under emergency approval. Minor revisions are proposed to a subset of the currently approved forms. Supporting Statement A sections A1, A2, A12 and A14 have been updated accordingly, and the proposed changes are described in section A15. ORR requests approval for a period of one year, during which time a more extensive revision request—with proposed revisions for all forms in this collection—will be finalized and submitted under normal Paperwork Reduction Act procedures.

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Authorizing Statute(s): US Code: 6 USC 279 Name of Law: Homeland Security Act (HSA)
   US Code: 8 USC 1232 Name of Law: Trafficking Victims Protection Reauthorization Act of 2008 (TVPRA)
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 46898	09/30/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 7992	02/19/2026
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 21

IC Title	Form No.	Form Name
Authorization for Medical, Dental, and Mental Health Care (Form P-2)	P-2	Authorization for Medical, Dental, and Mental Health Care - UC Path Version
Bed Assignment and Capacity Overview Module (Form P-12B)	P-12B	Bed Assignment Capacity Overview Module
Bed Configuration Module (Form P-12A)	P-12A	Bed Configuration Module
Care Provider Checklist for Transfers to Influx Care Facilities (Form P-8)	P-8	Care Provider Checklist for Transfers to Influx Care Facilities
Family Group Entity (Form P-15)	P-15	Family Group Entity
Influx Transfer Manifest (Form P-16)	P-16	Influx Transfer Manifest
Influx Transfer Manual and Prescreen Criteria Review (Form P-17)	P-17	Influx Transfer Manual and Prescreen Criteria Review
Long Term Foster Care Placement Memo (Form P-5)	P-5	Long Term Foster Care Placement Memo
Medical Checklist for Non-Influx Transfers (Form P-9A)	P-9A	Medical Checklist for Transfers
Medical Checklist for Transfers to Influx Care Facilities (Form P-9B)	P-9B	Medical Checklist for Influx Transfers
Notice of Administrative Review (Form P-18)	P-18, P-18s, P-18d, P-18p	Notice of Administrative Review ,   Notice of Administrative Review - Spanish ,   Notice of Administrative Review - Dari ,   Notice of Administrative Review - Pashto
Notice of Placement in a Restrictive Setting (Form P-4)	Form P-4	Notice of Placement in a Restrictive Setting
ORR Transfer Notification - ORR Notification to ICE Chief Counsel of Transfer of UC and Request to Change Address/Venue (Form P-14)	P-14	ORR Transfer Notification - UC Path Version
Placement Authorization (Form P-1)	P-1	Placement Authorization - UC Path Version
Placement Confirmation (Form P-10B) – Contractor Case Coordinator	P-10B	Placement Confirmation
Placement Confirmation (Form P-10B) – Grantee Case Manager	P-10B	Placement Confirmation
Program Entity (Form P-12C)	P-12C, P-12	Program Entity ,   UC Portal Capacity Report (Form P-12) - UC Portal
Transfer Request (Form P-10A) – Contractor Case Coordinator	P-10A	Transfer Request
Transfer Request (Form P-10A) – Grantee Case Manager	P-10A	Transfer Request
Transfer Summary and Tracking (Form P-11)	P-11	Transfer Summary and Tracking - UAC Path Version
Unaccompanied [Alien] Child Profile (Form P-13)	P-13, P-13	UAC Profile - UAC Portal ,   UAC Profile - UAC Path
Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist) (Form P-7)	P-7, P-7	UAC Referral - Path Version ,   Unaccompanied [Alien] Child Referral (aka Intakes Restrictive Placement Checklist)

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ICR Summary of Burden

	Total Approved	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	12,003,089	12,003,289	0	-200	0	0
Annual Time Burden (Hours)	5,950,799	5,950,965	0	-166	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Revisions were made to forms P-4 and P-7 in response to public comment. Other forms were updated to align with 2025 Executive Order 14168. Form P-18 and related burden was removed from this collection as it was transferred under Legal and Advocacy Services for Unaccompanied Alien Children (OMB# 0970-0565) when the collection was last approved on 05/25/2025.

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Annual Cost to Federal Government: $8,906,838

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

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Common Form ICR:  No

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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: 02/20/2026

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