Information Collection

Mental Health Assessment Form - Reporting Time

IC 229902 under ICR 202609-0970-009 · OMB 0970-0509.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Mental Health Assessment Form_Clean_9.30.26.docx	Other-Form
Dear Colleague Letter - Mental Health Assessment Form_clean_9.30.26.docx MHAF Dear Colleague letter	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Other-Form					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: 250

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
	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,450	-950	3,400
Annual IC Time Burden (Hours)	319	-293	612
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MHAF Dear Colleague letter		10/16/2026

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

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