OMB Control No:
ICR Reference No:
202102-0970-001
Status: Received in OIRA
Previous ICR Reference No:
Agency/Subagency: HHS/ACF
Agency Tracking No: ORR
Title: Monitoring and Compliance for
Office of Refugee Resettlement (ORR) Care Provider Facilities
Type of Information Collection: New
collection (Request for a new OMB Control Number)
Common Form ICR: No
Type of Review Request:
Emergency
Approval Requested By:
02/16/2021
Date Submitted to OIRA:
02/12/2021
Requested
Previously Approved
Expiration Date
6 Months From Approved
Responses
9,364
0
Time Burden (Hours)
13,364
0
Cost Burden (Dollars)
0
0
Abstract: These instruments allow ORR to monitor
its care provider facilities for compliance with Federal and State
laws and regulations, licensing and accreditation standards, ORR
policies and procedures, and child welfare standards.
Emergency Justfication: Consistent with the
Paperwork Reduction Act of 1995, and OMB procedures, the Department
requests approval for emergency processing for Monitoring and
Compliance forms for the Unaccompanied Children program. On January
21, 2021, the Department published a Notice of Request for Public
Comment for the forms, initiating a 60-day period for the public to
submit comments on the information collection. The 60-day comment
period ends on March 22, 2021. The monitoring and compliance forms
are necessary for the program to meet its statutory obligations
(Homeland Security Act, 6 U.S.C. 279). The Department requests
emergency OMB approval pursuant to 5 CFR 1320.13 in order for the
monitoring and compliance forms to be used by ORR field offices
while public comment is being sought. The Department plans to
complete the ongoing PRA process for the three-year approval of the
monitoring and compliance forms since approval based on emergency
processing under the PRA is only granted for a maximum of 180 days,
until August 2021.
Authorizing Statute(s): US Code:
8 USC
1232 Name of Law: Trafficking Victim Protection Reauthorization
Act of 2008
US Code: 6 USC
279 Name of Law: Homeland Security Act of 2002
Citations for New Statutory
Requirements: None
Associated Rulemaking
Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices &
Comments
60-day Notice:
Federal Register Citation:
Citation Date:
86 FR
6340
01/21/2021
Did the Agency receive public comments on
this ICR? No
Number of Information Collection (IC) in this
ICR: 60
IC Title
Form No.
Form Name
Corrective Action
Report (Form M-1) - Respondents
M-1
Corrective Action
Report (Form M-1)
Corrective Action
Report (Form M-1) - Recordkeeping
M-1
Corrective Action
Report (Form M-1)
FFS Compliance and
Safety Site Visit Report (Form M-3A) - Respondents
Form M-3A
FFS Compliance and
Safety Site Visit Report
FFS Compliance and
Safety Site Visit Report (Form M-3A) - Recordkeeping
Form M-3A
FFS Compliance and
Safety Site Visit Report
Out-of-Network Site
Visit Report (Form M-3B)
Form M-3B
Out-of-Network
Site Visit Report
Checklist for a
Child-Friendly Environment (Form M-4A to M4B)
Form M-4A, Form M-4B
Checklist for a
Child-Friendly Environment - Care Provider Facility ,
Checklist for a
Child-Friendly Environment - Individual Foster Home
Incident Reviews
(Forms M-5A to M-5B)
Form M-5A, Form M-5B
UAC Incident
Review , Adult Incident Review
Monitoring and Remote
Monitoring Notes (Forms M-6A to M-6B)
Form M-6A, Form M-6B
Monitoring
Notes , Remote Monitoring
Notes
LTFC Monitoring and
LTFC Remote Monitoring Notes (Forms M-6C to M-6D)
Form M-6C, Form M-6D
LTFC Monitoring
Notes , LTFC Remote Monitoring
Notes
Site Visit and Remote
Monitoring Site Visit Guides (Forms M-7A to M-7B) -
Recordkeeping
Form M-7A, Form M-7B
Site Visit
Guide , Remote Monitoring Site Visit
Guide
Site Visit and Remote
Monitoring Site Visit Guides (Forms M-7A to M-7B) -
Respondents
Form M-7A, Form M-7B
Site Visit
Guide , Remote Monitoring Site Visit
Guide
HS/PRS Site Visit
Guide (Form M-7E) - Respondents
Form M-7E
HS PRS Site Visit
Guide
HS/PRS Site Visit
Guide (Form M-7E) - Recordkeeping
Form M-7E
HS PRS Site Visit
Guide
Voluntary Agency Site
Visit Guide (Form M-7F) - Respondents
Form M-7F
Voluntary Agency
Site Visit Guide
Voluntary Agency Site
Visit Guide (Form M-7F) - Recordkeeping
Form M-7F
Voluntary Agency
Site Visit Guide
UAC Case File
Checklist (Form M-8A) - Respondents
Form M-8A
UAC Case File
Checklist
UAC Case File
Checklist (Form M-8A) - Recordkeeping
Form M-8A
UAC Case File
Checklist
Long Term Foster Care
File Checklist (Form M-8B) - Respondents
Form M-8B
Long Term Foster
Care File Checklist
Long Term Foster Care
File Checklist (Form M-8B) - Recordkeeping
Form M-8B
Long Term Foster
Care File Checklist
Home Study and
Post-Release Services Case File Checklist (Form M-8C) -
Respondents
Form M-8C
Home Study and
Post-Release Services Case File Checklist
Home Study and
Post-Release Services Case File Checklist (Form M-8C) -
Recordkeeping
Form M-8C
Home Study and
Post-Release Services Case File Checklist
Secure and Staff
Secure Addendum to Case File Checklist (Form M-8D) -
Recordkeeping
Form M-8D
Secure and Staff
Secure Addendum to Case File Checklist
On Site Monitoring
Checklist (Form M-9A)
Form M-9A
On Site Monitoring
Checklist
Personnel File
Checklist (Form M-10A)
Form M-10A
Personnel File
Checklist
Supplement to
Personnel File Checklist (Form M-10B)
Form M-10B
Supplement to
Personnel File Checklist
Home Study and
Post-Release Services Personnel File Checklist (Form
M-10C)
Form M-10C
Home Study and
Post-Release Services Personnel File Checklist
Long Term Foster Care
Foster Parent Checklist (Form M-10D)
Form M-10D
Long Term Foster
Care Foster Parent Checklist
Program Staff
Questionnaires (Form M-11A-K) - Respondents
Form M-11D, Form M-11E, Form M-11F, Form M-11H, Form M-11A,
Form M-11B, Form M-11C, Form M-11I, Form M-11J, Form M-11K, Form
M-11G
LTFC Clinician
Questionnaire , Case Manager Questionnaire
, LTFC Case
Manager Questionnaire , LTFC Educational Staff
Questionnaire , Program Director
Questionnaire , LTFC Program Director
Questionnaire , Clinician Questionnaire ,
Medical
Coordinator Questionnaire , Youth Care Worker
Questionnaire , PSA Compliance Manager
Questionnaire , Education Staff
Questionnaire
Program Staff
Questionnaires (Form M-11A-K) - Recordkeeping
Form M-11G, Form M-11A, Form M-11B, Form M-11C, Form M-11D,
Form M-11E, Form M-11F, Form M-11H, Form M-11I, Form M-11J, Form
M-11K
Education Staff
Questionnaire , Program Director
Questionnaire , LTFC Program Director
Questionnaire , Clinician Questionnaire ,
LTFC Clinician
Questionnaire , Case Manager Questionnaire
, LTFC Case
Manager Questionnaire , LTFC Educational Staff
Questionnaire , Medical Coordinator
Questionnaire , Youth Care Worker
Questionnaire , PSA Compliance Manager
Questionnaire
Secure Detention
Officer Questionnaire (Form M-11L) - Respondents
Form M-11L
Secure Detention
Officer Questionnaire
Secure Detention
Officer Questionnaire (Form M-11L) - Recordkeeping
Form M-11L
Secure Detention
Officer Questionnaire
Long Term Foster Care
Home Finder Questionnaire (Form M-11M) - Respondents
Form M-11M
Long Term Foster
Care Home Finder Questionnaire
Long Term Foster Care
Home Finder Questionnaire (Form M-11M) - Recordkeeping
Form M-11M
Long Term Foster
Care Home Finder Questionnaire
Long Term Foster Care
Independent Living Life Skills Staff Questionnaire (Form M-11N) -
Respondents
Form M-11N
Long Term Foster
Care Independent Living Life Skills Staff Questionnaire
Long Term Foster Care
Independent Living Life Skills Staff Questionnaire (Form M-11N) -
Recordkeeping
Form M-11N
Long Term Foster
Care Independent Living Life Skills Staff Questionnaire
Long Term Foster Care
Foster Parent Questionnaire (form M-11O) - Respondents
Form M-11O
LTFC Foster Parent
Questionnaire
UAC Questionnaires
(Forms M-12A-B) - Respondents
Form M-12A, Form M-12B
UAC Questionnaire
- Ages 6-12 Years Old , UAC Questionnaire - Ages 13
and Older
UAC Questionnaires
(Forms M-12A-B) - Recordkeeping
Form M-12A, Form M-12B
UAC Questionnaire
- Ages 6-12 Years Old , UAC Questionnaire - Ages 13
and Older
Long Term Foster Care
Client Questionnaire (M-12C) - Respondents
Form M-12C
LTFC Client
Questionnaire
Long Term Foster Care
Client Questionnaire (M-12C) - Recordkeeping
Form M-12C
LTFC Client
Questionnaire
Secure Client
Questionnaire (Form M-12D) - Respondents
Form M-12D
Secure Client
Questionnaire
Secure Client
Questionnaire (Form M-12D) - Recordkeeping
Form M-12D
Secure Client
Questionnaire
Home Study and
Post-Release Services Director Questionnaire (Form M-13A) -
Respondents
Form M-13A
HS PRS Program
Director Questionnaire
Home Study and
Post-Release Services Director Questionnaire (Form M-13A) -
Recordkeeping
Form M-13A
48 - HS PRS
Program Director Questionnaire
Home Study and
Post-Release Services Caseworker Questionnaire (Form M-13B) -
Respondents
Form M-13B
Home Study and
Post-Release Services Caseworker Questionnaire
Home Study and
Post-Release Services Caseworker Questionnaire (Form M-13B) -
Recordkeeping
Form M-13B
Home Study and
Post-Release Services Caseworker Questionnaire
Legal Service Provider
Questionnaire (Form M-13C) - Respondents
Form M-13C
Legal Service
Provider Questionnaire
Legal Service Provider
Questionnaire (Form M-13C) - Recordkeeping
Form M-13C
Legal Service
Provider Questionnaire
Long Term Foster Care
Legal Service Provider Questionnaire (Form M-13D) -
Reporting
Form M-13D
LTFC Legal Service
Provider Questionnaire
Long Term Foster Care
Legal Service Provider Questionnaire (Form M-13D) -
Recordkeeping
Form M-13D
LTFC Legal Service
Provider Questionnaire
Case Coordinator
Questionnaire (Form M-13E) - Respondents
Form M-13E
Case Coordinator
Questionnaire
Monitoring Visit (Form
M-14)
Form M-14
Monitoring
Visit
Monitoring Schedule
(Form M-15)
Form M-15
Monitoring
Schedule
LTFC Site Visit and
LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) -
Respondents
Form M-7C, Form M-7D
LTFC Site Visit
Guide , LTFC Remote Site Visit
Guide
LTFC Site Visit and
LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) -
Recordkeeping
Form M-7C, Form M-7D
LTFC Site Visit
Guide , LTFC Remote Site Visit
Guide
Secure and Staff
Secure Addendum to Case File Checklist (Form M-8D) -
Respondents
Form M-8D
Secure and Staff
Secure Addendum to Case File Checklist
Foster Home On Site
Monitoring Checklist (Form M-9B)
Form M-9
Foster Home On
Site Monitoring Checklist
Post-Release Services
Home Observation (Form M-9C)
Form M-9C
Post-Release
Services Home Observation
Long Term Foster Care
Foster Parent Questionnaire (form M-11O) - Recordkeeping
Form M-11O
LTFC Foster Parent
Questionnaire
Case Coordinator
Questionnaire (Form M-13E) - Recordkeeping
Form M-13E
Case Coordinator
Questionnaire
ICR Summary of Burden
Total Request
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
9,364
0
0
9,364
0
0
Annual Time Burden (Hours)
13,364
0
0
13,364
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency
Discretion: Yes
Burden Increase Due to: Miscellaneous
Actions
Burden decreases because of Program Change due to Agency
Discretion: No
Burden Reduction Due to:
Short Statement: This is a new information
collection request.
Annual Cost to Federal Government: $498,366
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.
Yes
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
Agency Contact: Molly Buck 202 205-4724
mary.buck@acf.hhs.gov