Program Staff Questionnaires (Form M-11A-K) - Recordkeeping

Monitoring and Compliance for Office of Refugee Resettlement (ORR) Care Provider Facilities

OMB: 0970-0564

IC ID: 245605

Documents and Forms
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Information Collection (IC) Details

View Information Collection (IC)

Program Staff Questionnaires (Form M-11A-K) - Recordkeeping
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form M-11A Program Director Questionnaire 29 - Program Director Questionnaire (Form M-11A).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11B LTFC Program Director Questionnaire 30 - LTFC Program Director Questionnaire (Form M-11B).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11C Clinician Questionnaire 31 - Clinician Questionnaire (Form M-11C).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11D LTFC Clinician Questionnaire 32 - LTFC Clinician Questionnaire (Form M-11D).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11E Case Manager Questionnaire 33 - Case Manager Questionnaire (Form M-11E).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11F LTFC Case Manager Questionnaire 34 - LTFC Case Manager Questionnaire (Form M-11F).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11G Education Staff Questionnaire 35 - Education Staff Questionnaire (Form M-11G).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11H LTFC Educational Staff Questionnaire 36 - LTFC Educational Staff Questionnaire (Form M-11H).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11I Medical Coordinator Questionnaire 37 - Medical Coordinator Questionnaire (Form M-11I).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11J Youth Care Worker Questionnaire 38 - Youth Care Worker Questionnaire (Form M-11J).docx Yes Yes Fillable Fileable
Form and Instruction Form M-11K PSA Compliance Manager Questionnaire 39 - PSA Compliance Manager Questionnaire (Form M-11K).docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

4 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 216 0 216 0 0 0
Annual IC Time Burden (Hours) 216 0 216 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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