OMB 0970-0564 [valid through MM/DD/2024]
(Revised: 4/29/2020)
Program name: |
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Level of Care: |
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Stakeholder’s Name: |
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Date/Time of Interview: |
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Type of Interview (phone and/or face-to-face): |
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Interview Completed by: |
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Note: Before beginning the interview and/or providing this questionnaire to stakeholders, provide a brief introduction, including monitor role and purpose of monitoring visit, overview/purpose of interview, and clarify any questions. See Introduction Prompt for Stakeholders for additional guidance as needed.
Describe your history working with ORR care providers and/or UACs? How long have you been working with this program?
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Tell me about how your case staffing works?
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Do you find that case management and clinical staff are aware of and prepared to discuss case happenings?
Do you find that case management and clinical staff have a collaborative means of addressing the issues during case staffing?
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Describe how cases of concerns are elevated to the FFS’s attention.
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Are you provided with all the information you need to be able to make a timely release recommendation?
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In your opinion, how is the program doing in ensuring safe and timely releases?
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Do you have any issues/concerns to share with us?
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Do you have any suggestions for improving the program or the case staffing process?
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Enter Additional Notes.
THE
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF
PUBLIC BURDEN: The purpose of this information collection is to
allow ORR Monitoring Team staff to interview and document responses
from legal service providers during biennial site visits. Public
reporting burden for this collection of information is estimated to
average 1.0 hour per response (plus an additional 1.0 hour if the
site visit is performed by a contractor monitor), including the
time for reviewing instructions, gathering and maintaining the data
needed, and reviewing the collection of information. This is a
mandatory collection of information (Homeland Security Act, 6
U.S.C. 279). An agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information subject to
the requirements of the Paperwork Reduction Act of 1995, unless it
displays a currently valid OMB control number. If you have any
comments on this collection of information please contact
UCPolicy@acf.hhs.gov.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Administrator |
File Modified | 0000-00-00 |
File Created | 2023-12-17 |