Checklist for a Child-Friendly Environment (Form M-4a to M-4B)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0564 can be found here:

Documents and Forms

Document Name Document Type
Form Form M-4A Checklist for a Child-Friendly Environment (Form M-4a to M-4B) Form and Instruction
Form M-4A Checklist for a Child-Friendly Environment - Care Provid Checklist for a Child-Friendly Environment - Care Provider Facility (Form M-4A).pdf Form and Instruction
Form M-4A Checklist for a Child-Friendly Environment - Care Provid Checklist for a Child-Friendly Environment - Care Provider Facility (Form M-4A).pdf Form and Instruction
Form M-4B Checklist for a Child-Friendly Environment - Individual Checklist for a Child-Friendly Environment - Individual Foster Home (Form M-4B).pdf Form and Instruction
Form M-4B Checklist for a Child-Friendly Environment - Individual Checklist for a Child-Friendly Environment - Individual Foster Home (Form M-4B).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Checklist for a Child-Friendly Environment (Form M-4a to M-4B)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form M-4A	Checklist for a Child-Friendly Environment - Care Provider Facility	Checklist for a Child-Friendly Environment - Care Provider Facility (Form M-4A).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	Form M-4B	Checklist for a Child-Friendly Environment - Individual Foster Home	Checklist for a Child-Friendly Environment - Individual Foster Home (Form M-4B).pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: ORR Unaccompanied Refugee Minors Records	FR Citation: 81 FR 46682

Number of Respondents: 262	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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,144	552	2,592
Annual IC Time Burden (Hours)	786	138	648
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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