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Office of Refugee Resettlement Waiver Request Form
Generic for ACF Program Monitoring Activities
OMB: 0970-0558
IC ID: 248146
OMB.report
HHS/ACF
OMB 0970-0558
ICR 202306-0970-012
IC 248146
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0558 can be found here:
2023-10-10 - Revision of a currently approved collection
2023-07-31 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Waiver Request Form__06252021.docx
Other-Request Form
Waiver Request Form__06252021.docx
Other-Request Form
Monitoring Generic_0970-0558 - ORR Waiver Request FINAL 06.30.21.docx
GenIC Generic Monitoring Activities Submission Form - ORR Waiver Request Form
IC Document
Monitoring Generic_0970-0558 - ORR Waiver Request FINAL 06.30.21.docx
GenIC Generic Monitoring Activities Submission Form - ORR Waiver Request Form
IC Document
ORR Waiver Request Procedures__06252021.docx
ORR Waiver Request Procedures
IC Document
ORR Waiver Request Procedures__06252021.docx
ORR Waiver Request Procedures
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Office of Refugee Resettlement Waiver Request Form
Agency IC Tracking Number:
ORR
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Request Form
Waiver Request Form__06252021.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
235
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:
0 %
Requested
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
470
0
0
0
0
470
Annual IC Time Burden (Hours)
141
0
0
0
0
141
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
GenIC Generic Monitoring Activities Submission Form - ORR Waiver Request Form
Monitoring Generic_0970-0558 - ORR Waiver Request FINAL 06.30.21.docx
07/01/2021
ORR Waiver Request Procedures
ORR Waiver Request Procedures__06252021.docx
07/01/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.