The ACF Office of Refugee Resettlement
(ORR) places unaccompanied children in their custody in care
provider programs until unification with a qualified sponsor. Care
provider programs are required to ensure children receive
appropriate medical, mental health and dental services. Children
identified as having complex medical/dental conditions may require
a procedure while in ORR custody to maintain and promote their
health and wellbeing. Procedures requiring general anesthesia,
surgeries, and invasive diagnostic procedures (e.g., cardiac
catheterization, invasive biopsy, amniocentesis) require advance
ORR approval. Before ORR can approve, the following data must be
collected and submitted to ORR by the care provider program and the
lead surgeon - diagnoses, procedure name(s), current procedural
terminology (CPT) code(s), clinical indications, potential
risks/complications of procedure, timing for procedure/proposed
date, potential adverse outcomes if the procedure is not performed,
timeframe for recovery, potential follow-up procedures, follow-up
care, and points of contact. In certain circumstances, ORR will
waive the completion of the SMR form if it is deemed to be in the
best interest of the child’s safety and well-being (e.g., during a
hospitalization or emergency department visit, medical
emergencies).
US Code:
6 USC
279 Name of Law: Homeland Security Act
Several changes were made to
the SMR Form including, 1) rewriting the intro section and adding
guidance on completing and submitting the form, 2) adding fields on
consent, procedure name and planned follow-up procedures, 3)
rewording existing fields, and 4) removing unnecessary fields. ORR
has incorporated these changes to the form to streamline the flow
of data collection, clarify intent and purpose of the form and
fields, improve data quality, and ensure alignment with ORR program
policies. The overall estimated time per form has increased by 1
minute and has been adjusted to reflect a decrease by 1 minute for
care provider program staff and an increase by 2 minutes for
surgeons.
$92,749
No
Yes
Yes
No
No
No
No
Molly Buck 202 205-4724
mary.buck@acf.hhs.gov
No
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form 1 Serious Medical Procedure (SMR) Form - Care provider program staff
Attachment A_Flores Agreement.docx
Serious Medical Procedure (SMR) Form - Care provider program staff