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

Forms and Documents

Document Name	Status
Form Form M-7C LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping Form and Instruction	Unchanged
Form Form M-7C LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Respondents Form and Instruction	Unchanged
Form Form M-15 Monitoring Schedule (Form M-15) Form and Instruction	Unchanged
Form Form M-14 Monitoring Visit (Form M-14) Form and Instruction	Unchanged
Form Form M-13E Case Coordinator Questionnaire (Form M-13E) - Recordkeeping Form and Instruction	Unchanged
Form Form M-13E Case Coordinator Questionnaire (Form M-13E) - Respondents Form and Instruction	Unchanged
Form Form M-13D Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping Form and Instruction	Unchanged
Form Form M-13D Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting Form and Instruction	Unchanged
Form Form M-13C Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping Form and Instruction	Unchanged
Form Form M-13C Legal Service Provider Questionnaire (Form M-13C) - Respondents Form and Instruction	Unchanged
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping Form and Instruction	Unchanged
Form Form M-13B Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents Form and Instruction	Unchanged
Form Form M-13A Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping Form and Instruction	Unchanged
Form Form M-13A Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents Form and Instruction	Unchanged
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Recordkeeping Form and Instruction	Unchanged
Form Form M-12D Secure Client Questionnaire (Form M-12D) - Respondents Form and Instruction	Unchanged
Form Form M-12C Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping Form and Instruction	Unchanged
Form Form M-12C Long Term Foster Care Client Questionnaire (M-12C) - Respondents Form and Instruction	Unchanged
Form Form M-12A UAC Questionnaires (Forms M-12A-B, E) - Recordkeeping Form and Instruction	Modified
Form Form M-12A UC Questionnaires (Forms M-12A-B, E) - Respondents Form and Instruction	Modified
Form Form M-11O Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping Form and Instruction	Unchanged
Form Form M-11O Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents Form and Instruction	Unchanged
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping Form and Instruction	Unchanged
Form Form M-11N Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents Form and Instruction	Unchanged
Form Form M-11M Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping Form and Instruction	Unchanged
Form Form M-11M Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents Form and Instruction	Unchanged
Form Form M-11L Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping Form and Instruction	Unchanged
Form Form M-11L Secure Detention Officer Questionnaire (Form M-11L) - Respondents Form and Instruction	Unchanged
Form Form M-11A Program Staff Questionnaires (Form M-11A-K) - Recordkeeping Form and Instruction	Unchanged
Form Form M-11A Program Staff Questionnaires (Form M-11A-K) - Respondents Form and Instruction	Unchanged
Form Form M-10D Long Term Foster Care Foster Parent Checklist (Form M-10D) Form and Instruction	Unchanged
Form Form M-10C Home Study and Post-Release Services Personnel File Checklist (Form M-10C) Form and Instruction	Unchanged
Form Form M-10B Supplement to Personnel File Checklist (Form M-10B) Form and Instruction	Unchanged
Form Form M-10A Personnel File Checklist (Form M-10A) Form and Instruction	Unchanged
Form Form M-9C Post-Release Services Home Observation (Form M-9C) Form and Instruction	Unchanged
Form Form M-9 Foster Home On Site Monitoring Checklist (Form M-9B) Form and Instruction	Unchanged
Form Form M-9A On Site Monitoring Checklist (Form M-9A) Form and Instruction	Unchanged
Form Form M-8D Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Recordkeeping Form and Instruction	Unchanged
Form Form M-8D Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Respondents Form and Instruction	Unchanged
Form Form M-8C Home Study and Post-Release Services Case File Checklist (Form M-8C) - Recordkeeping Form and Instruction	Unchanged
Form Form M-8C Home Study and Post-Release Services Case File Checklist (Form M-8C) - Respondents Form and Instruction	Unchanged
Form Form M-8B Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping Form and Instruction	Unchanged
Form Form M-8B Long Term Foster Care File Checklist (Form M-8B) - Respondents Form and Instruction	Unchanged
Form Form M-8A UAC Case File Checklist (Form M-8A) - Recordkeeping Form and Instruction	Unchanged
Form Form M-8A UAC Case File Checklist (Form M-8A) - Respondents Form and Instruction	Unchanged
Form Form M-7F Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping Form and Instruction	Unchanged
Form Form M-7F Voluntary Agency Site Visit Guide (Form M-7F) - Respondents Form and Instruction	Unchanged
Form Form M-7E HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping Form and Instruction	Unchanged
Form Form M-7E HS/PRS Site Visit Guide (Form M-7E) - Respondents Form and Instruction	Unchanged
Form Form M-7A Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping Form and Instruction	Unchanged
Form Form M-7A Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents Form and Instruction	Unchanged
Form Form M-6C LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D) Form and Instruction	Unchanged
Form Form M-6A Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B) Form and Instruction	Unchanged
Form Form M-5A Incident Reviews (Forms M-5A to M-5B) Form and Instruction	Unchanged
Form Form M-4A Checklist for a Child-Friendly Environment (Form M-4A to M4B) Form and Instruction	Unchanged
Form Form M-3B Out-of-Network Site Visit Report (Form M-3B) Form and Instruction	Unchanged
Form Form M-3A FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping Form and Instruction	Unchanged
Form Form M-3A FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents Form and Instruction	Unchanged
Form M-1 Corrective Action Report (Form M-1) - Recordkeeping Form and Instruction	Unchanged
Form M-1 Corrective Action Report (Form M-1) - Respondents Form and Instruction	Unchanged
0970-0564_Monitoring Compliance NonSub Chng Req_Tender Age 5 under_7.8.21.docx Justification for No Material/Nonsubstantive Change	2021-07-12
Supporting Statement - Monitoring Compliance - Emergency Request.docx Supporting Statement A	2021-02-12

IC Document Collections

IC ID	Document Title	Status
245634	LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping Form and Instruction	Unchanged
245633	LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Respondents Form and Instruction	Unchanged
245632	Monitoring Schedule (Form M-15) Form and Instruction	Unchanged
245631	Monitoring Visit (Form M-14) Form and Instruction	Unchanged
245630	Case Coordinator Questionnaire (Form M-13E) - Recordkeeping Form and Instruction	Unchanged
245629	Case Coordinator Questionnaire (Form M-13E) - Respondents Form and Instruction	Unchanged
245628	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping Form and Instruction	Unchanged
245627	Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting Form and Instruction	Unchanged
245626	Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping Form and Instruction	Unchanged
245625	Legal Service Provider Questionnaire (Form M-13C) - Respondents Form and Instruction	Unchanged
245624	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping Form and Instruction	Unchanged
245623	Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents Form and Instruction	Unchanged
245622	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping Form and Instruction	Unchanged
245621	Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents Form and Instruction	Unchanged
245619	Secure Client Questionnaire (Form M-12D) - Recordkeeping Form and Instruction	Unchanged
245618	Secure Client Questionnaire (Form M-12D) - Respondents Form and Instruction	Unchanged
245617	Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping Form and Instruction	Unchanged
245616	Long Term Foster Care Client Questionnaire (M-12C) - Respondents Form and Instruction	Unchanged
245615	UAC Questionnaires (Forms M-12A-B, E) - Recordkeeping Form and Instruction	Modified
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents Form and Instruction	Modified
245613	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping Form and Instruction	Unchanged
245612	Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents Form and Instruction	Unchanged
245611	Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping Form and Instruction	Unchanged
245610	Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents Form and Instruction	Unchanged
245609	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping Form and Instruction	Unchanged
245608	Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents Form and Instruction	Unchanged
245607	Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping Form and Instruction	Unchanged
245606	Secure Detention Officer Questionnaire (Form M-11L) - Respondents Form and Instruction	Unchanged
245605	Program Staff Questionnaires (Form M-11A-K) - Recordkeeping Form and Instruction	Unchanged
245604	Program Staff Questionnaires (Form M-11A-K) - Respondents Form and Instruction	Unchanged
245603	Long Term Foster Care Foster Parent Checklist (Form M-10D) Form and Instruction	Unchanged
245602	Home Study and Post-Release Services Personnel File Checklist (Form M-10C) Form and Instruction	Unchanged
245601	Supplement to Personnel File Checklist (Form M-10B) Form and Instruction	Unchanged
245600	Personnel File Checklist (Form M-10A) Form and Instruction	Unchanged
245599	Post-Release Services Home Observation (Form M-9C) Form and Instruction	Unchanged
245598	Foster Home On Site Monitoring Checklist (Form M-9B) Form and Instruction	Unchanged
245597	On Site Monitoring Checklist (Form M-9A) Form and Instruction	Unchanged
245596	Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Recordkeeping Form and Instruction	Unchanged
245595	Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Respondents Form and Instruction	Unchanged
245594	Home Study and Post-Release Services Case File Checklist (Form M-8C) - Recordkeeping Form and Instruction	Unchanged
245593	Home Study and Post-Release Services Case File Checklist (Form M-8C) - Respondents Form and Instruction	Unchanged
245592	Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping Form and Instruction	Unchanged
245591	Long Term Foster Care File Checklist (Form M-8B) - Respondents Form and Instruction	Unchanged
245590	UAC Case File Checklist (Form M-8A) - Recordkeeping Form and Instruction	Unchanged
245589	UAC Case File Checklist (Form M-8A) - Respondents Form and Instruction	Unchanged
245588	Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping Form and Instruction	Unchanged
245587	Voluntary Agency Site Visit Guide (Form M-7F) - Respondents Form and Instruction	Unchanged
245586	HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping Form and Instruction	Unchanged
245585	HS/PRS Site Visit Guide (Form M-7E) - Respondents Form and Instruction	Unchanged
245584	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping Form and Instruction	Unchanged
245583	Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents Form and Instruction	Unchanged
245582	LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D) Form and Instruction	Unchanged
245581	Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B) Form and Instruction	Unchanged
245580	Incident Reviews (Forms M-5A to M-5B) Form and Instruction	Unchanged
245579	Checklist for a Child-Friendly Environment (Form M-4A to M4B) Form and Instruction	Unchanged
245577	Out-of-Network Site Visit Report (Form M-3B) Form and Instruction	Unchanged
245576	FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping Form and Instruction	Unchanged
245575	FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents Form and Instruction	Unchanged
245574	Corrective Action Report (Form M-1) - Recordkeeping Form and Instruction	Unchanged
245572	Corrective Action Report (Form M-1) - Respondents Form and Instruction	Unchanged

ICR Details

OMB Control No: 0970-0564	ICR Reference No: 202107-0970-004
Status: Active	Previous ICR Reference No: 202102-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No: ORR
Title: Monitoring and Compliance for Office of Refugee Resettlement (ORR) Care Provider Facilities
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 02/16/2021
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/12/2021
	Date Received in OIRA: 07/12/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	08/31/2021	08/31/2021
Responses	9,364	0	9,364
Time Burden (Hours)	13,364	0	13,364
Cost Burden (Dollars)	0	0	0

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Abstract: The Monitoring and Compliance for Office of Refugee Resettlement (ORR) Care Provider Facilities information collection consists of several forms that allow the Unaccompanied Children (UC) Program to monitor its care provider facilities for compliance with Federal and State laws and regulations, licensing and accreditation standards, ORR policies and procedures, and child welfare standards. Currently, there are two versions of a questionnaire for UCs ages 6-12 and ages 13 and older (UC Questionnaires, Forms M-12A and M-12B, respectively). ORR is proposing to include an alternate version of the UC questionnaire for UCs aged 5 and under. The alternate form (Form M-12E) is designed to gather information on the same topics as the current forms, but the version for 6-12-year-old UCs has been modified to be more child-friendly for children 5 and under.

Emergency Justfication: Consistent with the Paperwork Reduction Act of 1995, and OMB procedures, the Department requests approval for emergency processing for Monitoring and Compliance forms for the Unaccompanied Children program. On January 21, 2021, the Department published a Notice of Request for Public Comment for the forms, initiating a 60-day period for the public to submit comments on the information collection. The 60-day comment period ends on March 22, 2021. The monitoring and compliance forms are necessary for the program to meet its statutory obligations (Homeland Security Act, 6 U.S.C. 279). The Department requests emergency OMB approval pursuant to 5 CFR 1320.13 in order for the monitoring and compliance forms to be used by ORR field offices while public comment is being sought. The Department plans to complete the ongoing PRA process for the three-year approval of the monitoring and compliance forms since approval based on emergency processing under the PRA is only granted for a maximum of 180 days, until August 2021.

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Authorizing Statute(s): US Code: 8 USC 1232 Name of Law: Trafficking Victim Protection Reauthorization Act of 2008
   US Code: 6 USC 279 Name of Law: Homeland Security Act of 2002
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 6340	01/21/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 60

IC Title	Form No.	Form Name
Case Coordinator Questionnaire (Form M-13E) - Recordkeeping	Form M-13E	Case Coordinator Questionnaire
Case Coordinator Questionnaire (Form M-13E) - Respondents	Form M-13E	Case Coordinator Questionnaire
Checklist for a Child-Friendly Environment (Form M-4A to M4B)	Form M-4A, Form M-4B	Checklist for a Child-Friendly Environment - Care Provider Facility ,   Checklist for a Child-Friendly Environment - Individual Foster Home
Corrective Action Report (Form M-1) - Recordkeeping	M-1	Corrective Action Report (Form M-1)
Corrective Action Report (Form M-1) - Respondents	M-1	Corrective Action Report (Form M-1)
FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping	Form M-3A	FFS Compliance and Safety Site Visit Report
FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents	Form M-3A	FFS Compliance and Safety Site Visit Report
Foster Home On Site Monitoring Checklist (Form M-9B)	Form M-9	Foster Home On Site Monitoring Checklist
HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping	Form M-7E	HS PRS Site Visit Guide
HS/PRS Site Visit Guide (Form M-7E) - Respondents	Form M-7E	HS PRS Site Visit Guide
Home Study and Post-Release Services Case File Checklist (Form M-8C) - Recordkeeping	Form M-8C	Home Study and Post-Release Services Case File Checklist
Home Study and Post-Release Services Case File Checklist (Form M-8C) - Respondents	Form M-8C	Home Study and Post-Release Services Case File Checklist
Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping	Form M-13B	Home Study and Post-Release Services Caseworker Questionnaire
Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents	Form M-13B	Home Study and Post-Release Services Caseworker Questionnaire
Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping	Form M-13A	48 - HS PRS Program Director Questionnaire
Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents	Form M-13A	HS PRS Program Director Questionnaire
Home Study and Post-Release Services Personnel File Checklist (Form M-10C)	Form M-10C	Home Study and Post-Release Services Personnel File Checklist
Incident Reviews (Forms M-5A to M-5B)	Form M-5A, Form M-5B	UAC Incident Review ,   Adult Incident Review
LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D)	Form M-6C, Form M-6D	LTFC Monitoring Notes ,   LTFC Remote Monitoring Notes
LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping	Form M-7C, Form M-7D	LTFC Site Visit Guide ,   LTFC Remote Site Visit Guide
LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Respondents	Form M-7C, Form M-7D	LTFC Site Visit Guide ,   LTFC Remote Site Visit Guide
Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping	Form M-13C	Legal Service Provider Questionnaire
Legal Service Provider Questionnaire (Form M-13C) - Respondents	Form M-13C	Legal Service Provider Questionnaire
Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping	Form M-12C	LTFC Client Questionnaire
Long Term Foster Care Client Questionnaire (M-12C) - Respondents	Form M-12C	LTFC Client Questionnaire
Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping	Form M-8B	Long Term Foster Care File Checklist
Long Term Foster Care File Checklist (Form M-8B) - Respondents	Form M-8B	Long Term Foster Care File Checklist
Long Term Foster Care Foster Parent Checklist (Form M-10D)	Form M-10D	Long Term Foster Care Foster Parent Checklist
Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping	Form M-11O	LTFC Foster Parent Questionnaire
Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents	Form M-11O	LTFC Foster Parent Questionnaire
Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping	Form M-11M	Long Term Foster Care Home Finder Questionnaire
Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents	Form M-11M	Long Term Foster Care Home Finder Questionnaire
Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping	Form M-11N	Long Term Foster Care Independent Living Life Skills Staff Questionnaire
Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents	Form M-11N	Long Term Foster Care Independent Living Life Skills Staff Questionnaire
Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping	Form M-13D	LTFC Legal Service Provider Questionnaire
Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting	Form M-13D	LTFC Legal Service Provider Questionnaire
Monitoring Schedule (Form M-15)	Form M-15	Monitoring Schedule
Monitoring Visit (Form M-14)	Form M-14	Monitoring Visit
Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B)	Form M-6A, Form M-6B	Monitoring Notes ,   Remote Monitoring Notes
On Site Monitoring Checklist (Form M-9A)	Form M-9A	On Site Monitoring Checklist
Out-of-Network Site Visit Report (Form M-3B)	Form M-3B	Out-of-Network Site Visit Report
Personnel File Checklist (Form M-10A)	Form M-10A	Personnel File Checklist
Post-Release Services Home Observation (Form M-9C)	Form M-9C	Post-Release Services Home Observation
Program Staff Questionnaires (Form M-11A-K) - Recordkeeping	Form M-11G, Form M-11D, Form M-11A, Form M-11B, Form M-11C, Form M-11E, Form M-11F, Form M-11H, Form M-11I, Form M-11J, Form M-11K	Program Director Questionnaire ,   LTFC Program Director Questionnaire ,   Clinician Questionnaire ,   LTFC Clinician Questionnaire ,   Case Manager Questionnaire ,   LTFC Case Manager Questionnaire ,   Education Staff Questionnaire ,   LTFC Educational Staff Questionnaire ,   Medical Coordinator Questionnaire ,   Youth Care Worker Questionnaire ,   PSA Compliance Manager Questionnaire
Program Staff Questionnaires (Form M-11A-K) - Respondents	Form M-11G, Form M-11A, Form M-11B, Form M-11C, Form M-11D, Form M-11E, Form M-11F, Form M-11H, Form M-11I, Form M-11J, Form M-11K	Program Director Questionnaire ,   LTFC Program Director Questionnaire ,   Clinician Questionnaire ,   LTFC Clinician Questionnaire ,   Case Manager Questionnaire ,   LTFC Case Manager Questionnaire ,   Education Staff Questionnaire ,   LTFC Educational Staff Questionnaire ,   Medical Coordinator Questionnaire ,   Youth Care Worker Questionnaire ,   PSA Compliance Manager Questionnaire
Secure Client Questionnaire (Form M-12D) - Recordkeeping	Form M-12D	Secure Client Questionnaire
Secure Client Questionnaire (Form M-12D) - Respondents	Form M-12D	Secure Client Questionnaire
Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping	Form M-11L	Secure Detention Officer Questionnaire
Secure Detention Officer Questionnaire (Form M-11L) - Respondents	Form M-11L	Secure Detention Officer Questionnaire
Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Recordkeeping	Form M-8D	Secure and Staff Secure Addendum to Case File Checklist
Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Respondents	Form M-8D	Secure and Staff Secure Addendum to Case File Checklist
Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping	Form M-7A, Form M-7B	Site Visit Guide ,   Remote Monitoring Site Visit Guide
Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents	Form M-7A, Form M-7B	Site Visit Guide ,   Remote Monitoring Site Visit Guide
Supplement to Personnel File Checklist (Form M-10B)	Form M-10B	Supplement to Personnel File Checklist
UAC Case File Checklist (Form M-8A) - Recordkeeping	Form M-8A	UAC Case File Checklist
UAC Case File Checklist (Form M-8A) - Respondents	Form M-8A	UAC Case File Checklist
UAC Questionnaires (Forms M-12A-B, E) - Recordkeeping	Form M-12E, Form M-12A, Form M-12B	UAC Questionnaire - Ages 6-12 Years Old ,   UAC Questionnaire - Ages 13 and Older ,   UC Questionnaire - Ages 5 and Under
UC Questionnaires (Forms M-12A-B, E) - Respondents	Form M-12A, Form M-12B, Form M-12E	UAC Questionnaire - Ages 6-12 Years Old ,   UAC Questionnaire - Ages 13 and Older ,   UC Questionnaire - Ages 5 and Under
Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping	Form M-7F	Voluntary Agency Site Visit Guide
Voluntary Agency Site Visit Guide (Form M-7F) - Respondents	Form M-7F	Voluntary Agency Site Visit Guide

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	9,364	9,364	0	0	0	0
Annual Time Burden (Hours)	13,364	13,364	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $498,366

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/12/2021

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