Form M-10C Form M-10C Home Study and Post-Release Services Personnel File Chec

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Overview

Employee 1
Employee 2
Employee 3

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Sheet 1: Employee 1

Updated: 04/28/2020				OMB 0970-0564 [valid through MM/DD/2024]
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 ensure that programs are meeting ORR policies and procedures related to the maintenance of personnel files during biennial site visits. Public reporting burden for this collection of information is estimated to average 1.0 hour per response (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.
Personnel File Checklist
Facility
Name
Date of Hire
Reviewer
Date of Review
Current Position (Past Positions?)
	Entered	Date	Notes
Meet minimum educational and work experience requirements? (FOA, Published 5/26/16)
I-9 Employment Eligibility Documents (I-9 form and copies of required I.D documents) (FOA, Published 5/26/16)
Child Abuse Mandated Reporter Agreement (FOA, Published 5/26/16)
Background Investigation Documentation			The following requirements reference ORR Guide 4.3, based upon the HS/PRS FOA 2016 **STILL PENDING GUIDANCE from PSA
CPS Background Investigation (child abuse and neglect record check, staff's State of US residence for the last 5 years, every 5 years) (Documentation of the review and conclusion. Completed prior to employment start date) (FOA, Published 5/26/16)
FBI fingerprint check of national and state criminal history repositories (Every 5 years) (Documentation of the review and conclusion. Completed prior to employment start date) (FOA, Published 5/26/16)
Background Investigation updates at a minimum of every 5 years of the staff/contractor/volunteer's start date or last background investigation update. (Documentation of the review and conclusion) (FOA, Published 5/26/16)
Efforts to ask applicants about previous misconduct and employee's response (Policy, Effective: 02/22/15) (FOA, Published 5/26/16)
Efforts to contact past employers where applicant had access to children and youth (Policy, Effective: 02/22/15) (FOA, Published 5/26/16)
Annual Performance Review (annual, signed, with employee's written comments, must incl. questions about any prior misconduct since last background investigation; (Policy, Effective: 02/22/15)) (FOA, Published 5/26/16)
Code of Conduct (signed by applicant (staff hired since Feb. 2019), acknowledging receipt; (Policy, Effective: 01/14/19) (FOA, Published 5/26/16)
Prevent and Report Sexual Abuse and Harassment (signed by applicant (staff hired since Feb. 2019), acknowledging receipt; Policy, Effective: 01/14/19) (FOA, Published 5/26/16)
Fraud Scheme Acknowledgement (signed; Fraud Scheme training document signed by employee is acceptable) (UAC MAP, Posted: 4/20/18)
Driver's Record and Clearance (if salaried staff required to travel outside of regional area) (FOA, Published 5/26/16) Note: Having a driver’s license is not required by PRS/HS policies and can only be included as a recommendation. Having a driver’s license is only applicable to staff who transport UAC. Monitor should verify if a staff member has transported youth in the past. Even if the staff member has not transported youth, but may do so in the future, monitor should recommend that HR keep the driver’s license on file.
Staff Trainings	Entered?	Date
ORR Policies and Procedures (FOA, Published 5/26/16)
The Flores Settlement Agreement (FOA, Published 5/26/16)
Trafficking Victims Protection Reauthorization Act of 2008 (FOA, Published 5/26/16)
Violence Against Women Reauthorization Act of 2013 (FOA, Published 5/26/16)
Mental health (FOA, Published 5/26/16)
Child welfare best practices, including mandated reporting (FOA, Published 5/26/16)
Safety working in the field (FOA, Published 5/26/16)
Child development theory (FOA, Published 5/26/16)
Substance abuse (FOA, Published 5/26/16)
Domestic violence (FOA, Published 5/26/16)
Gang prevention (FOA, Published 5/26/16)
Loss and family separation (FOA, Published 5/26/16)
Confidentiality (FOA, Published 5/26/16)
Child trafficking and smuggling (FOA, Published 5/26/16)
State license required trainings (FOA, Published 5/26/16)
HS/PRS Personnel Requirements
Employee Position: one of the following: Program Director, Regional Supervisor, Lead Case Manager, Home Study Case Worker, Post Release Services Case Worker, (FOA, Published 5/26/16)			List summary of employee experience and education.
Comments

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Sheet 2: Employee 2

Updated: 04/28/2020
Personnel File Checklist
Facility
Name
Date of Hire
Reviewer
Date of Review
Current Position (Past Positions?)
	Entered	Date	Notes
Meet minimum educational and work experience requirements? (FOA, Published 5/26/16)
I-9 Employment Eligibility Documents (I-9 form and copies of required I.D documents) (FOA, Published 5/26/16)
Child Abuse Mandated Reporter Agreement (FOA, Published 5/26/16)
Background Investigation Documentation			The following requirements reference ORR Guide 4.3, based upon the HS/PRS FOA 2016 **STILL PENDING GUIDANCE from PSA
CPS Background Investigation (child abuse and neglect record check, staff's State of US residence for the last 5 years, every 5 years) (Documentation of the review and conclusion. Completed prior to employment start date) (FOA, Published 5/26/16)
FBI fingerprint check of national and state criminal history repositories (Every 5 years) (Documentation of the review and conclusion. Completed prior to employment start date) (FOA, Published 5/26/16)
Background Investigation updates at a minimum of every 5 years of the staff/contractor/volunteer's start date or last background investigation update. (Documentation of the review and conclusion) (FOA, Published 5/26/16)
Efforts to ask applicants about previous misconduct and employee's response (Policy, Effective: 02/22/15) (FOA, Published 5/26/16)
Efforts to contact past employers where applicant had access to children and youth (Policy, Effective: 02/22/15) (FOA, Published 5/26/16)
Annual Performance Review (annual, signed, with employee's written comments, must incl. questions about any prior misconduct since last background investigation; (Policy, Effective: 02/22/15)) (FOA, Published 5/26/16)
Code of Conduct (signed by applicant (staff hired since Feb. 2019), acknowledging receipt; (Policy, Effective: 01/14/19) (FOA, Published 5/26/16)
Prevent and Report Sexual Abuse and Harassment (signed by applicant (staff hired since Feb. 2019), acknowledging receipt; Policy, Effective: 01/14/19) (FOA, Published 5/26/16)
Fraud Scheme Acknowledgement (signed; Fraud Scheme training document signed by employee is acceptable) (UAC MAP, Posted: 4/20/18)
Driver's Record and Clearance (if salaried staff required to travel outside of regional area) (FOA, Published 5/26/16) Note: Having a driver’s license is not required by PRS/HS policies and can only be included as a recommendation. Having a driver’s license is only applicable to staff who transport UAC. Monitor should verify if a staff member has transported youth in the past. Even if the staff member has not transported youth, but may do so in the future, monitor should recommend that HR keep the driver’s license on file.
Staff Trainings	Entered?	Date
ORR Policies and Procedures (FOA, Published 5/26/16)
The Flores Settlement Agreement (FOA, Published 5/26/16)
Trafficking Victims Protection Reauthorization Act of 2008 (FOA, Published 5/26/16)
Violence Against Women Reauthorization Act of 2013 (FOA, Published 5/26/16)
Mental health (FOA, Published 5/26/16)
Child welfare best practices, including mandated reporting (FOA, Published 5/26/16)
Safety working in the field (FOA, Published 5/26/16)
Child development theory (FOA, Published 5/26/16)
Substance abuse (FOA, Published 5/26/16)
Domestic violence (FOA, Published 5/26/16)
Gang prevention (FOA, Published 5/26/16)
Loss and family separation (FOA, Published 5/26/16)
Confidentiality (FOA, Published 5/26/16)
Child trafficking and smuggling (FOA, Published 5/26/16)
State license required trainings (FOA, Published 5/26/16)
HS/PRS Personnel Requirements
Employee Position: one of the following: Program Director, Regional Supervisor, Lead Case Manager, Home Study Case Worker, Post Release Services Case Worker, (FOA, Published 5/26/16)			List summary of employee experience and education.
Comments

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Sheet 3: Employee 3

Updated: 04/28/2020
Personnel File Checklist
Facility
Name
Date of Hire
Reviewer
Date of Review
Current Position (Past Positions?)
	Entered	Date	Notes
Meet minimum educational and work experience requirements? (FOA, Published 5/26/16)
I-9 Employment Eligibility Documents (I-9 form and copies of required I.D documents) (FOA, Published 5/26/16)
Child Abuse Mandated Reporter Agreement (FOA, Published 5/26/16)
Background Investigation Documentation			The following requirements reference ORR Guide 4.3, based upon the HS/PRS FOA 2016 **STILL PENDING GUIDANCE from PSA
CPS Background Investigation (child abuse and neglect record check, staff's State of US residence for the last 5 years, every 5 years) (Documentation of the review and conclusion. Completed prior to employment start date) (FOA, Published 5/26/16)
FBI fingerprint check of national and state criminal history repositories (Every 5 years) (Documentation of the review and conclusion. Completed prior to employment start date) (FOA, Published 5/26/16)
Background Investigation updates at a minimum of every 5 years of the staff/contractor/volunteer's start date or last background investigation update. (Documentation of the review and conclusion) (FOA, Published 5/26/16)
Efforts to ask applicants about previous misconduct and employee's response (Policy, Effective: 02/22/15) (FOA, Published 5/26/16)
Efforts to contact past employers where applicant had access to children and youth (Policy, Effective: 02/22/15) (FOA, Published 5/26/16)
Annual Performance Review (annual, signed, with employee's written comments, must incl. questions about any prior misconduct since last background investigation; (Policy, Effective: 02/22/15)) (FOA, Published 5/26/16)
Code of Conduct (signed by applicant (staff hired since Feb. 2019), acknowledging receipt; (Policy, Effective: 01/14/19) (FOA, Published 5/26/16)
Prevent and Report Sexual Abuse and Harassment (signed by applicant (staff hired since Feb. 2019), acknowledging receipt; Policy, Effective: 01/14/19) (FOA, Published 5/26/16)
Fraud Scheme Acknowledgement (signed; Fraud Scheme training document signed by employee is acceptable) (UAC MAP, Posted: 4/20/18)
Driver's Record and Clearance (if salaried staff required to travel outside of regional area) (FOA, Published 5/26/16) Note: Having a driver’s license is not required by PRS/HS policies and can only be included as a recommendation. Having a driver’s license is only applicable to staff who transport UAC. Monitor should verify if a staff member has transported youth in the past. Even if the staff member has not transported youth, but may do so in the future, monitor should recommend that HR keep the driver’s license on file.
Staff Trainings	Entered?	Date
ORR Policies and Procedures (FOA, Published 5/26/16)
The Flores Settlement Agreement (FOA, Published 5/26/16)
Trafficking Victims Protection Reauthorization Act of 2008 (FOA, Published 5/26/16)
Violence Against Women Reauthorization Act of 2013 (FOA, Published 5/26/16)
Mental health (FOA, Published 5/26/16)
Child welfare best practices, including mandated reporting (FOA, Published 5/26/16)
Safety working in the field (FOA, Published 5/26/16)
Child development theory (FOA, Published 5/26/16)
Substance abuse (FOA, Published 5/26/16)
Domestic violence (FOA, Published 5/26/16)
Gang prevention (FOA, Published 5/26/16)
Loss and family separation (FOA, Published 5/26/16)
Confidentiality (FOA, Published 5/26/16)
Child trafficking and smuggling (FOA, Published 5/26/16)
State license required trainings (FOA, Published 5/26/16)
HS/PRS Personnel Requirements
Employee Position: one of the following: Program Director, Regional Supervisor, Lead Case Manager, Home Study Case Worker, Post Release Services Case Worker, (FOA, Published 5/26/16)			List summary of employee experience and education.
Comments