Authorization for Release of Records (Form A-5 & A-5s)

Administration and Oversight of the Unaccompanied Children Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0547 can be found here:

Documents and Forms

Document Name Document Type
Form A-5 Authorization for Release of Records (Form A-5 & A-5s) Form
A-5 Authorization for Release of Records (English) A-5 (ENG) Authorization for Release of Records_v3_English.pdf Form
A-5s Authorization for Release of Records (Spanish) A-5 (ESP) Authorization for Release of Records_v3_Spanish.pdf Form

Information Collection (IC) Details

IC Title:	Authorization for Release of Records (Form A-5 & A-5s)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	A-5	Authorization for Release of Records (English)	A-5 (ENG) Authorization for Release of Records_v3_English.pdf		Yes	Yes	Fillable Fileable
Form	A-5s	Authorization for Release of Records (Spanish)	A-5 (ESP) Authorization for Release of Records_v3_Spanish.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	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.