Information Collection Request

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

ICR 202211-0970-002 · OMB 0970-0564 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0970-0564 can be found here:

Forms and Documents

Document Name	Status
Form Form M-13E-UF Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping Form and Instruction	New
Form Form M-13E-UF Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent Form and Instruction	New
Form Form M-13C-UF Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping Form and Instruction	New
Form Form M-13C-UF Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent Form and Instruction	New
Form Form M-12A-UF Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping Form and Instruction	New
Form Form M-12A-UF Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents Form and Instruction	New
Form Form M-11P-UF Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping Form and Instruction	New
Form Form M-11P-UF Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents Form and Instruction	New
Form Form M-11A-UF Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping Form and Instruction	New
Form Form M-11A-UF Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents Form and Instruction	New
Form Form M-11P Interpreter Questionnaire (Form M-11P) Form and Instruction	New
Form Form M-10A-UF Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping Form and Instruction	New
Form Form M-9A-UF Unlicensed Facility On-Site Monitoring Checklist (Form M-9A-UF) - Recordkeeping Form and Instruction	New
Form Form M-6A-UF Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping Form and Instruction	New
Form Form M-8A-UF Unlicensed Facility UC Case File Checklist (Form M-8A-UF) - Recordkeeping Form and Instruction	New
Form Form M-8A-UF Unlicensed Facility UC Case File Checklist (Form M-8A-UF) - Respondents Form and Instruction	New
Form Form M-7A-UF Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping Form and Instruction	New
Form Form M-7A-UF Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents Form and Instruction	New
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 UC Questionnaires (Forms M-12A-B, E) - Recordkeeping Form and Instruction	Unchanged
Form Form M-12A UC Questionnaires (Forms M-12A-B, E) - Respondents Form and Instruction	Unchanged
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-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-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) - 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
Expedited Review FRN Monitoring and Compliance_0970-0564_10.26.22.pdf Supplementary Document	2022-11-09
Emergency SSA_0970-0564_Monitoring and Compliance_005_2022 11 09.docx Supporting Statement A	2022-11-09

IC Document Collections

IC ID	Document Title	Status
256795	Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping Form and Instruction	New
256793	Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent Form and Instruction	New
256792	Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping Form and Instruction	New
256791	Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent Form and Instruction	New
256790	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping Form and Instruction	New
256789	Unlicensed Facility UC Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents Form and Instruction	New
256788	Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping Form and Instruction	New
256787	Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents Form and Instruction	New
256786	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping Form and Instruction	New
256785	Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents Form and Instruction	New
256784	Interpreter Questionnaire (Form M-11P) Form and Instruction	New
256783	Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping Form and Instruction	New
256782	Unlicensed Facility On-Site Monitoring Checklist (Form M-9A-UF) - Recordkeeping Form and Instruction	New
256781	Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping Form and Instruction	New
256780	Unlicensed Facility UC Case File Checklist (Form M-8A-UF) - Recordkeeping Form and Instruction	New
256779	Unlicensed Facility UC Case File Checklist (Form M-8A-UF) - Respondents Form and Instruction	New
256778	Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping Form and Instruction	New
256777	Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents Form and Instruction	New
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	UC Questionnaires (Forms M-12A-B, E) - Recordkeeping Form and Instruction	Unchanged
245614	UC Questionnaires (Forms M-12A-B, E) - Respondents Form and Instruction	Unchanged
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
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
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
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

Status	Active
Agency/Subagency	HHS/ACF
OMB Control No	0970-0564
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202112-0970-003
Agency Tracking No	ORR
Date Submitted to OIRA	2022-11-09
Requested Expiration Date	2022-11-10