Submission for Office of Management and Budget Review; Office of Refugee Resettlement (ORR) Unaccompanied Alien Child Health Forms

Issuing agencies

Abstract

The Administration for Children and Families (ACF) Office of Refugee Resettlement (ORR) is requesting to move the Serious Medical Procedure Request (SMR) Form (Office of Management and Budget (OMB) #: 0970-0561, expiration December 31, 2026) under the Medical Assessment Form and Dental Assessment Form (OMB #: 0970-0466, expiration 10/31/ 2026) information collection and update the title of OMB # 0970-0466 to Office of Refugee Resettlement (ORR) Unaccompanied Alien Child Health Forms. Revisions are proposed to the forms. The proposed restructuring and revisions will improve transparency, lessen burden, improve data quality, and ensure alignment with ORR requirements. In addition, to ensure continuity of care, the request has been revised to include the sharing of health information with the Department of Homeland Security (DHS) in specific circumstances.

Full Text

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<title>Federal Register, Volume 91 Issue 205 (Monday, October 26, 2026)</title>
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[Federal Register Volume 91, Number 205 (Monday, October 26, 2026)]
[Notices]
[Pages 67320-67321]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-21762]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families

[Office of Management and Budget #: 0970-0466]


Submission for Office of Management and Budget Review; Office of 
Refugee Resettlement (ORR) Unaccompanied Alien Child Health Forms

AGENCY: Office of Refugee Resettlement, Administration for Children and 
Families, U.S. Department of Health and Human Services.

ACTION: Request for public comments.

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SUMMARY: The Administration for Children and Families (ACF) Office of 
Refugee Resettlement (ORR) is requesting to move the Serious Medical 
Procedure Request (SMR) Form (Office of Management and Budget (OMB) #: 
0970-0561, expiration December 31, 2026) under the Medical Assessment 
Form and Dental Assessment Form (OMB #: 0970-0466, expiration 10/31/
2026) information collection and update the title of OMB # 0970-0466 to 
Office of Refugee Resettlement (ORR) Unaccompanied Alien Child Health 
Forms. Revisions are proposed to the forms. The proposed restructuring 
and revisions will improve transparency, lessen burden, improve data 
quality, and ensure alignment with ORR requirements. In addition, to 
ensure continuity of care, the request has been revised to include the 
sharing of health information with the Department of Homeland Security 
(DHS) in specific circumstances.

DATES: Comments due November 25, 2026.

ADDRESSES: The public may view and comment on this information 
collection request at: <a href="https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=">https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=</a> 202610-0970-004. You can also obtain copies of the 
proposed collection of information by emailing 
<a href="/cdn-cgi/l/email-protection#f0999e969f939f9c9c959384999f9eb0919396de989883de979f86"><span class="__cf_email__" data-cfemail="e58c8b838a868a89898086918c8a8ba5848683cb8d8d96cb828a93">[email&#160;protected]</span></a>. Identify all emailed requests by the title 
of the information collection.

SUPPLEMENTARY INFORMATION: 
    Description: Unaccompanied alien children in ORR custody are placed 
in care provider programs until unification with a qualified sponsor. 
Care providers ensure children receive a range of services including 
routine and emergency medical, dental, and mental health care. Children 
must receive medical and dental baseline exams, well-child checks, 
preventive dental care, and counseling services. Care provider staff 
are expected to implement all recommended treatment plans (e.g., 
referrals to specialists, procedures, accommodation for physical or 
mental impairments that impact daily living activities) as directed by 
the evaluating healthcare provider. All non-emergent procedures 
performed under anesthesia or IV sedation require ORR approval. Before 
a decision can be made by ORR, the SMR form must be completed by the 
treating healthcare provider (e.g., surgeon) and submitted to ORR via 
the care provider program. ORR will waive the completion of the SMR 
form requirement if it is deemed to be in the best interest of the 
child (e.g., during a hospitalization or emergency department visit, 
related to a medical emergency). If a child with a health condition 
that requires daily management or accommodation (e.g., medication, 
durable medical equipment) is identified for repatriation by DHS, 
relevant information from their established treatment plan must be 
shared with DHS to ensure continuity of care. See proposed changes for 
more information.
    Data from medical and dental assessments is captured through the 
following forms that are currently under two ORR information 
collections (OMB #s: 0970-0466 and 0970-0561):

<bullet> Medical Assessment Form (MAF)
<bullet> Dental Assessment Form (DAF)
<bullet> SMR Form

    Each Assessment form has a corresponding instructional Dear 
Colleague Letter that healthcare providers are expected to read at the 
initial visit with the child. The forms are used as worksheets by 
healthcare providers and care provider staff to compile information 
that would otherwise have been collected during the health assessment. 
Once completed, care provider staff transcribe the information from the 
form into ORR's secure, electronic system of record. Although the MAF 
is not completed during emergency or urgent care visits, 
hospitalizations, admissions to out-of-network facilities (e.g., 
medical rehab facility), or follow-up immunization visits in the 
absence of a healthcare provider evaluation, care providers are 
required to complete the respective form in ORR's electronic system of 
record by extracting relevant data from health records.
    Data is used by ORR to monitor and support the health of 
unaccompanied alien children while in care, for case management of 
identified illnesses/conditions, and to ensure care provider compliance 
with ORR requirements.
    Finally, ORR has updated the stated uses of data sharing to include 
the disclosure of relevant health information to DHS upon discharge of 
a child with healthcare needs from ORR custody for DHS-led 
repatriation.

Summary of Proposed Changes

    ORR is proposing the incorporation of the SMR Form currently 
approved under OMB #: 0970-0561 into the OMB #: 0970-0466 information 
collection and changing the title to Office of Refugee Resettlement 
(ORR) Unaccompanied Alien Child Health Forms to group forms with a 
similar purpose together. Other changes to the SMR form include the 
removal of the first page that was completed by care provider staff, 
clarifying the purpose of the form in the instructions, revising fields 
to reduce redundancy, enhance data quality and healthcare provider 
response.
    The MAF and DAF would also be revised to:
    <bullet> reduce duplicate documentation and encourage form 
completion by only requiring completion of the History section on the 
DAF for the initial dental exam and allowing healthcare providers the 
option of summarizing critical health information in the first two 
pages of the MAF instead of completing a third page for all scheduled 
visits except the initial medical exam and routine well-child visits.
    <bullet> improve compliance and care tracking by strengthening the 
disabilities and accommodations field and adding a field for all 
ordered or

[[Page 67321]]

completed labs and imaging on the MAF, and
    <bullet> improve data quality through clearer instructions by visit 
type, a healthcare provider acknowledgement and signature section 
authorizing record sharing with ORR, replacement of fixed diagnosis 
choices with free-text fields, and broader field reformatting.
    The related Dear Colleague Letter would also be updated to reflect 
these MAF and DAF changes.
    In addition, language was updated to expand the purposes of data to 
include sharing limited health data from the MAF and DAF with DHS when 
a child with healthcare needs departs ORR custody for DHS-led 
repatriation. Data will be shared with the DHS Field Office Juvenile 
Coordinator (FOJC) when travel arrangements have been made. Data is not 
shared for immigration enforcement purposes. Shared information 
includes:

<bullet> Child's identifying information (name, alien number, date of 
birth)
<bullet> Active diagnoses or concerns that require management during 
travel
<bullet> Allergies
<bullet> Current medications and dosages
<bullet> Isolation/Quarantine requirements
<bullet> Health-related accommodations (including durable medical 
equipment needs)
<bullet> Health-related ravel restrictions

    The purpose of sharing this data is to ensure children receive 
healthcare services and accommodation as recommended by their treating 
healthcare providers.
    Respondents: Healthcare providers (primary care providers, medical 
specialists, dentists, and surgeons).
    Annual Burden Estimates
    The overall annual burden of response and recordkeeping time 
decreased by 93.2 percent and 90.4 percent, respectively. The decrease 
is attributed to a significantly lower census of unaccompanied alien 
children in ORR care which reduced the number of respondents and 
responses per respondent. In addition, the average burden hours per 
response was decreased for each form by removing unnecessary fields and 
introducing skip patterns for fields that are only needed for specific 
types of visits.

                                     Estimated Response Time for Respondents
----------------------------------------------------------------------------------------------------------------
                                                                                              Average
                                                              Total number   Annual number    burden     Annual
             Instrument                     Respondent             of        of responses    hours per   burden
                                                               respondents  per respondent   response     hours
----------------------------------------------------------------------------------------------------------------
                                      Pediatricians, General           150             104       0.134   2,090.4
Medical Assessment Form.............  Medical Specialist,              300            27.4       0.137   1,126.1
                                       General.
Dental Assessment Form..............  Dentists..............           150           124.4        0.05       933
SMR Form............................  Surgeons..............           150            0.67        0.17      17.1
                                                             ---------------------------------------------------
    Estimated Total Annual Burden     ......................  ............  ..............  ..........   4,166.6
     Hours.
----------------------------------------------------------------------------------------------------------------


                                  Estimated Recordkeeping Time for Respondents
----------------------------------------------------------------------------------------------------------------
                                                                                              Average
                                                              Total number   Annual number    burden     Annual
             Instrument                     Respondent             of        of responses    hours per   burden
                                                               respondents  per respondent   response     hours
----------------------------------------------------------------------------------------------------------------
Medical Assessment Form completed by  Care Provider Staff...           150          158.72        0.24  5,713.92
 a medical provider.
Medical Assessment Form not                                            150           22.08        0.33  1,092.96
 completed by a medical provider
 (information obtained via health
 records).
Dental Assessment Form..............                                   150           124.4        0.15     2,799
SMR Form............................                                   150            0.67        0.08      8.04
                                                             ---------------------------------------------------
    Estimated Total Annual Burden     ......................  ............  ..............  ..........  9,613.92
     Hours.
----------------------------------------------------------------------------------------------------------------

    Authority: These information collections are related to and funded 
by the ORR Unaccompanied Alien Children Bureau (UACB), are authorized 
by the statutes and regulations listed below, and are being conducted 
by ORR UACB.
    <bullet> Homeland Security Act, 6 U.S.C. 279--Transferred 
responsibilities for the care and placement of unaccompanied alien 
children from the Commissioner of the former Immigration and 
Naturalization Service to the Director of ORR.
    <bullet> Unaccompanied Children Program Foundational Rule, 45 CFR 
part 410--Establishes a uniform set of standards and procedures 
concerning the placement, care, and services provided to unaccompanied 
alien children in ORR care that is consistent with ORR's statutory 
duties. Sections 410.1306(g) and 410.1307 require care provider 
programs to ensure children are provided with routine and emergency 
healthcare services while in care.
    <bullet> Lucas R. et al. v. Becerra et al. (Case No. 2:18-CV-05741-
DMG-PLA) Psychotropic Medication Settlement Agreement--Establishes 
standards for monitoring the administration of psychotropic medication 
to children in ORR custody and care.

Samantha L. Illangasekare,
ACF/OPRE Certifying Officer.
[FR Doc. 2026-21762 Filed 10-23-26; 8:45 am]
BILLING CODE 4184-45-P


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