Request for Specific Consent to Juvenile Court Jurisdiction

OMB Control No: 0970-0385	ICR Reference No: 201403-0970-005
Status: Historical Active	Previous ICR Reference No: 201011-0970-003
Agency/Subagency: HHS/ACF	Agency Tracking No: ACF\ORR
Title: Request for Specific Consent to Juvenile Court Jurisdiction
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/02/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/28/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	36 Months From Approved	05/31/2014
Responses	30	0	72
Time Burden (Hours)	10	0	24
Cost Burden (Dollars)	221	0	0

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Abstract: The collection of this information is needed so that ACF/ORR can recieve offiical notification by attorneys and representatives of UAC of a plannned SIJ Status action in a state court which may result in a determinination by the state court that the UAC in ORR custody will be subject to the jurisdiction of the state juvenile court. The information collection asks for the name and contact information of the UAC's attorney or representative; the UAC's biographical information; and brief explanation of why the attorney or representative is requesting that a UAC be placed in the jurisdiction of the state juvenile court. The attorney or representative is also required to attach with the request a copy a G-28, EOIR-28 or EOIR-29, or other form of authorization to act on behalf of the unaccompanied alien child.

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Authorizing Statute(s): US Code: 6 USC 279 Name of Law: William Wilberforce

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:
	79 FR 3596	01/22/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 17548	03/28/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title Form No. Form Name Request for Specific Consent to Junenile Court Jurisdiction 1 Request for Specific Consent

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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	30	72	0	-42	0	0
Annual Time Burden (Hours)	10	24	0	-14	0	0
Annual Cost Burden (Dollars)	221	0	0	221	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Burden reduced since there were fewer respondents.

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Annual Cost to Federal Government: $210

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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? Uncollected

Agency Contact: Robert Sargis 2026907275

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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: 03/28/2014

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