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):

• Medical Assessment Form (MAF)
• Dental Assessment Form (DAF)
• 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:

• 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.
• improve compliance and care tracking by strengthening the disabilities and accommodations field and adding a field for all ordered or ( printed page 67321) completed labs and imaging on the MAF, and
• 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:

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

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.

• 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.
• 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.
• 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.

91 FR 67320