# Submission for OMB Review; ORR Serious Medical Procedure Request (SMR) Form (New Collection)
**AGENCY:**
Office of Refugee Resettlement, Administration for Children and Families, HHS.
**ACTION:**
Request for public comment.
**SUMMARY:**
The Office of Refugee Resettlement (ORR), Administration for Children and Families (ACF), U.S. Department of Health and Human Services (HHS), is proposing to collect data for a new data collection, *the Serious Medical Procedure Request (SMR) Form.*
**DATES:**
*Comments due within 30 days of publication.* OMB must make a decision about the collection of information between 30 and 60 days after publication of this document in the *Federal Register* . Therefore, a comment is best assured of having its full effect if OMB receives it within 30 days of publication.
**ADDRESSES:**
Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to *www.reginfo.gov/public/do/PRAMain.* Find this particular information collection by selecting “Currently under 30-day Review—Open for Public Comments” or by using the search function.
**SUPPLEMENTARY INFORMATION:**
*Description:* Children with complex medical/dental conditions may require surgical intervention or procedures in order to maintain and promote their health while in ORR custody. Procedures requiring general anesthesia, surgeries, and invasive diagnostic procedures ( *e.g.,* cardiac catheterization, invasive biopsy, amniocentesis) require advance ORR approval. Before a decision can be rendered by ORR, data on clinical indications, risks and benefits of the surgery/procedure, potential adverse outcomes if services are not rendered, timeframe for recovery, follow-up care, and points of contact must be collected and submitted to ORR. The form is not required for emergency procedures, procedures performed during hospitalization, or procedures resulting from complication of a previously approved procedure.
*Respondents:* Healthcare providers, ORR grantee staff.
*Annual Burden Estimates:*
| Instrument | Annual | Annual | Average | Total burden hours | Annual burden hours |
| --- | --- | --- | --- | --- | --- |
| Healthcare providers: | | | | | |
| Serious Medical Procedure Request (SMR) Form | 195 | 1 | .22 | 128.7 | 42.9 |
*Estimated Total Annual Burden Hours:* 42.9.
| Instrument | Annual | Annual | Average | Total burden hours | Annual burden hours |
| --- | --- | --- | --- | --- | --- |
| ORR Grantee Staff: | | | | | |
| Serious Medical Procedure Request (SMR) Form | 195 | 1 | .08 | 46.8 | 15.6 |
*Estimated Total Annual Burden Hours:* 15.6.
| Instrument | Annual | Annual | Average | Total burden hours | Annual burden hours |
| --- | --- | --- | --- | --- | --- |
| ORR Grantee Staff: | | | | | |
| Serious Medical Procedure Request (SMR) Form | 195 | 1 | .08 | 46.8 | 15.6 |
*Estimated Total Annual Burden Hours:* 15.6.
**Authority:**
6 U.S.C. Section 279: Exhibit 1, part A.2 of the Flores Settlement Agreement (Jenny Lisette Flores, et al., v. Janet Reno, Attorney General of the United States, et al., Case No. CV 85-4544-RJK [C.D. Cal. 1996]).
Mary B. Jones,
ACF/OPRE Certifying Officer.