Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Admission (Form S-18) Unchanged 60048 20016 0 Form and Instruction S-18
Adult Contact Profile (Portal Form S-5; Path Form S-7) Unchanged 285984 214488 0 Form and Instruction S-7
Form and Instruction S-5
Assessment for Risk (Form S-9) Unchanged 120096 90072 0 Form and Instruction S-9
Form and Instruction S-9
Case Manager Call Log and Case Notes (Form S-23) Unchanged 1820016 151668 0 Form and Instruction S-23
Child Advocate Recommendation and Appointment (Form S-15) Unchanged 1080 270 0 Form and Instruction S-15
Home Study Assessment (Form S-6) Unchanged 4860 3645 0 Form and Instruction S-6
Form and Instruction S-6
Home Study/Post-Release Service (HS/PRS) Primary Provider Entity (Form S-21A) Unchanged 9 1 0 Form and Instruction S-21A
Home Study/Post-Release Service (HS/PRS) Primary Provider Profile (Form S-21C) Unchanged 117 10 0 Form and Instruction S-21C
Home Study/Post-Release Service (HS/PRS) Referral (Form S-19) Unchanged 14688 4896 0 Form and Instruction S-19
Home Study/Post-Release Service (HS/PRS) Subcontractor Entity (Form S-21B) Unchanged 51 4 0 Form and Instruction S-21B
Home Study/Post-Release Service (HS/PRS) Subcontractor Profile (Form S-21D) Unchanged 663 55 0 Form and Instruction S-21D
Individual Service Plan (Form S-13) Unchanged 149904 49968 0 Form and Instruction S-13
Form and Instruction S-13
Initial Intakes Assessment (Form S-8) Unchanged 60048 20016 0 Form and Instruction S-8
Form and Instruction S-8
Long Term Foster Care Travel Request (Form S-14) Unchanged 240 80 0 Form and Instruction S-14
Form and Instruction S-14
Post-Release Service (PRS) Event (Form S-22) Unchanged 58080 58080 0 Form and Instruction S-22
Sponsor Application (Form S-24) Unchanged 57240 57240 0 Form and Instruction S-24
Sponsor Assessment (Form S-5) Unchanged 57240 57240 0 Form and Instruction S-5
Form and Instruction S-5
Thirty Day Restrictive Placement Case Review (Form S-16) Unchanged 1005 754 0 Form and Instruction S-16
UC Assessment (Form S-11) Unchanged 60048 120096 0 Form and Instruction S-11
Form and Instruction S-11
UC Authorized/Restricted Call List and Call Log (Form S-20) Unchanged 1507896 125658 0 Form and Instruction S-20
UC Case Review (Form S-12) Unchanged 120096 240192 0 Form and Instruction S-12
Form and Instruction S-12
UC Case Status Modified 60048 5004 0 Form and Instruction 1
Total burden requested under this ICR: 4439457 1219453 0  
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