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 Admission
Adult Contact Profile (Portal Form S-5; Path Form S-7) Unchanged 285984 214488 0 Form and Instruction S-7 Adult Contact Profile
Form and Instruction S-5 Sponsor Assessment - New UC Portal
Assessment for Risk (Form S-9) Unchanged 120096 90072 0 Form and Instruction S-9 Assessment for Risk - UC Path Version
Form and Instruction S-9 Assessment for Risk - UC Portal Version
Case Manager Call Log and Case Notes (Form S-23) Unchanged 1820016 151668 0 Form and Instruction S-23 Case Manager Call Log and Case Notes
Child Advocate Recommendation and Appointment (Form S-15) Unchanged 1080 270 0 Form and Instruction S-15 Child Advocate Recommendation and Appointment
Home Study Assessment (Form S-6) Unchanged 4860 3645 0 Form and Instruction S-6 Home Study Assessment - UC Path Version
Form and Instruction S-6 Home Study Assessment - Word Version
Home Study/Post-Release Service (HS/PRS) Primary Provider Entity (Form S-21A) Unchanged 9 1 0 Form and Instruction S-21A HS-PRS Primary Provider Entity
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) Primary Provider Profile
Home Study/Post-Release Service (HS/PRS) Referral (Form S-19) Unchanged 14688 4896 0 Form and Instruction S-19 HS-PRS Referral - UC Path Version
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 Entity
Home Study/Post-Release Service (HS/PRS) Subcontractor Profile (Form S-21D) Unchanged 663 55 0 Form and Instruction S-21D Home Study/Post-Release Service (HS/PRS) Subcontractor Profile
Individual Service Plan (Form S-13) Unchanged 149904 49968 0 Form and Instruction S-13 Individual Service Plan - UC Path Version
Form and Instruction S-13 Individual Service Plan - UC Portal Version
Initial Intakes Assessment (Form S-8) Unchanged 60048 20016 0 Form and Instruction S-8 Initial Intakes Assessment (Form S-8) - UC Path Version
Form and Instruction S-8 Initial Intakes Assessment - UC Portal Version
Long Term Foster Care Travel Request (Form S-14) Unchanged 240 80 0 Form and Instruction S-14 Long Term Foster Care Travel Request - UC Path Version
Form and Instruction S-14 Long Term Foster Care Travel Request - UC Portal Version
Post-Release Service (PRS) Event (Form S-22) Unchanged 58080 58080 0 Form and Instruction S-22 Post-Release Service (PRS) Event
Sponsor Application (Form S-24) Unchanged 57240 57240 0 Form and Instruction S-24 Sponsor Application
Sponsor Assessment (Form S-5) Modified 57240 57240 0 Form and Instruction S-5 Sponsor Assessment - UC Path Version
Form and Instruction S-5 Sponsor Assessment - New UC Portal
Thirty Day Restrictive Placement Case Review (Form S-16) Unchanged 1005 754 0 Form and Instruction S-16 Thirty Day Restrictive Placement Case Review
UC Assessment (Form S-11) Unchanged 60048 120096 0 Form and Instruction S-11 UC Assessment - UC Path Version
Form and Instruction S-11 UC Assessment - UC Portal Version
UC Authorized/Restricted Call List and Call Log (Form S-20) Unchanged 1507896 125658 0 Form and Instruction S-20 UC Authorized-Restricted Call List and Call Log - UC Path Version
UC Case Review (Form S-12) Unchanged 120096 240192 0 Form and Instruction S-12 UC Case Review - UC Path Version
Form and Instruction S-12 UC Case Review - UC Portal Version
UC Case Status Unchanged 60048 5004 0 Form and Instruction 1 UC Case Status
Total burden requested under this ICR: 4439457 1219453 0  
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