Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Authorization for Release of Records (Form A-5 & A-5s) Modified 4000 1000 0 Form A-5 Authorization for Release of Records (English)
Form A-5s Authorization for Release of Records (Spanish)
Authorization for Release of Records (Form A-5 & A-5s) - Record keeping Unchanged 4104 1368 0 Form A-5 Authorization for Release of Records
Form A-5s Authorization for Release of Records - Spanish
Behavioral Note (Form A-9E) Unchanged 29592 14796 0 Form A-9E Behavioral Note
Care Provider Facility Tour Request (Form A-1A) Unchanged 200 33 0 Form A-1A Care Provider Facility Tour Request
Care Provider Facility Tour Request (Form A-1A) - Record Keeping Unchanged 216 432 0 Form Form A-1A Care Provider Facility Tour Request
Child-Level Event (Form A-9A) Unchanged 44160 7360 0 Form A-9A Child-Level Event
Emergency Significant Incident Report (Form A-9B) Unchanged 5616 8424 0 Form A-9B Emergency Significant Incident Report - UC Path Version
Form A-9B Emergency Significant Incident Report
Historical Disclosure (Form A-9D) Unchanged 35208 52812 0 Form A-9D Historical Disclosure
Key Personnel Minimum Qualifications Checklist and Attestation (Form A-14) Unchanged 2115 353 0 Form A-14 Key Personnel Qualification Checklist and Attestation
Non-Emergency Significant Incident Report and Addendum (Form A-9C) Unchanged 56376 84564 0 Form A-9C Emergency Significant Incident Report Addendum - UC Path Version
Form A-9C Emergency Significant Incident Report Addendum - UC Portal Version
Notice to UAC for Flores Visits (Forms A-4 & A-4s) Unchanged 20 5 0 Form A-4 Notice to UC for Flores Visits
Form A-4s Notice to UC for Flores Visits - Spanish
Notification of Concern (Form A-7) Unchanged 4500 1125 0 Form Form A-7 Notification of Concern
ORR Waiver Request (Form A-15) Unchanged 470 157 0 Form Form A-15 ORR Waiver Request
Program Level Event (Form A-10) Unchanged 1512 1512 0 Form A-10 Program-Level Event Report - UC Portal Version
Form A-10 Program-Level Event Report and Addendum - UC Path Version
Total burden requested under this ICR: 188089 173941 0  
To view an IC, click on IC Title