Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Admission (Form S-18) Modified 60048 19816 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) Modified 1820016 145601 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) Modified 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 Referral (Form S-26) New 4752 1568 0 Form and Instruction S-26 HS Referral - UC Portal
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) Modified 117 9 0 Form and Instruction S-21C Home Study/Post-Release Service (HS/PRS) Primary Provider Profile
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) Modified 663 53 0 Form and Instruction S-21D Home Study/Post-Release Service (HS/PRS) Subcontractor Profile
Individual Service Plan (Form S-13) Modified 149904 49468 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) Modified 60048 19816 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) Modified 240 79 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
Post-Release Service (PRS) Referral (Form S-19) Modified 9936 3279 0 Form and Instruction S-19 PRS Referral - UC Portal
Form and Instruction Form S-19 PRS Referral Appendix - PRS Administrative Actions
Sponsor Application (Form S-24) Unchanged 57240 57240 0 Form and Instruction S-24 Sponsor Application
Sponsor Assessment (Form S-5) Unchanged 57240 57240 0 Form and Instruction S-5 Sponsor Assessment - UC Path Version
Form and Instruction S-5 Sponsor Assessment - New UC Portal
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) Modified 1507896 120632 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 Modified 60048 4804 0 Form and Instruction 1 UC Case Status
Form 1b Location of Child
Total burden requested under this ICR: 4438452 1206453 0  
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