Information Collection Request

Services Provided to Unaccompanied Children

ICR 202109-0970-020 · OMB 0970-0553 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form S-24 Sponsor Application (Form S-24) Form and Instruction New Missing upstream
Form S-23 Case Manager Call Log and Case Notes (Form S-23) Form and Instruction New Repair queued
Form S-22 Post-Release Service (PRS) Event (Form S-22) Form and Instruction New Missing upstream
Form S-21D Home Study/Post-Release Service (HS/PRS) Subcontractor Profile (Form S-21D) Form and Instruction New Repair queued
Form S-21C Home Study/Post-Release Service (HS/PRS) Primary Provider Profile (Form S-21C) Form and Instruction New Repair queued
Form S-21B Home Study/Post-Release Service (HS/PRS) Subcontractor Entity (Form S-21B) Form and Instruction New Repair queued
Form S-21A Home Study/Post-Release Service (HS/PRS) Primary Provider Entity (Form S-21A) Form and Instruction New Missing upstream
Form S-20 UC Authorized/Restricted Call List and Call Log (Form S-20) Form and Instruction New Repair queued
Form S-19 Home Study/Post-Release Service (HS/PRS) Referral (Form S-19) Form and Instruction New Missing upstream
Form S-18 Admission (Form S-18) Form and Instruction Modified Repair queued
Form S-16 Thirty Day Restrictive Placement Case Review (Form S-16) Form and Instruction Modified Repair queued
Form S-15 Child Advocate Recommendation and Appointment (Form S-15) Form and Instruction Modified Repair queued
Form S-14 Long Term Foster Care Travel Request (Form S-14) Form and Instruction Modified Repair queued
Form S-13 Individual Service Plan (Form S-13) Form and Instruction Modified Repair queued
Form S-12 UC Case Review (Form S-12) Form and Instruction Modified Repair queued
Form S-11 UC Assessment (Form S-11) Form and Instruction Modified Repair queued
Form S-9 Assessment for Risk (Form S-9) Form and Instruction Modified Repair queued
Form S-8 Initial Intakes Assessment (Form S-8) Form and Instruction Modified Repair queued
Form S-7 Adult Contact Profile (Form S-7) Form and Instruction Modified Missing upstream
Form S-6 Home Study Assessment (Form S-6) Form and Instruction Modified Repair queued
Form S-5 Sponsor Assessment (Form S-5) Form and Instruction Modified Repair queued
SSA Attachment A_0970-0553_Services_002_2021 09 27 FINAL.docx Supplementary Document Uploaded 2021-09-29 Repair queued
SSA_0970-0553_Services_002_2021 09 27 FINAL.docx Supporting Statement A Uploaded 2021-09-29 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
249583 Ohio Youth Assessment System (OYAS) Reentry Tool Other-Copyrighted Tool New
249581 Sponsor Application (Form S-24) Form and Instruction New
249580 Case Manager Call Log and Case Notes (Form S-23) Form and Instruction New
249579 Post-Release Service (PRS) Event (Form S-22) Form and Instruction New
249578 Home Study/Post-Release Service (HS/PRS) Subcontractor Profile (Form S-21D) Form and Instruction New
249577 Home Study/Post-Release Service (HS/PRS) Primary Provider Profile (Form S-21C) Form and Instruction New
249576 Home Study/Post-Release Service (HS/PRS) Subcontractor Entity (Form S-21B) Form and Instruction New
249575 Home Study/Post-Release Service (HS/PRS) Primary Provider Entity (Form S-21A) Form and Instruction New
249574 UC Authorized/Restricted Call List and Call Log (Form S-20) Form and Instruction New
249573 Home Study/Post-Release Service (HS/PRS) Referral (Form S-19) Form and Instruction New
242815 Admission (Form S-18) Form and Instruction Modified
242814 Thirty Day Restrictive Placement Case Review (Form S-16) Form and Instruction Modified
242813 Child Advocate Recommendation and Appointment (Form S-15) Form and Instruction Modified
242812 Long Term Foster Care Travel Request (Form S-14) Form and Instruction Modified
242811 Individual Service Plan (Form S-13) Form and Instruction Modified
242810 UC Case Review (Form S-12) Form and Instruction Modified
242809 UC Assessment (Form S-11) Form and Instruction Modified
242808 Assessment for Risk (Form S-9) Form and Instruction Modified
242807 Initial Intakes Assessment (Form S-8) Form and Instruction Modified
242806 Adult Contact Profile (Form S-7) Form and Instruction Modified
242805 Home Study Assessment (Form S-6) Form and Instruction Modified
242804 Sponsor Assessment (Form S-5) Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 03/31/2022
4,380,924 888,622
1,216,343 384,209
0 0





Reginfo record details
22
table that charts list of burden
IC Title Form No. Form Name
Admission (Form S-18) S-18 Admission
Adult Contact Profile (Form S-7) S-7 Adult Contact Profile
Assessment for Risk (Form S-9) S-9, S-9 Assessment for Risk - UC Path Version ,   Assessment for Risk - UC Portal Version
Case Manager Call Log and Case Notes (Form S-23) S-23 Case Manager Call Log and Case Notes
Child Advocate Recommendation and Appointment (Form S-15) S-15 Child Advocate Recommendation and Appointment
Home Study Assessment (Form S-6) S-6, S-6 Home Study Assessment - UC Path Version ,   Home Study Assessment - Word Version
Home Study/Post-Release Service (HS/PRS) Primary Provider Entity (Form S-21A) S-21A HS-PRS Primary Provider Entity
Home Study/Post-Release Service (HS/PRS) Primary Provider Profile (Form S-21C) S-21C Home Study/Post-Release Service (HS/PRS) Primary Provider Profile
Home Study/Post-Release Service (HS/PRS) Referral (Form S-19) S-19 HS-PRS Referral - UC Path Version
Home Study/Post-Release Service (HS/PRS) Subcontractor Entity (Form S-21B) S-21B Home Study/Post-Release Service (HS/PRS) Subcontractor Entity
Home Study/Post-Release Service (HS/PRS) Subcontractor Profile (Form S-21D) S-21D Home Study/Post-Release Service (HS/PRS) Subcontractor Profile
Individual Service Plan (Form S-13) S-13, S-13 Individual Service Plan - UC Path Version ,   Individual Service Plan - UC Portal Version
Initial Intakes Assessment (Form S-8) S-8, S-8 Initial Intakes Assessment (Form S-8) - UC Path Version ,   Initial Intakes Assessment - UC Portal Version
Long Term Foster Care Travel Request (Form S-14) S-14, S-14 Long Term Foster Care Travel Request - UC Path Version ,   Long Term Foster Care Travel Request - UC Portal Version
Ohio Youth Assessment System (OYAS) Reentry Tool
Post-Release Service (PRS) Event (Form S-22) S-22 Post-Release Service (PRS) Event
Sponsor Application (Form S-24) S-24 Sponsor Application
Sponsor Assessment (Form S-5) S-5, S-5 Sponsor Assessment - UC Path Version ,   Sponsor Assessment - Word Version
Thirty Day Restrictive Placement Case Review (Form S-16) S-16 Thirty Day Restrictive Placement Case Review
UC Assessment (Form S-11) S-11, S-11 UC Assessment - UC Path Version ,   UC Assessment - UC Portal Version
UC Authorized/Restricted Call List and Call Log (Form S-20) S-20 UC Authorized-Restricted Call List and Call Log - UC Path Version
UC Case Review (Form S-12) S-12, S-12 UC Case Review - UC Path Version ,   UC Case Review - UC Portal Version

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,380,924 888,622 0 3,492,302 0 0
Annual Time Burden (Hours) 1,216,343 384,209 0 832,134 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No