Information Collection

Notice of Placement in a Restrictive Setting (Form P-4/4s)

IC 242789 under ICR 202110-0970-001 · OMB 0970-0554.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0554 can be found here:

Documents and Forms

Document Name Document Type
Form P-4 Notice of Placement in a Restrictive Setting (Form P-4/4s) Form and Instruction
P-4 Notice of Placement in a Restrictive Setting (English) Notice of Placement in a Restrictive Setting - Eng (Form P-4) - UC Path.pdf Form and Instruction
P-4s Notice of Placement in a Restrictive Setting (Spanish) Notice of Placement in a Restrictive Setting - Span (Form P-4s) - UC Path.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice of Placement in a Restrictive Setting (Form P-4/4s)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	P-4	Notice of Placement in a Restrictive Setting (English)	Notice of Placement in a Restrictive Setting - Eng (Form P-4) - UC Path.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	P-4s	Notice of Placement in a Restrictive Setting (Spanish)	Notice of Placement in a Restrictive Setting - Span (Form P-4s) - UC Path.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: 09-80-0321 ORR Division of Children's Services Records	FR Citation: 81 FR 46682

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	510	-510	1,020
Annual IC Time Burden (Hours)	170	-170	340
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.