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Federal forms, ICRs, and supporting documents

Information Collection Request

ICR 202309-0970-010 · OMB 0970-0553 · Public filing

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 UC Case Status Form and Instruction Unchanged Available
Form 1 UC Case Status Form and Instruction Unchanged Repair queued
Form S-24 Sponsor Application Form and Instruction Unchanged Repair queued
Form S-24 Sponsor Application (Form S-24) Form and Instruction Unchanged Repair queued
Form S-23 Case Manager Call Log and Case Notes Form and Instruction Unchanged Available
Form S-23 Case Manager Call Log and Case Notes (Form S-23) Form and Instruction Unchanged Repair queued
Form S-22 Post-Release Service (PRS) Event Form and Instruction Unchanged Available
Form S-22 Post-Release Service (PRS) Event (Form S-22) Form and Instruction Unchanged Repair queued
Form S-21D Home Study/Post-Release Service (HS/PRS) Subcontractor Profile Form and Instruction Unchanged Available
Form S-21D Home Study/Post-Release Service (HS/PRS) Subcontractor Profile (Form S-21D) Form and Instruction Unchanged Repair queued
Form S-21C Home Study/Post-Release Service (HS/PRS) Primary Provider Profile Form and Instruction Unchanged Available
Form S-21C Home Study/Post-Release Service (HS/PRS) Primary Provider Profile (Form S-21C) Form and Instruction Unchanged Repair queued
Form S-21B Home Study/Post-Release Service (HS/PRS) Subcontractor Entity Form and Instruction Unchanged Available
Form S-21B Home Study/Post-Release Service (HS/PRS) Subcontractor Entity (Form S-21B) Form and Instruction Unchanged Repair queued
Form S-21A HS-PRS Primary Provider Entity Form and Instruction Unchanged Available
Form S-21A Home Study/Post-Release Service (HS/PRS) Primary Provider Entity (Form S-21A) Form and Instruction Unchanged Repair queued
Form S-20 UC Authorized-Restricted Call List and Call Log - UC Path Version Form and Instruction Unchanged Available
Form S-20 UC Authorized/Restricted Call List and Call Log (Form S-20) Form and Instruction Unchanged Repair queued
Form S-19 HS-PRS Referral - UC Path Version Form and Instruction Unchanged Available
Form S-19 Home Study/Post-Release Service (HS/PRS) Referral (Form S-19) Form and Instruction Unchanged Repair queued
Form S-18 Admission Form and Instruction Unchanged Available
Form S-18 Admission (Form S-18) Form and Instruction Unchanged Repair queued
Form S-16 Thirty Day Restrictive Placement Case Review Form and Instruction Removed Available
Form S-16 Thirty Day Restrictive Placement Case Review (Form S-16) Form and Instruction Removed Repair queued
Form S-15 Child Advocate Recommendation and Appointment Form and Instruction Unchanged Available
Form S-15 Child Advocate Recommendation and Appointment (Form S-15) Form and Instruction Unchanged Repair queued
Form S-14 Long Term Foster Care Travel Request - UC Portal Version Form and Instruction Unchanged Available
Form S-14 Long Term Foster Care Travel Request - UC Path Version Form and Instruction Unchanged Available
Form S-14 Long Term Foster Care Travel Request (Form S-14) Form and Instruction Unchanged Repair queued
Form S-13 Individual Service Plan - UC Portal Version Form and Instruction Unchanged Repair queued
Form S-13 Individual Service Plan - UC Path Version Form and Instruction Unchanged Available
Form S-13 Individual Service Plan (Form S-13) Form and Instruction Unchanged Repair queued
Form S-12 UC Case Review - UC Portal Version Form and Instruction Unchanged Available
Form S-12 UC Case Review - UC Path Version Form and Instruction Unchanged Available
Form S-12 UC Case Review (Form S-12) Form and Instruction Unchanged Repair queued
Form S-11 UC Assessment - UC Portal Version Form and Instruction Unchanged Available
Form S-11 UC Assessment - UC Path Version Form and Instruction Unchanged Available
Form S-11 UC Assessment (Form S-11) Form and Instruction Unchanged Repair queued
Form S-9 Assessment for Risk - UC Portal Version Form and Instruction Unchanged Available
Form S-9 Assessment for Risk - UC Path Version Form and Instruction Unchanged Available
Form S-9 Assessment for Risk (Form S-9) Form and Instruction Unchanged Repair queued
Form S-8 Initial Intakes Assessment - UC Portal Version Form and Instruction Modified Available
Form S-8 Initial Intakes Assessment (Form S-8) - UC Path Version Form and Instruction Modified Available
Form S-8 Initial Intakes Assessment (Form S-8) Form and Instruction Modified Repair queued
Form S-5 Sponsor Assessment - New UC Portal Form and Instruction Unchanged Available
Form S-7 Adult Contact Profile Form and Instruction Unchanged Available
Form S-7 Adult Contact Profile (Portal Form S-5; Path Form S-7) Form and Instruction Unchanged Repair queued
Form S-6 Home Study Assessment - Word Version Form and Instruction Unchanged Repair queued
Form S-6 Home Study Assessment - UC Path Version Form and Instruction Unchanged Available
Form S-6 Home Study Assessment (Form S-6) Form and Instruction Unchanged Repair queued
Form S-5 Sponsor Assessment - New UC Portal Form and Instruction Modified Available
Form S-5 Sponsor Assessment - UC Path Version Form and Instruction Modified Available
Form S-5 Sponsor Assessment (Form S-5) Form and Instruction Modified Repair queued
Nonsub Memo_0970-0553_Services_008 _2023 09 25.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-09-25 Repair queued
Nonsub Memo_0970-0553_Services_006 _2023 07 25.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-07-25 Repair queued
Appendix B - S-5 Sponsor Assessment - Flags Section Mockup.pdf Supplementary Document Uploaded 2023-07-25 Repair queued
Appendix A - Proposed Revisions for S-5 Sponsor Assessment - Flags Section.xlsx Supplementary Document Uploaded 2023-07-25 Repair queued
0970-0553_Services_NonSub Change Request _UC Case Status_2022 05 23.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-06-09 Repair queued
0970-0553 NonSub Change Request Memo (04.21.22).docx Justification for No Material/Nonsubstantive Change Uploaded 2022-04-22 Repair queued
SSA Attachment A_0970-0553_Services_003_2022 04 20.docx Supplementary Document Uploaded 2022-04-20 Repair queued
SSA_0970-0553_Services_003_2022 4 22 UPDATED.docx Supporting Statement A Uploaded 2022-04-22 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
249583 UC Case Status Form and Instruction UnchangedUC Case Status
249583 UC Case Status Form and Instruction Unchanged
249581 Sponsor Application (Form S-24) Form and Instruction UnchangedSponsor Application
249581 Sponsor Application (Form S-24) Form and Instruction Unchanged
249580 Case Manager Call Log and Case Notes (Form S-23) Form and Instruction UnchangedCase Manager Call Log and Case Notes
249580 Case Manager Call Log and Case Notes (Form S-23) Form and Instruction Unchanged
249579 Post-Release Service (PRS) Event (Form S-22) Form and Instruction UnchangedPost-Release Service (PRS) Event
249579 Post-Release Service (PRS) Event (Form S-22) Form and Instruction Unchanged
249578 Home Study/Post-Release Service (HS/PRS) Subcontractor Profile (Form S-21D) Form and Instruction UnchangedHome Study/Post-Release Service (HS/PRS) Subcontractor Profile
249578 Home Study/Post-Release Service (HS/PRS) Subcontractor Profile (Form S-21D) Form and Instruction Unchanged
249577 Home Study/Post-Release Service (HS/PRS) Primary Provider Profile (Form S-21C) Form and Instruction UnchangedHome Study/Post-Release Service (HS/PRS) Primary Provider Profile
249577 Home Study/Post-Release Service (HS/PRS) Primary Provider Profile (Form S-21C) Form and Instruction Unchanged
249576 Home Study/Post-Release Service (HS/PRS) Subcontractor Entity (Form S-21B) Form and Instruction UnchangedHome Study/Post-Release Service (HS/PRS) Subcontractor Entity
249576 Home Study/Post-Release Service (HS/PRS) Subcontractor Entity (Form S-21B) Form and Instruction Unchanged
249575 Home Study/Post-Release Service (HS/PRS) Primary Provider Entity (Form S-21A) Form and Instruction UnchangedHS-PRS Primary Provider Entity
249575 Home Study/Post-Release Service (HS/PRS) Primary Provider Entity (Form S-21A) Form and Instruction Unchanged
249574 UC Authorized/Restricted Call List and Call Log (Form S-20) Form and Instruction UnchangedUC Authorized-Restricted Call List and Call Log - UC Path Version
249574 UC Authorized/Restricted Call List and Call Log (Form S-20) Form and Instruction Unchanged
249573 Home Study/Post-Release Service (HS/PRS) Referral (Form S-19) Form and Instruction UnchangedHS-PRS Referral - UC Path Version
249573 Home Study/Post-Release Service (HS/PRS) Referral (Form S-19) Form and Instruction Unchanged
242815 Admission (Form S-18) Form and Instruction UnchangedAdmission
242815 Admission (Form S-18) Form and Instruction Unchanged
242814 Thirty Day Restrictive Placement Case Review (Form S-16) Form and Instruction RemovedThirty Day Restrictive Placement Case Review
242814 Thirty Day Restrictive Placement Case Review (Form S-16) Form and Instruction Removed
242813 Child Advocate Recommendation and Appointment (Form S-15) Form and Instruction UnchangedChild Advocate Recommendation and Appointment
242813 Child Advocate Recommendation and Appointment (Form S-15) Form and Instruction Unchanged
242812 Long Term Foster Care Travel Request (Form S-14) Form and Instruction UnchangedLong Term Foster Care Travel Request - UC Portal Version
242812 Long Term Foster Care Travel Request (Form S-14) Form and Instruction UnchangedLong Term Foster Care Travel Request - UC Path Version
242812 Long Term Foster Care Travel Request (Form S-14) Form and Instruction Unchanged
242811 Individual Service Plan (Form S-13) Form and Instruction UnchangedIndividual Service Plan - UC Portal Version
242811 Individual Service Plan (Form S-13) Form and Instruction UnchangedIndividual Service Plan - UC Path Version
242811 Individual Service Plan (Form S-13) Form and Instruction Unchanged
242810 UC Case Review (Form S-12) Form and Instruction UnchangedUC Case Review - UC Portal Version
242810 UC Case Review (Form S-12) Form and Instruction UnchangedUC Case Review - UC Path Version
242810 UC Case Review (Form S-12) Form and Instruction Unchanged
242809 UC Assessment (Form S-11) Form and Instruction UnchangedUC Assessment - UC Portal Version
242809 UC Assessment (Form S-11) Form and Instruction UnchangedUC Assessment - UC Path Version
242809 UC Assessment (Form S-11) Form and Instruction Unchanged
242808 Assessment for Risk (Form S-9) Form and Instruction UnchangedAssessment for Risk - UC Portal Version
242808 Assessment for Risk (Form S-9) Form and Instruction UnchangedAssessment for Risk - UC Path Version
242808 Assessment for Risk (Form S-9) Form and Instruction Unchanged
242807 Initial Intakes Assessment (Form S-8) Form and Instruction ModifiedInitial Intakes Assessment - UC Portal Version
242807 Initial Intakes Assessment (Form S-8) Form and Instruction ModifiedInitial Intakes Assessment (Form S-8) - UC Path Version
242807 Initial Intakes Assessment (Form S-8) Form and Instruction Modified
242806 Adult Contact Profile (Portal Form S-5; Path Form S-7) Form and Instruction UnchangedSponsor Assessment - New UC Portal
242806 Adult Contact Profile (Portal Form S-5; Path Form S-7) Form and Instruction UnchangedAdult Contact Profile
242806 Adult Contact Profile (Portal Form S-5; Path Form S-7) Form and Instruction Unchanged
242805 Home Study Assessment (Form S-6) Form and Instruction UnchangedHome Study Assessment - Word Version
242805 Home Study Assessment (Form S-6) Form and Instruction UnchangedHome Study Assessment - UC Path Version
242805 Home Study Assessment (Form S-6) Form and Instruction Unchanged
242804 Sponsor Assessment (Form S-5) Form and Instruction ModifiedSponsor Assessment - New UC Portal
242804 Sponsor Assessment (Form S-5) Form and Instruction ModifiedSponsor Assessment - UC Path Version
242804 Sponsor Assessment (Form S-5) Form and Instruction Modified

ICR Details

Record metadata
OMB Control No0970-0553