Information Collection

UC Assessment (Form S-11)

IC 242809 under ICR 202310-0970-013 · OMB 0970-0553.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0553 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form S-11 UC Assessment (Form S-11)	Form and Instruction
S-11 UC Assessment - UC Path Version UC Assessment (Form S-11) - UC Path.pdf	Form and Instruction
S-11 UC Assessment - UC Portal Version S-11 UC Assessment - New UC Portal.docx	Form and Instruction

IC Title:

UC Assessment (Form S-11)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	S-11	UC Assessment - UC Path Version	UC Assessment (Form S-11) - UC Path.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	S-11	UC Assessment - UC Portal Version	S-11 UC Assessment - New UC Portal.docx		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: 216

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	60,048	60,048
Annual IC Time Burden (Hours)	120,096	120,096
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.