Form S-20 UAC Authorized/ Restricted Call List and Call Log (Form

UAC Authorized/ Restricted Call List and Call Log (Form S-20)

UC Path Version

OMB# 0970-0553

Call Logs Tab - DISPLAY

Details

Legal

Call Logs

Restricted Contacts List (## COUNT) – System Generated

Contact Name	Relationship to UAC	Proof of Relationship	Phone Number	Contact Approved
(Auto Populate)	(Auto Populate)	(Auto Populate)	(Auto Populate)	(Auto Populate)

Authorized Contacts List (##COUNT) - SYSTEM GENERATED

Contact Name	Relationship to UAC	Proof of Relationship	Phone Number	Contact Approved	Call Supervision Required?
(Auto Populate)	(Auto Populate)	(Auto Populate)	(Auto Populate)	(Auto Populate)	(Auto Populate)

>|New Contact

>|New Contact

>|Add New Call

UAC Call Log (## COUNT) – System Generated

Contact Name	Date of Call	Call Duration	Supervision Required?	Supervised by:	Call Method
<Dropdown Menu> (-Select One – Authorized Contacts List: NAME 1; NAME 2, etc.)	<Pop Up Calendar> (MM/DD/YYYY)	(Open Text)	(Auto Populate)	(Open Text)	<Dropdown Menu> (-Select One- Phone; Video call)

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow case managers to create a list of authorized and restricted contacts to ensure safe communication for the UC and document the details of phone calls made by a UAC. Public reporting burden for this collection of information is estimated to average 0.08 hours per response, including the time for reviewing instructions, gathering, and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security Act, 6 U.S.C. 279, and Trafficking Victims Protection Reauthorization Act, 8 U.S.C. 1232). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information, please contact [email protected].

Authorized and Restricted Contacts List Data Entry Window

New Relationship: Family Friend

Family & Friends Details
*First Name	(Open Text)	*Type	<Dropdown Menu>
*Last Name	(Open Text)	*Relationship to UAC	<Dropdown Menu>
*UAC	(Auto-Populate)	DOB	<Pop-Out Calendar>
Address	(Open Text)	*Phone	(Open Text)
Last Contact with This Person?	<Pop-Out Calendar>	Current Location	(Open Text)
		Country	<Dropdown Menu>
Common Child Information (Not in ORR)
Child First Name	(Open Text)	Child Current Location	(Open Text)
Child Last Name	(Open Text)	Other Parent Information	(Open Text)
Child DOB	(Open Text)
Contact Details
Proof of Relationship	<Dropdown Menu>	Contact Restricted Date	<Pop-Out Calendar>
Notes	(Open Text)	Contact Unrestricted Date	<Pop-Out Calendar>
Contact Approved Date	<Pop-Out Calendar>	Unrestricted Notes	(Open Text)
Contact Discontinued Date	<Pop-Out Calendar>	Contact Type	<Dropdown Menu>
Discontinued Notes	(Open Text)	Call Supervision Required?	<Dropdown Menu> Yes; No
System Information
Record Type		Admission Assessment	(Open Text Search Bar)

>|Save

>| Save & New

>|New

Family & Friends Details
*First Name	(Open Text)	*Type	<Dropdown Menu>
*Last Name	(Open Text)	*Relationship to UAC	<Dropdown Menu>
*UC	(Auto-Populate)	DOB	<Pop-Out Calendar>
Address	(Open Text)	*Phone	(Open Text)
Last Contact with This Person?	<Pop-Out Calendar>	Current Location	(Open Text)
		Country	<Dropdown Menu>
Common Child Information (Not in ORR)
Child First Name	(Open Text)	Child Current Location	(Open Text)
Child Last Name	(Open Text)	Other Parent Information	(Open Text)
Child DOB	(Open Text)
Contact Details
Proof of Relationship	<Dropdown Menu>	Contact Restricted Date	<Pop-Out Calendar>
Notes	(Open Text)	Contact Unrestricted Date	<Pop-Out Calendar>
Contact Approved Date	<Pop-Out Calendar>	Unrestricted Notes	(Open Text)
Contact Discontinued Date	<Pop-Out Calendar>	Contact Type	<Dropdown Menu>
Discontinued Notes	(Open Text)	Call Supervision Required?	<Dropdown Menu> Yes; No
System Information
Record Type		Admission Assessment	(Open Text Search Bar)

Relationship: (Profile Name) SYSTEM GENERATED

>| Edit

>| Delete

Details

Family & Friends Details
*First Name	(Auto-Populate) editable	*Type	(Auto-Populate) editable
*Last Name	(Auto-Populate) editable	*Relationship to UAC	(Auto-Populate) editable
Age	SYSTEM GENERATED	DOB	(Auto-Populate) editable
*UAC	(Auto-Populate)	*Phone	(Auto-Populate) editable
Address	(Auto-Populate) editable	Current Location	(Auto-Populate) editable
Last Contact with This Person?	(Auto-Populate) editable	Country	(Auto-Populate) editable
Common Child Information (Not in ORR)
Child First Name	(Auto-Populate) editable	Child Age	SYSTEM GENERATED
Child Last Name	(Auto-Populate) editable	Child Current Location	(Auto-Populate) editable
Child DOB	(Auto-Populate) editable	Other Parent Information	(Auto-Populate) editable
Contact Details
Proof of Relationship	(Auto-Populate) editable	Contact Restricted Date	(Auto-Populate) editable
Notes	(Auto-Populate) editable	Contact Unrestricted Date	(Auto-Populate) editable
Contact Approved Date	(Auto-Populate) editable	Unrestricted Notes	(Auto-Populate) editable
Contact Discontinued Date	(Auto-Populate) editable	Contact Type	(Auto-Populate) editable
Discontinued Notes	(Auto-Populate) editable	Call Supervision Required?	Yes/ No
System Information
Created By	(Auto-Populate)	Last Modified By	(Auto-Populate)
Record Type	(Auto-Populate)	Admission Assessment	(Auto-Populate) editable

Relationship History (## - Count) – SYSTEM GENERATED ## Count Item – Updated ## (time duration since previous update)						(Settings)	(Reload)
SYSTEM GENERATED Item list	Date	Field		User		Original Value	New Value
1	<Popup Calendar Auto-populate	(Auto-Populate)		(Auto-Populate)		(Auto-Populate)	(Auto-Populate)
			>| View All

UAC Authorized/ Restricted Call List and Call Log – UAC Contact Profile Display

UAC Authorized/ Restricted Call List and Call Log – UAC Call Log Data Entry Window

S-20 | Version #.#

Valid Through MM/DD/YYYY

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