Information Collection

Individual 504 Service Plan (Form S-25) – Care Provider Case Manager

IC 274814 under ICR 202603-0970-010 · OMB 0970-0643.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form S-25 Individual 504 Service Plan Individual 504 Service Plan (Form S-25) – Care Provider Case Manager	Form and Instruction
Form S-25 (Spanish) Individualized Section 504 Service Plan - Spanish Individual 504 Service Plan (Form S-25) – Care Provider Case Manager	Form and Instruction
S-25 Individual 504 Service Plan S-25 (ENG) Individualized Section 504 Service Plan_v2_English_CLEAN (03.13.26).docx	Form and Instruction
S-25 (Spanish) Individualized Section 504 Service Plan - Spanish S-25 (SPA) Individualized Section 504 Service Plan_v2_Spanish_CLEAN (03.13.26).docx	Form and Instruction

IC Title:

Individual 504 Service Plan (Form S-25) â Care Provider Case Manager

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-25				Yes	Yes	Fillable Fileable
Form and Instruction	S-25 (Spanish)				Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: ORR Unaccompanied Children Bureau (UCB) Administrative Program Records

FR Citation: 89 FR 100500

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,100	2,100
Annual IC Time Burden (Hours)	6,300	6,300
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.

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