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Federal Register / Vol. 86, No. 36 / Thursday, February 25, 2021 / Notices
reworded some of the fields. No changes were made to the content.
11. 30 Day Restrictive Placement Case Review formerly titled Summary Notes:
Thirty Day Restrictive Placement Case Review Form S16: This instrument is used by care providers to document their 30-day review for UAC in placed in a restrictive setting. ORR revised the formatting and added the following fields: Out-of-Network RTC Provider, Case Manager Name, Case Coordinator Name, FFS Name, Name and Title, and Date.
12. Admission Form S18: This instrument is used by ORR grantee case managers and clinicians to document the UACs initial needs, functioning, and history. Other instruments are also accessible from within the Admission instrument, such as transfer requests, travel requests, and various child assessments. This is a new instrument that ORR plans to add to this collection.
13. Home Study/Post-Release Service HS/PRS Referral Form S19: This instrument is used by ORR grantee case managers to refer a UAC for a home study and/or post-release services. This is a new instrument that ORR plans to add to this collection.
14. UAC Authorized/Restricted Call List and Call Log Form S20: This instrument is used by case managers to create a list of authorized and restricted contacts to ensure safe communication for the UAC and document the details of phone calls made by a UAC. This is a new instrument that ORR plans to add to this collection.

15. Home Study/Post-Release Service HS/PRS Primary Provider Entity Form S21A: This instrument is used by grantee HS/PRS providers to add identifying information about their organization into the UAC Path system.
Each organization only needs to be created once. Field values may be updated as often as needed. This is a new instrument that ORR plans to add to this collection.
16. Home Study/Post-Release Service HS/PRS Subcontractor Entity Form S
21B: Entity record. Each organization only needs to be created once. Field values may be updated as often as needed. This is a new instrument that ORR plans to add to this collection.
17. Home Study/Post-Release Service HS/PRS Primary Provider Profile Form S21C: This instrument is used by HS/PRS providers to add identifying information about caseworkers employed by their organization. Each organization only needs to be created once. Field values may be updated as often as needed. This is a new instrument that ORR plans to add to this collection.
18. Home Study/Post-Release Service HS/PRS Subcontractor Profile Form S21D: This instrument is used by HS/
PRS providers to add identifying information about caseworkers employed their sub-grantee organizations. Each organization only needs to be created once. Field values may be updated as often as needed. This is a new instrument that ORR plans to add to this collection.

19. Post-Release Service PRS Event Form S22: This instrument is used by post-release service caseworkers to document referrals made and services provided at critical junctures of service provision, such as 14 day, 6 month, 12
month, and closure. The instrument contains auto-populated sponsor information and areas to document information about the HS/PRS provider, reason for referral, the minors placement and safety status, and services areas addressed. This is a new instrument that ORR plans to add to this collection.
20. Case Manager Call Log and Case Notes Form S23: This instrument is used by case managers to log any contact in-person, phone, video, social media, or mail they make in relation to the UACs case, including any related notes. This is a new instrument that ORR plans to add to this collection.
21. Sponsor Application Form S24:
This instrument is used by care providers to document certain information and milestones in the sponsor application process. This is a new instrument that ORR plans to add to this collection.
22. Ohio Youth Assessment System OYAS Reentry Tool: No changes were made to this instrument.
23. UAC Case Status: ORR is discontinuing this instrument.
Respondents: ORR grantee and contractor staff; UAC; sponsors; and child advocates.

ANNUAL BURDEN ESTIMATES

Sponsor Assessment Form S5
Home Study Assessment Form S6
Adult Contact Profile Form S7
Initial Intakes Assessment Form S8
Assessment for Risk Form S9
UAC Assessment Form S11
UAC Case Review Form S12
Individual Service Plan Form S13
Long Term Foster Care Travel Request Form S14
Child Advocate Recommendation and Appointment Form S15
Thirty Day Restrictive Placement Case Review Form S16
Admission Form S18
Home Study/Post-Release Service HS/PRS Referral Form S19
UAC Authorized/Restricted Call List and Call Log Form S20
Home Study/Post-Release Service HS/PRS Primary Provider Entity Form S21A
Home Study/Post-Release Service HS/PRS Subcontractor Entity Form S21B
Home Study/Post-Release Service HS/PRS Primary Provider Profile Form S21C
Home Study/Post-Release Service HS/PRS Subcontractor Profile Form S21D
Post-Release Service PRS Event Form S22
Case Manager Call Log and Case Notes Form S23

VerDate Sep<11>2014

17:04 Feb 24, 2021

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Annual number of responses per respondent
Annual number of respondents
Information collection title
Frm 00046

Fmt 4703

Sfmt 4703

Average burden minutes per response
Annual total burden hours
216
60
216
216
216
216
216
216
30
216
15
216
216
216

265
81
1,324
278
556
278
556
694
8 5
67
278
68
6,981

60
45
45
20
45
120
120
20
20
15
45
20
20
5

57,240
3,645
214,488
20,016
90,072
120,096
240,192
49,968
80
270
754
20,016
4,896
125,658

9

1

5

1

51

1

5

4

9

13

5

10

51
60
216

13
968
8,426

5
60
5

55
58,080
151,668

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