Information Collection

Release Request (Form R-4) - Modernized UC Portal - Case Coordinator

IC 264190 under ICR 202401-0970-003 · OMB 0970-0552.

Documents and Forms

Document Name Document Type
Form R-4 Release Request (Form R-4) - Modernized UC Portal - Case Coordinator Form and Instruction
R-4 Release Request - Modernized UC Portal Version Program Exit Processing (Form R-10) - Modernized UC Portal.docx Form and Instruction
R-4 Release Request - Modernized UC Portal Version Program Exit Processing (Form R-10) - Modernized UC Portal.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Release Request (Form R-4) - Modernized UC Portal - Case Coordinator	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	R-4	Release Request - Modernized UC Portal Version	Program Exit Processing (Form R-10) - Modernized 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: 170	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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	128,520	128,520
Annual IC Time Burden (Hours)	64,260	64,260
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.