Form S-6 Home Study Assessment - UC Path Version

Home Study Assessment (Form S-6)
Background & Overview Tab

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow home study providers to document their assessment of a potential sponsor after performing a home site visit. Public
reporting burden for this collection of information is estimated to average 0.75 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 UCPolicy@acf.hhs.gov.
UAC-S-6 [Rev. MM/DD/YYYY]

Sponsor Background Tab

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow home study providers to
document their assessment of a potential sponsor after performing a home site visit. Public reporting burden for this collection of information is estimated to average 0.75
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 UCPolicy@acf.hhs.gov.
UAC-S-6 [Rev. MM/DD/YYYY]

Home Community Tab

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow home study providers to
document their assessment of a potential sponsor after performing a home site visit. Public reporting burden for this collection of information is estimated to average 0.75
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 UCPolicy@acf.hhs.gov.
UAC-S-6 [Rev. MM/DD/YYYY]

Home Community Tab – Community Resource Data Entry Window

Summary & Certification Tab

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow home study providers to
document their assessment of a potential sponsor after performing a home site visit. Public reporting burden for this collection of information is estimated to average 0.75
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 UCPolicy@acf.hhs.gov.
UAC-S-6 [Rev. MM/DD/YYYY]