S-21A HS-PRS Primary Provider Entity

HS/PRS Primary Provider Entity (Form S-21A)
Data Entry Window
OMB 0970-#### [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 and post-release service providers to add identifying information about their organization into
the system. 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 UACPolicy@acf.hhs.gov.
UAC-S-21A [Rev. MM/DD/YYYY]

HS/PRS Primary Provider Entity Page – Details Tab

OMB 0970-#### [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 and post-release service providers to add identifying information about their organization into the
system. 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 UACPolicy@acf.hhs.gov.
UAC-S-21A [Rev. MM/DD/YYYY]

HS/PRS Primary Provider Entity Page – Subcontractors Tab

OMB 0970-#### [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 and post-release service providers to add identifying information about their organization into the
system. 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 UACPolicy@acf.hhs.gov.
UAC-S-21A [Rev. MM/DD/YYYY]