Form S-5 Sponsor Assessment - UC Path Version

Sponsor Assessment (Form S-5)
Data Entry

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 document the suitability assessment of a potential sponsor to provide for the safety and
well-being of a UAC. Public reporting burden for this collection of information is estimated to average 1.0 hour 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-5 [Rev. MM/DD/YYYY]

Sponsor Assessment Page

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 document the suitability assessment of a potential
sponsor to provide for the safety and well-being of a UAC. Public reporting burden for this collection of information is estimated to average 1.0 hour 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-5 [Rev. MM/DD/YYYY]

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