Form S-23 Case Manager Call Log and Case Notes

Case Manager Call Log and Case Notes (Form S-23)
CM/Notes/Contacts 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 case managers to log any
contact (in-person, phone, video, social media, or mail) they make in relation to the UAC’s case, including any related notes. 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-23 [Rev. MM/DD/YYYY]

Log a Note/Contact 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 case
managers to log any contact (in-person, phone, video, social media, or mail) they make in relation to the UAC’s case, including any related notes. 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-23 [Rev. MM/DD/YYYY]