Form R-2 Discharge Notification - UC Path Version

Discharge Notification (Form R-2)
Data Entry Window

OMB 0970-0552 [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 ORR to notify stakeholders of the transfer of a UAC to another care provider facility
or the release of a UAC from ORR custody. Public reporting burden for this collection of information is estimated to
average 0.17 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). 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-R-2 [Rev. MM/DD/YYYY]

Discharge Notification Page

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OMB 0970-0552 [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 ORR to notify stakeholders of the transfer of a
UAC to another care provider facility or the release of a UAC from ORR custody. Public reporting burden for this collection of information is estimated to average 0.17 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). 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-R-2 [Rev. MM/DD/YYYY]

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