Form R-4 Release Request - UC Path Version

Release Request (Form R-4)
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 process recommendations and decisions for release of a UAC from ORR custody. Public
reporting burden for this collection of information is estimated to average 0.42 hours per grantee case manager and
0.33 hours per contractor case coordinator (a total of 0.75 hours), 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-4 [Rev. MM/DD/YYYY]

Release Request Page

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 process recommendations and decisions for release
of a UAC from ORR custody. Public reporting burden for this collection of information is estimated to average 0.42 hours per grantee case manager and 0.33 hours per contractor case coordinator
(a total of 0.75 hours), 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-4 [Rev. MM/DD/YYYY]

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