Form S-23 Case Manager Call Log and Case Notes

Case Manager Call Log and Case Notes (Form S-23)

UC Path Version

OMB# 0970-0553

CM/ Notes/ Contacts Tab (Display)

Details	Related	CM Notes/ Contacts
CM Notes/ Contacts (# AUTO-POPULATE)			>|Log a Note/ Contact			qRefresh
Task	Contact Outside of U.S.?	Contact	New Case Contact	Type of Contact	Attempt Status	Date/ Time
AUTO-POPULATE	AUTO-POPULATE	AUTO-POPULATE	AUTO-POPULATE	AUTO-POPULATE	AUTO-POPULATE	AUTO-POPULATE

Log a Note/ Contact (Data Entry Window)

New Task: Call Log
Contact
Contact Outside of U.S.?		<Dropdown Menu> (-Select One- Yes; No)		Contact Name:		<Search Field – OPEN TEXT (Help Text: “Search Profiles”)>
				New Case Contact i		(OPEN TEXT)
Call Log
Date*	<POP UP CALENDAR>		Time*	(OPEN TEXT) HH:MM AM/PM	Status*		<Dropdown Menu> (-Select One- Successful; Unsuccessful)
Type*		<Dropdown Menu> (-Select One- Phone Call; In-Person; Video Call; Social Media; Mail)		Duration*		(OPEN TEXT)
Type of Interaction*		(OPEN TEXT)		Contact Details* i		(OPEN TEXT)
Follow Up Action Required?*		<Dropdown Menu> (-Select One- Yes; No)		Comments		(OPEN TEXT)
				Follow Up Action Notes		(OPEN TEXT)
Translation
UAC Primary Language		(OPEN TEXT)		Translation Services Used?		<Dropdown Menu> (-Select One- Yes; No)
Language		(OPEN TEXT)		Translator Name		(OPEN TEXT)
System Information
Name*		AUTO-POPULATE (Case Manager)		Assigned To: *		<Search Field – OPEN TEXT>
Related To:		AUTO-POPULATE (Child’s A#)		Due Date:		<POP UP CALENDAR>
Subject*		<Search Field – OPEN TEXT>
Priority*		<Dropdown Menu> (-Select One- High; Medium; Low)
>|Save >|Cancel >|Save & New

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.

Form S-23 | Version #.#

Valid Through MM/DD/YYYY

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