Individual 504 Service Plan (Form S-25) – Care Provider Case Manager

Services for Unaccompanied Alien Children with Disabilities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0643 can be found here:

Documents and Forms

Document Name Document Type
Form S-25 Individual 504 Service Plan (Form S-25) – Care Provider Case Manager Form and Instruction
S-25 Individual 504 Service Plan S-25 Individualized Section 504 Service Plan_Final Draft_2025 03 06.pdf Form and Instruction
S-25 Individual 504 Service Plan S-25 Individualized Section 504 Service Plan_Final Draft_2025 03 06.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Individual 504 Service Plan (Form S-25) – Care Provider Case Manager	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	S-25	Individual 504 Service Plan	S-25 Individualized Section 504 Service Plan_Final Draft_2025 03 06.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: ORR Unaccompanied Children Bureau (UCB) Administrative Program Records	FR Citation: 89 FR 100500

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,100	2,100
Annual IC Time Burden (Hours)	6,300	6,300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.