Form P-7 Intakes Placement Checklist

OMB 0970-#### [Valid through MM/DD/2020]

Intakes Placement Checklist
Office of Refugee Resettlement
ORR staff use this Intakes Placement Checklist to determine the initial placement of UAC who may require placement
in a restrictive setting, such as a staff secure or secure facility. An ORR Federal Field Specialist approves the final
placement decision.
1. UAC INFORMATION
Alien Number:

DOB:

Previously in ORR
Custody

Name (Last, First):
Date of Referral:
Gender:

Age:

Male
■

Female

2. PLACEMENT DETERMINATION
Intakes Staff:
Recommended Placement:
Staff Secure
Secure
Shelter/TFC

Approving FFS:

Therapeutic

FFS Decision:

(select)

RTC

Final Placement Determination:
Staff Secure
Secure

Country of Origin:

Therapeutic

Designated Placement:

RTC

Shelter/TFC

Reason for FFS override of Intakes’ recommendation, if applicable:

3. ESCAPE RISK

Any positive indication of escape risk meets minimum requirements for designation to a staff secure facility.

Yes

No

Yes

No

Yes

No

Yes

No

Referral indicates that UAC has attempted to escape or expressed intent to escape from
detention or government custody.
UAC was previously in ORR care and has SIR(s) for attempting to escape or expressing intent
to escape from ORR custody.
UAC will be turning 18 years of age in the next month.
UAC has immigration history that includes: 1) a final order of removal 2) prior breach of bond
3) failure to appear before DHS or the immigration court 4) previous repatriation to home
country.

4. DANGER TO SELF

Any positive indication of danger to self meets the minimum requirements for designation to a therapeutic or secure facility.

Yes

No

Yes

No

Referral indicates that UAC has committed or attempted an act of self-harm, or threatened to
harm him/herself while in the custody of the referring agency.
UAC was previously in ORR care and has SIR(s) for committing, attempting or threatening to
harm him/herself.

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 determine whether initial placement in a restrictive
setting is appropriate for a UAC. Public reporting burden for this collection of information is estimated to average 0.25 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 [email protected].

5.

DANGER TO OTHERS

UAC are not placed in a secure facility absent a determination that the child poses a danger to self, others, or has been charged with
having committed a criminal offense. In assessing danger, ORR considers criminal history, gang affiliation that requires further
assessment, and/or sexual predatory behavior/inappropriate sexual behavior. ORR considers certain criminal history as evidence of
danger as provided below.

A. CRIMINAL HISTORY

Criminal history or behavior meets the minimum requirements for placement into a secure care provider if it: 1) involved an element
of violence from the action, threat or harassment; 2) involved multiple incidents of the same offense (showing a pattern or practice
of criminal activity); or, 3) involved different incidents of separate offenses. Criminal history not falling into one of these three
categories does not meet the “dangerousness” requirement for placement in a secure facility, but may justify placement in a staff
secure facility.

Yes

No

Yes

No

Violent Offenses
Yes

No

Multiple
Counts/Offenses
Yes
No

The UAC has been charged with or convicted of a crime or been adjudicated delinquent; or, is
subject to delinquency proceedings or other criminal proceedings.
The referral indicates that the UAC has committed a crime or delinquent act that he/she is
"chargeable" for. NOTE: "Chargeable" means that there is probable cause (based on a law
enforcement officer's judgment) that the UAC committed the specified offense.
UAC has criminal offenses, is chargable with, or has made threats involving violence against
a victim including the following (indicate specific offenses):
Assault/Battery
Kidnapping
Sexual Assault/Rape
Robbery

Homicide

Serious Moving Violation (reckless driving)

Crimes involving a minor victim
(child molestation; child abuse;
possession or distribution of child
pornography; statutory rape)

Threats or behavior intended to physically
harm, harass or intimidate another
individual (bullying; threats while in
government custody)

Other Offenses
Yes
No
Multiple
Counts/Offenses
Yes
No
If YES did the
multiple counts
stem from
different
incidents in
time?
Yes
No

Possession of a deadly weapon
(including use of a vehicle as a weapon)
Alien smuggling/trafficking in persons

UAC has other criminal offenses or is chargeable with the following (indicate specific offenses):
Burglary/ Breaking and Entering

Soliciting a Prostitute

Arson
Destruction of Property/Vandalism

Pandering
Theft (including petty theft)

Drug Smuggling
Fraud (identity theft, possession or use
of fraudulent documents, grifting,
forgery)
Drug Possession (including with intent to
distribute)
Status Offense (A crime only a minor
could
commit,
examples
include
possession of alcohol by a minor, curfew
violations, truancy).

Shoplifting

Intakes Placement Checklist, 11/02/2018
ORR UAC/P-7

Moving violation (DUI/DWI; speeding;
running a stop sign)

Other (describe):

B. GANG AFFILIATION
Attach referring agency’s basis (if not in the UAC Portal) for determining gang affiliation.
Yes
No
Referral indicates that referring agency has identified the UAC as affiliated with a gang based
on admissions by the UAC or UAC displays gang affiliation.
Yes

No

Yes

No

Referring agency suspects the UAC is affiliated with a gang. Basis for suspicion must be
included in referral notes. If the UAC was previously in ORR custody and released to
a sponsor; and re-referred to ORR custody only because of the UAC’s alleged gang
ties, DHS must submit a copy of the Saravia order with the new referral.
UAC was previously in ORR care and ORR records indicate UAC is affiliated with a gang.

C. SEXUAL PREDATION

Any positive indication or history of sexual predatory behavior or engaging in inappropriate sexual behavior meets minimum
requirement for placement to a therapeutic or secure facility. “Sexual predatory behavior” refers to a UAC with (1) a history of sexual
assault or sexual harassment, (2) that is part of a pattern of behavior with the goal of committing a sexually based crime, and (3)
that is based on a mental disorder or impulse. ORR may consider case history (e.g., law enforcement or court records, ORR custodial
documents such as SIRs) and/or self-disclosures related to the UAC’s history to determine whether their conduct is predatory in
nature.

Yes

No

Referral indicates the referring agency has evidence that the UAC has a history of or displays
sexual predatory behavior or engaged in inappropriate sexual behavior.

Yes

No

UAC was previously in ORR care and ORR records indicate the UAC has sexual predatory
behavior or engaged in inappropriate sexual behavior.

D. CONDUCT IN ORR CUSTODY

A UAC’s conduct in ORR custody that indicates dangerousness may justify placement into a secure facility. Previous SIRs or other
internal ORR documents indicating dangerousness are submitted in support of this finding.

Yes

No

UAC was previously in ORR care and ORR records indicate the UAC committed, or made
credible threats, to commit a violent or malicious act while in ORR custody

Intakes Placement Checklist, 11/02/2018
ORR UAC/P-7