ORR-3 Placement Report Form Instructions
Unaccompanied Refugee Minors (URM) Program
Office of Refugee Resettlement
What is the ORR-3 Report?
An initial placement, change of status, termination, or re-entry report for minors and youth in the URM Program.
Provides basic identifying data, as well as immigration, placement, and legal responsibility data.
Provides the Office of Refugee Resettlement (ORR) with the youth’s current location and status, which meets requirements of the Immigration and Nationality Act (8 U.S.C. 1522(d)).
Assists ORR in understanding program effectiveness and broader planning for the URM Program.
Note 1: Failure to provide these reports may result in delay, suspension, or termination of grant support. Note 2: “URM,” “minor,” or “youth” in the ORR-3 Report Form and Instructions refers to both children under the age of 18 and youth over the age of 18 who are receiving or have received placement, services, and/or benefits funded by ORR. |
Who completes and submits the ORR-3 Report?
The URM provider completes the report form in the URM module of ORR’s Refugee Arrivals Data System (RADS).
Once the report form is completed, the URM provider submits it to the State Agency.
The State Agency then reviews the report and submits it to ORR.
How is the ORR-3 Report structured? There are six sections in the report form.
Section I: Report Action
Section II: Identifying/Basic Data
Section III: Immigration
Section IV: Placement
Section V: Legal Responsibility
Section VI: Report Submission Authority
When are the ORR-3 Reports due?
Initial Placement: due within 30 days of the initial placement into the URM Program.
Change of Status: due within 60 days of the reportable change.
Termination from ORR-funded services: due within 60 days of case closure.
Re-entry for ORR-funded services: due within 60 days of re-entry.
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, the Administration for Children and Families (ACF) is gathering data on youth served through the Unaccompanied Refugee Minors Program including their location, status, and progress. Public reporting burden for this collection of information is estimated to average .25 hours for respondents from state agencies and .50 hours for respondents from provider agencies, 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 (8 U.S.C. 1522(d)). 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 Office of Management and Budget (OMB) control number. The OMB # is 0970-0034 and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact Anne Mullooly at [email protected].
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How is a new URM case created in RADS?
ORR will create case records in RADS for youth who are in the U.S. at the time of referral to the URM Program. However, ORR will not have the case-specific information on a refugee youth who arrives directly to the URM Program from overseas. The URM provider must follow these steps to create a child information record in RADS for refugee youth:
Under the URM menu, navigate to Cases, then select Add New. After clicking on Add New, a New URM Child Information screen will pop up.
From UAC program and HHS Tracking No./Case ID: These fields are not applicable for refugees who arrive to the URM Program directly from overseas.
Alien No: Can be found on the I-94.
Responsible State: Select state where the minor is placed.
Date of Birth: Enter month, day, and year from an official document such as minor’s I-94 or birth certificate.
State Agency: Select name of the state agency (this will only populate after Responsible State is selected).
Responsible Provider: Select local URM provider agency with whom the minor is placed.
Name: Enter minor’s full name including first, last, and middle (if applicable), as it appears on minor’s I-94 or birth certificate. Include any Alias or Also Known As names.
Sex: Select either female or male.
Eligibility Date: Enter the month, day, and year the minor became eligible for services. For refugees, the date of eligibility is the date that the minor arrived in the U.S. and can be found on the I-94. For non-refugee cases, do NOT change the eligibility date that was entered in the case record by ORR. The eligibility date for youth who are in the U.S. at the time of referral is the date the youth became eligible to apply for the URM Program (e.g., date of U.S. Department of Homeland Security (DHS)/U.S. Citizenship and Immigration Services (USCIS) adjudication of Special Immigrant Juvenile Status).
Country of Origin: Enter the name of the minor’s country of nationality, as found on the Bio data form issued by the U.S. Department of State, or birth certificate if available.
National Placement Agency: Choose the name of the national resettlement agency that assisted in the placement of the youth.
Add: Once all required information is filled out, click the Add button at the bottom to save the case. Please confirm all information was entered accurately before clicking Add.
How do I begin a new ORR-3 Report in RADS?
Log in to the URM database using your registered User ID and Password.
If you do not have a registered User ID and Password, please contact your state agency.
Under the URM menu, navigate to Cases, then select “Search.” Search for the case using youth’s identifying criteria. ORR suggests searching by either Alien Number or Case ID, as there are often youth with the same or similar names in the database.
Click “Edit”, then select “ORR-3” at the bottom. Finally, select “New ORR-3 Form.”
Begin at Section I: Report Action. Follow instructions below.
Reminders:
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SECTION I: REPORT ACTION
Initial Placement: Select this option to indicate if a report is an Initial Placement report.
Change of Status: Select all related changes and enter date(s) of action(s). Multiple data elements can be selected. When completing the ORR-3 for a ‘change of status,’ only fill out Section I, the information that is new or changing, and Section VI: Report Submission Authority. That is, completing a change of status report does not require filling out the entire form but only the information that is changing. Due to auto-population of past data, it is best practice to review all parts of the form to verify all data is accurate, prior to submission.
Transfer to/from another URM program: Select if youth transfers to/from another URM program within the same state or a different state. Then, select either “Transfer to” or “Transfer from” followed by the date and name of State Agency and Provider Agency.
A transfer to/from will require direct communication with ORR followed by an ORR-3 change of status report for both intrastate and interstate transfers.
If a youth comes into your URM Program from another URM Program, you only need to submit a change of status report and do not need to submit an initial ORR-3 placement report again.
If it is a transfer to/from another state, the states’ procedures1 for interstate transfer apply.
Note: Transfers to/from another URM Program are to be reported to ORR as a change of status rather than termination and re-entry, since the youth remains in the URM Program. Per ORR, no post-18 interstate transfer is allowed.
Change in identifying data: Select if youth’s identifying information needs to be changed, such as age/date of birth, name, alien number, eligibility date, or initial placement date.
Change in age/date of birth. ORR must concur with the age change that was authorized by a court, before submission of the ORR-3 Report. Please follow ORR guidance in the online URM Program Policy Guide2 on how to seek ORR concurrence with the age change.
ORR will make the changes in RADS upon receipt of the ORR-3 change of status report.
Became a parent: Select if youth became a parent through giving birth or fathering a child.
Change in biological parent’s location: Select if youth’s biological parents’ location has changed.
Change in immigration data: Select if youth’s immigration status has changed.
Change in work authorization (i.e., Employment Authorization Documentation): Select if youth received work authorization, or there is a change in work authorization (e.g. lost, expired and not renewed.)
Change in placement type, placement cost, or youth’s address: Select if youth changes placement type, or if there is a change in placement cost or youth’s address.
Options for placement change include absent from program but legal custody retained of a minor under 18 who has run away and living independently but receiving ORR-funded services/benefits.
Note: A change in placement cost, even if placement type or address remains the same, must be reported.
Establishment of or change in legal responsibility: Select if legal responsibility has been established, changed, or ended by an appropriate court.
This does not apply to each permanency hearing review. ORR only wants a change of status report should the custodian change, etc.
Explain “Change of Status”: Use the box to provide ORR with additional information if the change requires further explanation.
Termination: Provide Final Report for youth terminating URM services, including the date ORR-funded services ended, as well as an explanation of the youth’s destination or current situation at case closure. Only complete Section I and Section VI: Report Submission Authority when submitting a termination report. Select only one reason for termination from the given options.
Reunified with parents: Select if youth is reunified with parents in the U.S. or overseas.
Unified with relatives: Select if youth is unified with a relative or a non-relative, and custody or guardianship was obtained by the relative. Also, select if youth over age 18 leaves the program early to live with relatives.
Adopted: Select if youth is legally adopted and, therefore, is no longer eligible to receive any ORR-funded services or benefits.
Became a U.S. Citizen: Select if youth attains citizenship status while in the program and, therefore, is no longer eligible to receive any ORR-funded services or benefits.
Emancipated: Select if youth exits the program due to reaching the maximum age for foster care according to state law and is no longer receiving any ORR-funded services.
Note: Select the “change in placement type or youth’s address” option under Change of Status, above, if the youth emancipates from foster care and is no longer eligible to receive placement services, but continues to receive ORR-funded transition to adulthood services, health coverage, and/or educational benefits. Then, update Section IV: Placement.
Concluded ORR-funded services/benefits: Select if youth has concluded all ORR-funded services including transition to adulthood services, health coverage, and/or Education and Training Voucher (ETV) benefits.
Left program voluntarily: Select if youth, although eligible to remain in foster care, leaves the program early prior to age of emancipation.
Not compliant with State/Program Requirements: Select if youth was non-compliant of a voluntary agreement or program rules, or for other violations, which result in the youth’s dismissal from the program.
Ran away: Select if youth has run away or AWOL from the program, is no longer receiving services, and legal custody is not retained.
Departed from U.S. (Removal or Voluntary Departure): Select if youth is no longer residing in the U.S., either due to removal by the DHS or voluntary departure.
Immigration detention: Select if youth has been detained by an immigration authority and is no longer receiving placement and/or services under the URM Program.
Incarcerated: Select if youth has been incarcerated, whose custody is released, and is no longer receiving placement and/or services under the URM Program.
Deceased: Select if youth has died while in URM care.
Other: Any other reasons not identified that result in termination from the program.
Re-entered for ORR-funded placement or services: Select for youth re-entering the URM Program. Youth re-entering for URM placement and/or services is limited to youth who were previously enrolled as a URM and who are eligible to return to the program according to the State’s Title IV-B plan. The submission of this report should follow the same 60-day reporting guidelines, as it is considered a change of status.
URM Placement: Select if youth is re-entering placement. URM placement can include foster family home, therapeutic foster home, group home, supervised independent living, or residential treatment center. Provide date of re-entry.
Update Section IV: Placement and any other relevant sections of the report form.
Services/Benefits only: Select if youth is re-entering to receive ORR-funded services or benefits only, such as transition to adulthood services, health coverage, and/or Education and Training Vouchers (ETVs). Provide date of re-entry.
Update Sections III: Immigration and V: Legal Responsibility, if necessary.
SECTION II: IDENTIFYING/BASIC DATA
Complete requested information below. Please note that some of the information in this section will auto-populate from the URM Child Information screen.
Sex: Data is auto populated from the data entered when the case record was created.
Date of Birth: Data is auto populated from the data entered when the case record was created. When a change in Date of Birth is needed, follow instructions found in Section I above.
Date of Eligibility: Data is auto populated from the data entered when the case record was created. The date of eligibility signifies the date the youth becomes eligible for the URM program; however, it does not confer approval for the URM program and is different from the URM date of approval. In RADS, for UAC to URM transfer cases, the date of eligibility is found on the child info screen and is entered by URM program/case specialists at ORR, once the youth has been approved to enter the program. For refugees, the date of eligibility is the date that the youth arrived in the U.S, and can be found on the I-94 Arrival Card.
Date of Initial Placement: Enter the month, day, and year when URM placement and services commenced. For youth who transfer from the UAC program and will remain in the same placement, use the date that the youth was discharged from the UAC program. For youth who must travel to their URM placement, please use the date that the youth physically arrived and began receiving URM-funded services. For youth who are approved to enter URM care by ORR, the date of initial placement must never precede the date of URM approval.
a) Country of Origin: Data is auto populated from the data entered when the case record was created.
b) Ethnic Group: Enter the youth’s ethnic group, if known. Consult the Reception and Placement Bio Data Form for refugees. If ethnic group is known and not listed as an option, contact ORR.
a) Language of Origin: Enter the youth’s native or first language.
b) Other Language(s): Enter other languages the youth has acquired.
7. Eligibility Type: Data is auto populated from the data entered when the case record was created.
8. Caseworker/Provider Assessment on Personal Functioning of the Youth (complete at initial placement only): Assess the youth’s functioning in the following domains upon enrollment, using the 5-point scale provided. Provide an explanation, if necessary.
Scale: 1 for poor, 2 for below average, 3 for average, 4 for above average, 5 for excellent.
Assessment domains:
English Language Skill
Education (other than English)
Health Condition
Includes both medical and dental health.
Mental Health
Youth’s cognitive, behavioral, and emotional wellbeing that affect their daily life, relationships, and functioning.
Note: While URM youth come from a wide variety of cultural and educational backgrounds, assessment of URM youth should be based on the age-appropriate functioning level of their peers in the general population. ORR acknowledges the subjective nature of this assessment but is interested in the baseline functioning of each URM youth at the time of initial placement into the URM Program.
9. URM’s Children in Care: If the URM youth is a parent to a child or children with them in care, provide the name (First Name, Middle Name, Last Name), date of birth, and citizenship/immigration status for each child. Do not include information on dependent children of URM youth who does not reside with the URM in the program, and reside either in home country or in another location within the U.S.
10. Mother of URM: Provide the mother’s last, first, and middle names.
Indicate "Yes," "No," or “Unknown” as to whether the mother of the youth is living.
Provide her last known address at the time the youth arrived in the U.S.
Provide the current address of mother, if different from above address.
11. Father of URM: Provide the father’s last, first, and middle names.
a) Indicate "Yes," "No," or “Unknown” as to whether the father of the youth is living.
b) Provide his last known address at the time the youth arrived in the U.S.
c) Provide the current address of father, if different from above address.
SECTION III: IMMIGRATION
Immigration: Select the youth’s immigration status from the following options. Please reference Policy Letter 16-013 or the online URM Program Policy Guide4 for additional guidance.
Refugee: Select if youth has an I-94 documenting refugee status but is not yet a Lawful Permanent Resident.
Asylee: Select if youth has a letter from USCIS or an Immigration Judge’s order granting asylum but is not yet a Lawful Permanent Resident.
SIJ (I-360 approval): Select if youth has documentation of USCIS approval of an I-360 petition but is not yet a Lawful Permanent Resident.
Cuban/Haitian Entrant-No immigration status: Select if youth has an I-94, parole, Notice to Appear, or other document establishing them as a Cuban/Haitian Entrant.
Victim of Trafficking-No Immigration Status (OTIP letter only): Select if youth has a Letter of Eligibility from the ACF Office on Trafficking in Persons (OTIP) and no other immigration status.
U-Status Recipient: Select if youth has received documentation of U Status from USCIS.
T-Status Recipient: Select if youth has received a documentation of T Status from USCIS.
Lawful Permanent Resident: Select if youth has adjusted status to lawful permanent residency and is in receipt of their green card. This could include refugees, asylees, or SIJs with an approved I-485 application.
Other: Select if youth has an immigration status not mentioned above. Describe immigration status in the text field provided.
Youth is receiving immigration assistance: Indicate if youth is receiving immigration assistance by selecting “Yes” or “No.”
Youth has work authorization/Employment Authorization Document: Indicate if youth has work authorization/Employment Authorization Document by selecting “Yes” or “No.”
Note 1: A change in immigration status may mean the youth is no longer eligible for the URM Program. Consult ORR immediately with any questions. Note 2: A URM who has received U.S. citizenship is no longer eligible for URM benefits and services and must be terminated from the program immediately. |
SECTION IV: PLACEMENT
Placement Type: Select the appropriate option to indicate the type of placement for the youth.
Foster Family Home: Select if youth is placed in a conventional foster family home. In general, foster family homes meet the standards established for licensing or approval by the state and are provided a regular foster care maintenance rate. For the purpose of completing the ORR-3, youth placed in foster family homes do not require the additional care or treatment provided by therapeutic foster homes.
May include relative/kinship foster care placements or agency-operated homes with foster parents who are employees of the URM provider agency.
Therapeutic Foster Home: Select if youth is placed in a therapeutic foster home. Therapeutic foster homes are licensed at a therapeutic level by the state and/or meet criteria in the state’s agreement with the URM provider as a therapeutic foster home. Therapeutic foster home parents have received additional training to meet the needs of youth with mental health or behavioral health needs, in a family setting. Youth placed in therapeutic foster homes require emotional or behavioral therapeutic interventions and a higher level of care than is provided in a conventional foster family home, but do not require placement in a more restrictive setting. Therapeutic foster homes typically receive higher maintenance rates than conventional foster family homes.
Group Home: Select if youth is placed in a group home setting licensed or approved by the state. Settings can include therapeutic group homes or transitional group homes.
Therapeutic group homes provide on-site treatment planning and services in a non-secure setting for youth with significant emotional or behavioral problems who have the capacity to engage in community-based activities. Treatment services typically include individual and group therapy/counseling, behavior modification, recreational therapy, or skill building. Therapeutic group homes offer a less restrictive environment than residential treatment but are more restrictive than therapeutic foster homes. Therapeutic group homes are in the community where residents attend local schools and have around-the-clock staffing onsite.
Transitional group homes provide mostly independent living skill-building services that focus on transition to adulthood. Transitional group homes may or may not have around-the-clock staffing onsite.
Supervised Independent Living: Select if youth is placed in supervised independent living. Supervised independent living may also be referred to as semi-independent living. For the purpose of completing the ORR-3, youth placed in supervised independent living may:
Not be supervised 24 hours a day, but an agency or adult is responsible and accountable for the youth’s wellbeing and safety;
Continue to receive case management services;
Be given increased responsibilities for managing their own living arrangements (e.g., paying bills, assuming leases, and working with a landlord).
Residential Treatment: Select if youth is placed in a residential treatment facility. For the purpose of completing the ORR-3, residential treatment:
Is a live-in health care facility that provides treatment/therapeutic services for mental illness, substance abuse, and/or behavioral issues in a secure and/or restrictive setting for youth who, because of the severity of their issues, are unable to adjust to other placements but do not require inpatient psychiatric hospitalization;
May include crisis stabilization, initial and continuing bio-psychosocial assessment, care management, medication management, therapy and mobilization of family support and community resources in the context of a comprehensive multidisciplinary treatment plan;
Develops a plan for the youth to step down into a lesser restrictive, non-secure setting once treatment goals are met.
Long-term hospitalization (more than 2 weeks): Select if youth has been hospitalized more than 2 weeks, for either medical or psychiatric reasons.
Absent from program but legal responsibility retained: Select if a state, county, or program still retains legal custody of a minor under 18 who has run away or has been detained. There is no need to update any part of the form unless other changes have been indicated.
Living independently but receiving ORR-funded services/benefits: Select if youth is living independently (i.e., not receiving any placement services), but is still receiving ORR-funded services or benefits such as transition to adulthood services, Education and Training Vouchers (ETVs), and/or health coverage. Occasional minimal staff support can be provided on a case-by-case basis.
Other: Select if youth is placed in a setting other than the options provided and describe the placement setting.
Placement Cost: Enter the average daily rate in dollars related to placement type.
For youth in foster homes, enter the foster care maintenance rate provided to the licensed foster family.
For placements through a contract (e.g., group home, residential treatment), enter the per diem cost.
For youth categorized as “No Placement (but receiving ORR-funded services/benefits),” enter the stipend amount provided to the youth to help pay for their rent.
Do not include administrative costs in the average daily rate.
Youth’s Residence: Enter the name and relation of the caregiver, if relevant, in addition to the address of the youth.
Provider Agency for Placement: If “Same as URM provider” is selected, this information will auto-populate from the first page. If different from the URM provider agency, then select “Placement via Subcontract.”
Note 1: Do not report change in placement if youth is placed in respite care that is less than 30 days. Note 2: Job Corps can be reported as either supervised independent living or living independently, depending on the state’s discernment. |
SECTION V: LEGAL RESPONSIBILITY
Legal responsibility has been petitioned. Select from the following options:
Yes, it was petitioned within 30 days of enrollment. Select if procedures to establish legal responsibility for the minor were initiated with an appropriate court within 30 days of the minor’s arrival at the URM Program. Enter the date the petition was filed.
Yes, it was petitioned past 30 days of enrollment. Select if procedures to establish legal responsibility for the minor were initiated with an appropriate court after 30 days of the minor’s arrival at the URM Program. Enter the date the petition was filed.
No, it hasn’t been petitioned. Select if procedures to establish legal responsibility for the minor have not yet been initiated with an appropriate court.
Legal responsibility has been established in accordance with applicable State law.
Check the appropriate box to indicate “Yes” or “No.”
“Yes” indicates that legal responsibility was established for the minor in accordance with applicable State law. Enter the date that the court established legal responsibility.
“No” indicates that legal responsibility was not established for the minor in accordance with applicable State law.
Select “Pending” if procedures were initiated to establish legal responsibility for the minor in accordance with applicable State law, but legal responsibility has not yet been established.
2.a. In lieu of legal responsibility, youth has signed Voluntary Placement Agreement (VPA). Select “Yes” if the youth signed a VPA in lieu of establishment of legal responsibility. Enter the date youth signed the VPA. Select “No” if the youth did not sign a VPA.
Note: Currently, 2.a. (VPA signed in lieu of legal responsibility) is applicable to the state of Massachusetts only.
Court name with jurisdiction: Provide the name of the court that has jurisdiction over the youth.
Agency name to whom legal responsibility assigned: Provide the name of the agency with legal responsibility for the youth. If the same as URM provider, check corresponding box.
Legal responsibility has ended. Select “Yes” if the legal responsibility has ended and enter the date that legal responsibility has ended. Select “No” if legal responsibility is still intact.
SECTION VI: REPORT SUBMISSION AUTHORITY
The agency information will auto-populate from the first page. Complete user information only.
Provider Agency:
Provide the name, title, phone number, and email address of the person preparing the report and the date the report was approved to be submitted to the state.
Do not backdate approval of reports.
State/URD Agency:
Provide the name, title, phone number, and email address of the state official submitting the report, and the date the report was approved to be submitted to ORR.
Do not backdate approval of reports.
When returning reports for revisions to the URM provider agency, it is important to clearly identify the issue and explain corrective measures.
ORR: Provide the name, title, and approval date. Enter any comments on the approval or denial of the report.
1 Per 45 CFR 400.119
2 https://www.acf.hhs.gov/orr/resource/orr-guide-to-eligibility-placement-and-services-for-unaccompanied-refugee-minors-urm
3 https://www.acf.hhs.gov/orr/resource/policy-letter-16-01
4 https://www.acf.hhs.gov/orr/resource/orr-guide-to-eligibility-placement-and-services-for-unaccompanied-refugee-minors-urm-section-1#1.1
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | URM ORR-3 and ORR-4 Report Forms |
| Author | ypark |
| File Modified | 0000-00-00 |
| File Created | 2021-01-12 |