RSS and RSS Set Aside Sub-grantee List

OMB#: 0970-0556

Expiration Date: XX/XX/XXXX

Refugee Support Services (RSS) and RSS Set Aside Sub-Grantee List Instructions

The Refugee Support Services (RSS) and RSS Set Aside Sub-Grantee List will provide a list of sub-grantees who have been contracted to provide RSS and RSS Set Aside Programming {Refugee School Impact (RSI), Services to Older Refugees (SOR), Youth Mentoring (YM), and Refugee Health Promotion (RHP)}. In line with the ORR-6 Annual Service Plan, this form will be submitted every November 30. The Sub-Grantee information reported must reflect the 12-month period of services under contract as of October 1 that year. (For more information, see “Fiscal Year” below.) The information below, apart from 4.e Funding Amount, may be shared publicly.

Item	Data Element	Instructions
1.	State/Grantee	If the Refugee Resettlement Program (RRP) is state administered, enter only the state. If the RRP is administered by a Replacement Designee, enter the name of the agency and the state in which it operates.
2.	Fiscal Year	Enter the Federal Fiscal Year (FFY) for which the RSS and RSS Set Aside Sub-Grantee Form is being submitted. Due to differences in state contracting cycles, the Office of Refugee Resettlement (ORR) does not specify that the contract period coincide with the FFY. Instead, this information is to reflect each state’s 12-month period of services under contract effective at the beginning of a FFY, October 1, regardless of when that period begins and ends.
3.	Date	Enter the date that the report is submitted.
4.	Sub-Grantee Information	In this section, provide the sub-grantees for all RSS and RSS Set Aside sources of funding, including RSI, SOR, YM, and RHP. If funding is not sub-granted out, please simply list the State/Grantee as identified above in this section. If funding is directed to another entity who is responsible for the further sub-granting of funds, list final service provider (sub)sub-grantees. The term "sub-grantee" in the remainder of these instructions will refer to all three possibilities. As stated above, this information must reflect the 12-month period of services under contract as of October 1 that year.
4. A.	City	Enter the city where the sub-grantee is located.
4. B.	Name of Sub-Grantee	Enter the name of sub-grantee under contract, as of October 1 that year.
4. C.	Agency Website	Enter the agency website address for that sub-grantee.
4. D.	Program	Program should provide whether this sub-grantee is providing RSS, RSI, SOR, YM, or RHP. Only one program should be identified for each row.
4. E.	Funding Amount	Provide the funding amount for the contract, as of October 1 that year. If funding is not sub-granted out, please simply list the total funding amount received for that source of funding in relation to the State/Grantee listed.