R-6 Safety and Well-Being Call Report - UC Path Version

Safety and Well-Being Call Report (Form R-6)
Data Entry Window

• Yes
• No
• NA
• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No
• NA
• Yes
• No
• NA

• Yes
• No
• Yes
• No
• Yes
• No

Sponsor in need
of additional
support to care
for UC?

• Yes
• No
• Yes
• No
• Yes
• No

• UC no longer resides with Sponsor
• Sponsor overlooked hearing
• UC turned 18
• Sponsor non-compliant with ORR
condition of release
• Sponsor unable to UC to hearing
due to unforeseen circumstances
• Future court hearing pending
• Court hearing date not set

• Yes
• No
• Yes
• No
• Yes
• No
• Yes
• No
• NA
• Yes
• No
• UC residing with sponsor
• UC aged out/moved out
• UC runaway
• UC relocation with nonsponsor
• UC arrested
• UC death
• UC deported/returned to COB
• UC location unknown
• Yes
• No
• Yes
• No
• NA

• Yes
• No
• Yes
• No

• Yes
• No
• NA
• Yes
• No
• NA

• Yes
• No
• NA
• Yes
• No
• NA
• Yes
• No
• NA
• Yes
• No
• NA
• Yes
• No
• NA
• Yes
• No
• NA

• Yes
• No
• NA

• Yes
• No
• NA
• Yes
• No
• NA
• Yes
• No
• NA
• Yes
• No
• NA
• Yes
• No
• NA
• Yes
• No
• NA
• Yes
• No
• NA
• Yes
• No
• NA

• Yes
• No
• NA
• Yes
• No
• NA
• Human Trafficking
• Neglect/Abandonment
• Physical Abuse
• Sexual Abuse/Harassment
• Sponsor Criminal Activity
• UC and Sponsor Criminal Activity
• UC Criminal Activity
• UC Death
• UC Medical/Mental Health Issue
• Fraud Against Sponsor
• Fraudulent Sponsor
• N/A

• Yes
• No
• NA
• Yes
• No

• Yes
• No

• Draft
• Submitted

OMB 0970-0552 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: This information
collection allows ORR to document the outcome of calls made to UC and their sponsors after release to ensure the
child is safe and refer the sponsor to additional resources as needed. Public reporting burden for this collection of
information is estimated to average 0.75 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 (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
[email protected].
R-6 [Rev. MM/DD/YYYY]

Safety and Well-Being Call Report Page

OMB 0970-0552 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: This information collection allows ORR to document the outcome of calls made to UC and their
sponsors after release to ensure the child is safe and refer the sponsor to additional resources as needed. Public reporting burden for this collection of information is estimated to average 0.75
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 (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 [email protected].
R-6 [Rev. MM/DD/YYYY]

Call Attempts for Sponsor/UAC Data Entry Window
• Sponsor
• UC

• No Reached
• Reached and Participated
• Reached and Declined to
Participate