P-1 Placement Authorization - UC Portal Version

OMB 0970-0554 [Valid through 02/28/2021]

The U.S. Department of Health and Human Services (HHS), Office of Refugee Resettlement (ORR), Division of Unaccompanied
Children Operations (DUCS) is responsible for coordinating and implementing the care and placement of (6 U.S.C. 279 (b)(1)(A)):
Minor's Name:
Date of Birth:

Nationality:

Hereby authorizes, hereinafter “care provider,” to provide 24 hour care for the minor. Care and placement will include, but
is not limited to:
1. CUSTODY
The minor is in the legal custody of the Federal government and is placed in the care provider's physical custody for care and
shelter. The care provider must provide for the minor's daily care and protection, which conforms to all applicable ORR
instructions and minimum standards based in statute or law. The minor's placement with the care provider is based on the care
provider's compliance with the requirements set forth in the contract or cooperative agreement with ORR. ORR, at its sole
discretion, may remove the minor from the care provider at any time.
2. AUTHORITY
The case provider will adhere to all Federal and State licensing laws, rules, and regulations. Additionally, the care provider will
adhere to all ORR policies, guidance, and instructions. Failure to adhere to State licensing or ORR requirements will result in
corrective action up to and including termination of the grant or contract.
3. EDUCATION
The care provider must enroll the child in an educational program(s) as directed by ORR. This may include educational
programming created by the care provider if approved by ORR. The care provider may sign any documents needed to enroll the
child in an educational program. The care provider may also receive and review all of the minor's educational records.
4. TRAVEL
The care provider may provide routine transportation for the minor, including transportation to and from medical, mental and
dental care; court hearings; transfer to other care provider programs; trips, outings, or other travel pertinent to the minor's
educational, social and emotional development.
5. PHOTOGRAPHS AND VIDEOTAPES
The care provider may take photographs and record videotapes of the minor for the minor's personal use and for purposes of
identification. The care provider may not release any photographs or videotapes of the minor for public use without ORR's prior
written permission.
6. MEDICAL CARE
The care provider may consent to the child's medical, dental, and mental health care as specified in the Authorization to
Consent to Medical, Dental, and Mental health Care. The care provider may receive, review, and maintain all of the minor's
medical, dental, and mental health records in a separate medical file.
7. FILES/CONFIDENTIALITY
All records maintained by the care provider in reference to the minor are considered ORR property. Under penalty of law, the
care provider must not release information about the minor to any individual, organization, or entity without the prior

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
authorize a care provider to provide care and services to UAC placed in their facility. Public reporting burden for this collection of information is estimated to average 0.02
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].

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a. The care provider may provide information about the minor to the minor's educational program, medical, mental health,
dental and other service providers to the extent that the information is needed for the minor's education, recreation, social
development, medical, dental, or mental health treatment.
b. The care provider must give ORR and its designees, as directed by ORR, unrestricted free access to information about the
minor at all times.
c. All case file information maintained under grants or contracts with the Federal government are the property of the Federal
government and are fully accessible to ORR/DCS, or any of their duly authorized representatives, in accordance with applicable
federal law, regulations, and OMB circulars The records should be retained in accordance with these applicable laws,
regulations, OMB circulars. The records should be retained in accordance with these applicable laws, regulations, OMB
circulars, and ORR policies.
8. CONTACT WITH THE FAMILY
The care provider must permit the minor and the minor's family (as well as other individuals at ORR's discretion) to maintain
contact through direct visitation, telephone calls, mail, and gifts under the terms and conditions specified by applicable law,
regulations, and ORR policies.
9. SCHOOL PROGRAMS AND EXTRACURRICULAR ACTIVITIES
The care provider may authorize the minor to participate in routine school programs as well as social and extracurricular
activities that do no involve an unusual risk of injury to the minor unless otherwise specified by ORR.
10. REASON FOR PLACEMENT
An unaccompanied minor who meets the definition of an unaccompanied alien child, 6 U.S.C. 279(g)(2), and is in Feeral
custody by reason of his or her immigration status.
11. TIME IN CARE
The care provider's care giving authority will terminate upon the minor's physical discharge from the care provider's custody.
The care provider will still have legal obligations for maintaining the minor's property if it is still in the care provider's custody
and case file as directed by ORR.
12. FINANCIAL
ORR agrees to provide financially for the care of said minor according to the financial agreement between ORR and care
provider or subsequent agreements agreed to by ORR and the care provider.
13. RESTRAINTS
The care provider must exhaust preventive, de-escalative and less restrictive techniques before it uses any type of restraint.

Signature - Authorized Representative of Care Provider

Signature - Official Representative
Office of Refugee Resettlement
Administration for Children and Families
U.S. Department of Health and Human Services

Date

Telephone Number

Date

Telephone Number

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