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OMB #: 0970-0043 |
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Expiration Date: XX/XX/XXXX |
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| Refugee Data Submission System for Formula Funds Allocations (ORR-5) |
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| Row Number |
ORR5 Data |
Format |
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| 1 |
Alien Number |
8 or 9 digits |
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| 2 |
Status |
Refugee, SIV, VOT, Asylee, C/H Entrant |
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| 3 |
Name |
Last, First, Middle |
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| 4 |
Date of Birth |
mm/dd/yyyy |
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| 5 |
Gender |
M, F, or U for Unknown |
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| 6 |
State |
State Code |
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| 7 |
County |
County Name |
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| 8 |
Nationality |
Country Name |
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| 9 |
Organization providing the support |
State Name or Replacement Designee Name |
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| 10 |
Date eligible for ORR benefits |
mm/dd/yyyy |
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| 11 |
Medical Screening Initial Enrollment Date |
mm/dd/yyyy or Null if not enrolled |
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| 12 |
Medical Screening Exit Date |
mm/dd/yyyy or Null if not enrolled or still active |
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| 13 |
Social Services Program Initial Enrollment Date |
mm/dd/yyyy or Null if not enrolled |
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| 14 |
Social Services Program Exit Date |
mm/dd/yyyy or Null if not enrolled or still active |
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| 15 |
RCA Initial Enrollment Date |
mm/dd/yyyy or Null if not enrolled |
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| 16 |
RCA Exit Date |
mm/dd/yyyy or Null if not enrolled or still active |
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| 17 |
RMA Initial Enrollment Date |
mm/dd/yyyy or Null if not enrolled |
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| 18 |
RMA Exit Date |
mm/dd/yyyy or Null if not enrolled or still active |
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| 19 |
Migration Status |
In, Out, or No change |
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| 20 |
Date of Migration |
mm/dd/yyyy - In/Out date based on Migration Status |
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| PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF is gathering information to inform evidence-based policy making and guide resource allocation. Public reporting burden for this collection of information is estimated to average 90 hours per grantee, 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 [INA, Section 412(a)(3)]. 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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