RDH-4 Risk Determination Hearing Transcript Request

OMB 0970-TBD [valid through MM/DD/YYYY]

Administration for Children & Families
Office of Refugee Resettlement

Risk Determination Hearing
Transcript Request
If you are the unaccompanied child listed below, the child’s parent/legal guardian, or the child’s authorized representative, you may
use this optional form to request a Risk Determination Hearing transcript. Please submit this form following the instructions below.
below.
I am the unaccompanied child listed below, the child’s parent/legal guardian, or the child’s authorized representative and I request a
transcript of the following administrative hearing:

Child’s Name
DAB Docket No. U -

-

Date of Proceeding

Signature

Name of Person Requesting Transcript

Relation to Unaccompanied Child

Street Address

Date

City

State

Email Address

Zip Code

Phone Number

Please submit this form to the child’s care provider Case Manager or directly to ORR via [email protected]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow an
unaccompanied child, the child’s parent/legal guardian, or the child’s representative to request a written transcript of the Risk Determination hearing. Public
reporting burden for this collection of information is estimated to average 0.17 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 (45 C.F.R. § 410.1903). 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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