NonSub Change Appendix - S-16 and S-26

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Overview

HS Referral
PRS Referral
PRS Referral Appendix
Fields Removed

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Sheet 1: HS Referral

Home Study (HS) Referral (Form S-26)
Located in UC Portal System
Section	Subsection	Field	Modifications	Location in UC Path HS/PRS Referral	Notes
UC Basic Information	n/a	First Name	Reorganized and reworded	UC Basic Information	Original Wording: "Profile Name" Split into separate fields for first and last name
		Last Name	Reorganized and reworded	UC Basic Information	Original Wording: "Profile Name" Split into separate fields for first and last name
		Date of Birth	Merged and functionality change	UC Basic Information	"Date of Birth" and "Age" fields merged under "Date of Birth System will calculate age and display it in parentheses after the auto-populated date of birth
		A#	No change	UC Basic Information
		Country of Birth	No change	UC Basic Information
		Gender	No change	UC Basic Information
		AKA	Reworded	UC Basic Information	Original Wording: "Also Known As"
		Status	Added	n/a	System-generated field
		Admitted Date	Reworded	UC Basic Information	Original Wording: "Admission Date/Time"
		Length of Stay	No change	UC Basic Information
		Current Program	Reworded	UC Basic Information	Original Wording: "Program"
		Portal ID	Added	n/a	System-generated field
Home Study Care Referral	Referring Facility Information	Referring Facility Name	Reworded	HS/PRS Referral Information	Original Wording: "Program Case Manager"
		Facility/Case Manager (Email Address)	Reworded	HS/PRS Referral Information	Original Wording: "Case Manager Email"
		Alternative Email Addr	Reworded	HS/PRS Referral Information	Original Wording: "Alternative Email"
		Acceptance Date	Reworded	HS/PRS Referral Information	Original Wording: "Date Accepted by Program"
		Referral ID	Reworded	HS/PRS Referral Information	Original Wording: "Entry Number" System-generated fields
		Referral Status	Changed field type	HS/PRS Referral Information	Changed from dropdown field to system-generated field Dropdown Options: Pending Closed Cancelled HS/PRS Referral Initiation Active
		Expected Closure Date	No change	HS/PRS Referral Information
Home Study Care Referral	Sponsor Information	Sponsor Name	Reworded	Sponsor Information	Original Wording: "Sponsor"
		Sponsor Category	No change	Sponsor Information
		Sponsor City	Reworded	Sponsor Information	Original Wording: "City"
		Sponsor State	Reworded	Sponsor Information	Original Wording: "State"
		Sponsor Zip Code	Reworded	Sponsor Information	Original Wording: "Zip Code"
		Primary Sponsor	Added	n/a	Auto-populated
Home Study Care Referral	Subsection is unnamed	Expedited	No change	HS/PRS Referral Information
		Reason Expedited • High Length of Care • Age Out • Other	Changed dropdown options	HS/PRS Referral Information	Original Dropdown Options: • Imminent Age Out • Length of Time Since Referral • Tender Age • Other
		Specify	Reworded	HS/PRS Referral Information	Original Wording: "Other Reason Expedited (If Applicable)"
		Special Instructions • RTC Placement • Medically Fragile • Pregnant • Parenting • Tender Age • Sibling Group • Related	Replaced	HS/PRS Referral Information	Replaced "Referral Notes" field in part
		Reason for Referral • Victims of Trafficking (TVPRA) • American Disability Act (TVPRA) • Physical or Sexual Abuse by Caregiver (TVPRA) • Sponsor Risk (TVPRA) • 12 and Under Going to Non-Relative Sponsor (ORR Mandated) • Non-Relative Sponsor Multiple Sponsorship (ORR Mandated) • ORR Discretionary	Changed dropdown options	HS/PRS Referral Information	Original Dropdown Options: • HS-Victims of Trafficking (TVPRA) • HS-American Disability Act (TVPRA) • HS-Physical or Sexual Abuse by Care Giver (TVPRA) • HS-Sponsor Risk (TVPRA) • HS- 12 and under going to non-relative sponsor (ORR Mandated) • HS-Non-Relative Sponsor Multiple Sponsorship (ORR Mandated) • HS- Child Safety Concerns (ORR Discretionary) • HS-Sponsor Stability (ORR Discretionary) • HS-Assess Household Composition(ORR Discretionary) • PRS-Placement Stability and Safety • PRS-Immigration Proceeding • PRS-Guardianship • PRS-Legal Services • PRS-Education • PRS-Medical Services • PRS-Individual Mental Health Services • PRS-Family Stabilization/Counseling • PRS-Substance Use • PRS-Gang Prevention • PRS- Other Services
Home Study Care Referral	Cross-Referenced Case	Relationship Group ID	Added	n/a	System-generated
Close Case Referral Button	n/a	File to attach	Replaced	Assessments	Assessments are not currently integrated into UC Portal. Replaced area where the system would have linked to integrated assessments with functionality that will allow documents to be uploaded.
Cancel Case Referral Button	n/a	Reason for Cancellation	Changed field type	HS/PRS Referral Information	Changed from dropdown to open text Original Dropdown Options: • Sponsor is unavailable • UAC Returned to Home Country • UAC is no longer in the home • Other

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Sheet 2: PRS Referral

Post-Release Services (PRS) Referral (Form S-19)
Located in UC Portal System
Section(s)	Subsection	Field	Modifications	Location in UC Path HS/PRS Referral	Notes
UC Basic Information	n/a	First Name	Reorganized and reworded	UC Basic Information	Original Wording: "Profile Name" Split into separate fields for first and last name
		Last Name	Reorganized and reworded	UC Basic Information	Original Wording: "Profile Name" Split into separate fields for first and last name
		Date of Birth	Merged and functionality change	UC Basic Information	"Date of Birth" and "Age" fields merged under "Date of Birth System will calculate age and display it in parentheses after the auto-populated date of birth
		A#	No change	UC Basic Information
		Country of Birth	No change	UC Basic Information
		Gender	No change	UC Basic Information
		AKA	Reworded	UC Basic Information	Original Wording: "Also Known As"
		Status	Added		System-generated field
		Admitted Date	Reworded	UC Basic Information	Original Wording: "Admission Date/Time"
		Length of Stay	No change	UC Basic Information
		Current Program	Reworded	UC Basic Information	Original Wording: "Program"
		Portal ID	Added		System-generated field
Post Release Services	n/a	Untitled radio buttons PRS-TVPRA PRS	Added	n/a	Auto-populated
		PRS Level Level 1 Level 2 Level 3	Added	n/a
PRS-TVPRA & PRS Subsection populates when either option is selected	Referring Facility Information	Referring Facility Name	Reworded	HS/PRS Referral Information	Original Wording: "Program Case Manager"
		Facility/Case Manager (Email Address)	Reworded	HS/PRS Referral Information	Original Wording: "Case Manager Email"
		Alternative Email Addr	Reworded	HS/PRS Referral Information	Original Wording: "Alternative Email"
		Referral ID	Reworded	HS/PRS Referral Information	Original Wording: "Entry Number System-generated fields
		Referral Status	Changed field type	HS/PRS Referral Information	Changed from dropdown field to system-generated field Original Dropdown Options: Pending Closed Cancelled HS/PRS Referral Initiation Active
		Acceptance Date	Reworded	HS/PRS Referral Information	Original Wording: "Date Accepted by Program"
		Expected Closure Date	No change	HS/PRS Referral Information
PRS-TVPRA & PRS Subsection populates when either option is selected	Sponsor Information	Sponsor Name	Reworded	Sponsor Information	Original Wording: "Sponsor"
		Sponsor Category	No change	Sponsor Information
		Sponsor City	Reworded	Sponsor Information	Original Wording: "City"
		Sponsor State	Reworded	Sponsor Information	Original Wording: "State"
		Sponsor Zip Code	Reworded	Sponsor Information	Original Wording: "Zip Code"
		Primary Sponsor	Added	n/a	Auto-populated
PRS-TVPRA & PRS Subsection only populates when PRS-TVPRA is selected	Provider Information	What Provider Conducted the Home Study List of all home study providers	Replaced	Entry Team	Replaced area where users search for and select individuals working on the child's case (including the HS provider)
PRS-TVPRA & PRS Subsection populates when either option is selected	Subsection is unnamed "Referral Date" and "Planned Discharge Date" fields only populate when PRS is selected	Special Instructions • RTC Placement • Medically Fragile • Pregnant • Parenting • Tender Age • Sibling Group • Related	Replaced	HS/PRS Referral Information	Replaced "Referral Notes" field in part
		Reason for Referral For PRS-TVPRA • Victims of Trafficking (TVPRA) • American Disability Act (TVPRA) • Physical or Sexual Abuse by Caregiver (TVPRA) • Sponsor Risk (TVPRA) • 12 and Under Going to Non-Relative Sponsor (ORR Mandated) • Non-Relative Sponsor Multiple Sponsorship (ORR Mandated) • ORR Discretionary For PRS • 12 and Under Going to Non-Relative Sponsor - ORR Mandated Home Study • Non-Relative Sponsor Multiple Sponsorship - ORR Mandated Home Study • ORR Discretionary Home Study • UC Going to Non-Relative Sponsor - ORR Mandated No Home Study • Other - No Home Study	Changed dropdown options	HS/PRS Referral Information	Original Dropdown Options: • HS-Victims of Trafficking (TVPRA) • HS-American Disability Act (TVPRA) • HS-Physical or Sexual Abuse by Care Giver (TVPRA) • HS-Sponsor Risk (TVPRA) • HS- 12 and under going to non-relative sponsor (ORR Mandated) • HS-Non-Relative Sponsor Multiple Sponsorship (ORR Mandated) • HS- Child Safety Concerns (ORR Discretionary) • HS-Sponsor Stability (ORR Discretionary) • HS-Assess Household Composition(ORR Discretionary) • PRS-Placement Stability and Safety • PRS-Immigration Proceeding • PRS-Guardianship • PRS-Legal Services • PRS-Education • PRS-Medical Services • PRS-Individual Mental Health Services • PRS-Family Stabilization/Counseling • PRS-Substance Use • PRS-Gang Prevention • PRS- Other Services
		Referral Date	Added	n/a
		Planned Discharge Date	Added	n/a
PRS-TVPRA & PRS	Cross-Referenced Case	Relationship Group ID	Added	n/a	System-generated
Close Case Referral Button	n/a	File to attach	Replaced	Assessments	Assessments are not currently integrated into UC Portal. Replaced area where the system would have linked to integrated assessments with functionality that will allow documents to be uploaded.
Cancel Case Referral Button	n/a	Reason for Cancellation	Changed field type	HS/PRS Referral Information	Changed from dropdown to open text Original Dropdown Options: • Sponsor is unavailable • UAC Returned to Home Country • UAC is no longer in the home • Other

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Sheet 3: PRS Referral Appendix

Post-Release Services (PRS) Referral (Form S-19)
Appendix Located in New PRS System
Addendum Action	Field	Modifications	Location in UC Path HS/PRS Referral	Notes
Accept Case	n/a - Referred cases are imported from the UC Portal system and appear in a queue (table). Users use checkboxes to select cases and click an "Accept Case" button to accept them.	Changed functionality	HS/PRS Provider Information	Replaces manual entry in Assigned Provider, Assigned Provider Agency, and Assigned Subcontractor Agency field. NOTE: Function currently resides in UC Portal and will be moved into the new system. Providers are automatically assigned based on which cases they choose to accept from the queue and their user account information.
Assign Case Manager	Case Manager		Entry Team	Replaced area where users to search for and select individuals working on the child's case (including the PRS case manager). The new field has the same functionality, but searchable options are limited to those in a PRS case manager role.
Request Extension	New Close Date	Allow for editing field	HS/PRS Provider Information	Users can enter a new close date when requesting an extension. Date is initially system-generated in the PRS Referral (in the Expected Closure Date field).
	Reason for Extension • Recent safety concerns • Child not enrolled in education services • Child not enrolled in medical services • Placement disruption • Other (open text field populates if selected)	Added	n/a	Multiselect
	Details	Replaced	HS/PRS Provider Information	Replaced "Referral Notes" field in part
	Attach Supporting Documentation	Replaced	HS/PRS Provider Information	Replaced "Referral Notes" field in part. Includes open text field to add notes about attached documents.
Transfer Case	n/a	Changed functionality	Assessment Outcomes	A case was transferred by selecting the "Transferred to Another PRS Provider" option in the "Reason for Closure" field. Addendum replaces this function and adds follow-up questions/fields.
	Have you found another provider who can accept this case? • No, please share this transfer request with POs and potential providers • Yes	Added
	Provider Name	Added		Dropdown field populates if "Yes" is selected for "Have you found another provider who can accept this case?"
	Reason for Transfer • Child moved • Duplication of services • Provider capacity • Child requires more services • Coordinate services in shared household or family group • Other (open text field populates if selected)	Added
	New Location	Added		Text field populates if "Child Moved" is selected for "Reason for Transfer"
	Details	Added		Optional open text field
	Include Family Members	Added		Optional. Checklist of cases in a family group assigned to the same provider that allows the provider to apply the same transfer to members of the same family group.
Change PRS Level	New PRS Level • Level 1, Only virtual check-ins are needed • Level 2, Referrals and connection to community resources • Level 3, Intensive, at-home engagements	Allow for editing field	n/a	Allows user to change the level of PRS to meet the needs of the child and sponsor and adds follow-up questions/fields. PRS Level is initially captured in the PRS Referral in UC Portal.
	Reason for Level Change If level is increased • Recent safety concerns • Recent mental health concerns • Recent medical concerns • Risk of placement disruption • Child not enrolled in education services • Child involved in criminal activity • Other (open text field populates if selected) If level is decreased • Circumstances improved • Sponsor or family prefers less engagement • Awaiting TVPRA • Other (open text field populates if selected)	Added		Multiselect
	Details	Added		Optional open text field
	Attach Supporting Documentation	Added		Optional. Includes open text field to add notes about attached documents.
Close Case	Close Date	Added
	Reason for Case Closure • Service period reached end date • Child turned 18 • Child no longer requires services (PRS assessment) • Legal status achieved • Sponsor declined services (category 1) • Sponsor and child declined services (category 2A, 2B, or 3) • Child ran away • Other (open text field populates if selected)	Reworded and changed dropdown options	Assessment Outcome	Original Wording: "Reason for Closure" Original Dropdown Options: • UAC turned 18 • Legal Case- Status Achieved • Legal Case Closed Without Status • Sponsor DECLINED Services • PRS Assessment deemed services completed / no longer needed • Unable to Contact Sponsor / UAC • Transferred to another PRS Provider • UAC Ran Away • UAC Arrested • Other
	Details	Added		Optional open text field
	Child agrees to be contacted after case closure	Added		Checkbox
	Attach Supporting Documentation	Added		Optional. Includes open text field to add notes about attached documents.

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Sheet 4: Fields Removed

HS/PRS Referral (Form S-19) Fields Removed
Section	Field	Notes
UC Basic Information	Phone Number	Information not necessary to process a referral
HS/PRS Referral Information	Type	Not needed since HS and PRS referrals will be separate forms Dropdown Options: • PRS-Only • PRS-TVPRA • PRS-After ORR Mandated • PRS-After Discretionary • Home Study-TVPRA • Home Study-ORR Mandated • Home Study-Discretionary
	Queue	Related to UC Path system process that is not present in UC Portal
	Referred By?	Duplicative of "Referring Facility Name"
	Lead Program Case Manager	Information not necessary to process a referral
Sponsor Information	Street Address	Information not necessary to process a referral
	Email	Information not necessary to process a referral
	Phone Number	Information not necessary to process a referral
	Alternate Phone Number	Information not necessary to process a referral
	Adult Caregiver	Information not necessary to process a referral
	Caregiver Contact Details	Information not necessary to process a referral
	Street Address	Information not necessary to process a referral
Assessment Outcomes	Reason for Closure	Dropdown Options: UAC turned 18 Legal Case- Status Achieved Legal Case Closed Without Status Sponsor DECLINED Services PRS Assessment deemed services completed / no longer needed Unable to Contact Sponsor / UAC Transferred to another PRS Provider UAC Ran Away UAC Arrested Other
	Mitigation	Not needed. Not all cases require mitigation.
	Profile Name	Duplicative
	Outcome of Assessment	Duplicative. Already collected in HS Assessment (Form S-6) Dropdown Options: • Positive • Negative
	Describe Assessment Outcome	Duplicative. Already collected in HS Assessment (Form S-6)
	Date/Time Opened	Extraneous Salesforce system field
	Date/Time Closed	Extraneous Salesforce system field
	Parent Entry	Extraneous Salesforce system field
	Entry Owner	Extraneous Salesforce system field
System functionality that was specific to UC Path and is not currently present in UC Portal or the new PRS system was also removed. This includes:
Function	Description
Assessments	UC Path system displayed a list of completed assessments and included hyperlinks users could click to view the assessments. It also included links to create new assessments.
Entry Team	UC Path system allowed users to search for and select individuals working on the child's case. This was replaced in part by fields/functionality in UC Portal and the new PRS system (see other tabs for details).
Entry History	UC Path system generated an entry in this table each time a user made a change to the form.
Related tab	UC Path system generated hyperlinked lists of Sponsor HS/PRS Referrals, Related UAC Contacts, and Related UAC HS/PRS Referrals.
Case Notes tab	UC Path system allowed users to log contact history to document when they reached out to the sponsor and/or child.
Email tab	UC Path system allowed users to generate and send emails within the system.