Form S-27 Form S-27 UAC Case Status

UAC Case Status (Form S-27)

UAC Portal

OMB# 0970-0553

Main Case Status Page Located on the Case File Landing Page
UAC Basic Information
	First Name:	(Auto populate)	AKA:	(Auto populate)
	Last Name:	(Auto populate)	Status:	(Auto populate)
	Date of Birth:	(Auto populate)	Admitted Date:	(Auto populate)
	A#:	(Auto populate)	Length of Stay:	System Generated
	Country of Birth:	(Auto populate)	Current Program:	(Auto populate)
	Sex:	(Auto populate)	Portal ID:	(Auto populate)
	Physical Location of the Child:		(Auto populate – Source UC Portal Discharge Tab)

>| Go to Intakes

>| Go to Admission

>| Go to Child-Level Event

>| Go to Health

>| Go to Assessments

>| Go to Discharge

UAC Case Status

Child Assessments
Initial Intakes Assessment		Last Updated:			(Auto populate)
Assessment For Risk		Last Updated:			(Auto populate)
UAC Assessment		Last Updated:			(Auto populate)
Medical
Initial Medical Exam		Date Evaluated:			(Auto populate)
TB Screening		Outcome:			(Auto populate)
Immunizations (IME Only)		Last Updated:			(Auto populate)
Home Study and Post-Release Service Cases
Home Study	Type of Home Study:		(Auto populate)	Date Referred:		(Auto populate)	Date Accepted:	(Auto populate)
Post Release Services	Type of PRS:		(Auto populate)	Date Referred:		(Auto populate)	Date Accepted:	(Auto populate)

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L.104-13) Statement OF PUBLIC BURDEN: The purpose of this information collection is to allow care providers to monitor high-level milestones in a UAC’s case in ORR’s case Management Portal. The instrument is auto populated with information recorded in other assessments or spaces in UAC Portal. Public reporting burden for this collection of information is estimated to average 0.25 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, and Trafficking Victims Protection Reauthorization Act. 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]

Act of 1995, unless it displays a currently valid 0MB control number. If you have any comments on this collection of information please contact [email protected].

Family Reunification

Sponsor

(Auto Populate NAME)

Sponsor Assessment

Date Completed:

<Pop up Calendar>

Family Reunification Application Sent to Sponsor

Date Sent:

<Pop up Calendar>

Date Received:

<Pop up Calendar>

Authorization For Release of Information (ARI)

Date Received:

<Pop up Calendar> c N/A

Proof of Sponsor Identity

Date Completed:

<Pop up Calendar>

Proof of Sponsor Address

Date Completed:

<Pop up Calendar>

Proof of Relationship Between UAC and Sponsor

Date Completed:

<Pop up Calendar>

Concurrent Planning: Additional Potential Sponsors

Potential Sponsor Name:	Relationship to child:
	Sponsor Category:

(Auto populate)

(Auto populate)

(Auto populate)

Household Members

(Auto Populate NAME)
<Popup Calendar> Authorization For Release of Information (ARI)        Date Received:                 c N/A

Alternate Adult Caregiver

(Auto Populate NAME)
<Popup Calendar> Authorization For Release of Information (ARI)        Date Received:                 c N/A

 

Background Checks

Sponsor/ Adult Household Members & Alternate Adult Caregiver

(Auto populate)

Sponsor/ Alternate Adult Caregiver Name:  

Background Checks

Type	Date Requested	Date Results Received	Results Options: Clear; Appears Clear; Not Clear; Referred to FFS Results
Internet Criminal	(Auto populate)	(Auto populate)	(Auto populate)
Sex Abuse History	(Auto populate)	(Auto populate)	(Auto populate)
CA/N	(Auto populate)	(Auto populate)	(Auto populate)
FBI Criminal History	(Auto populate)	(Auto populate)	(Auto populate)

FBI Criminal History Fingerprinting Details

Method of Fingerprinting:

<Dropdown Menu> (-- Select Method --  FieldPrint;  ORR Digital Site;  Paper Fingerprint Card;  ) 

 

<OPTION 1 POP-UP> FieldPrint
First available FieldPrint fingerprint appointment*	Date available:	<Popup Calendar>
Accepted FieldPrint fingerprint appointment	Date of appointment:	<Popup Calendar>

 

<OPTION 2 Pop-Up> ORR Digital Site
First available ORR Digital Site fingerprint appointment*	Date available:	<Popup Calendar>
Accepted ORR Digital Site fingerprint appointment	Date of appointment:	<Popup Calendar>
ID sent to ORR Digital Site	Date sent:	<Popup Calendar>
ARI sent to ORR Digital Site	Date sent:	<Popup Calendar>

 

<OPTION 3 POP-UP> Paper Fingerprint Card
Fingerprint cards sent to adult by case manager	Date sent:	<Popup Calendar>
Complete fingerprint cards received by PSC	Date received:	<Popup Calendar>

>|Save

 

Legal
Know Your Rights Presentation:	Date Completed:	(Auto populate)
Legal Screening:	Date Completed:	(Auto populate)

Release Recommendations
Case Manager Release Request:	Last Updated:	(Auto populate)
Case Coordination Release Request:	Last Updated:	(Auto populate)
ORR Release Request Decision:	Last Updated:	(Auto populate)	Release Approved:	(Auto populate)

Case Manager Information

c Update my Information

Primary Case Manager Information

(Auto populate) Primary Case Manager Name:		Assigned on:	(System Generated)
(Auto populate) Primary Case Manager Email Address:
(Auto populate) Primary Case Manager Phone Number:
(Auto populate) Primary Case Manager Organization:

Back-up Case Manager

(Auto populate) Back-up Case Manager Name:		Assigned on:	(System Generated)
(Auto populate) Back-up Case Manager Email Address:
(Auto populate) Back-up Case Manager Phone Number:
(Auto populate) Back-up Case Manager Organization:

Previous Case Manager Information

(Auto populate) Previous Case Manager Name:		Assigned on:	(System Generated)
(Auto populate) Previous Case Manager Email Address:
(Auto populate) Previous Case Manager Phone Number:
Previous (Auto populate) Case Manager Organization:

ALTERNATIVE: // There is no Previous Case Manager associated with the UAC//

Unification Specialist Information
c Update my Information
Primary Unification Specialist Information
Primary Unification Specialist Name	(Auto Populate)		Assigned On		(Auto Populate)
Primary Unification Specialist Email Address:			(Auto Populate)
Primary Unification Specialist Phone Number:			(Auto Populate)
Primary Unification Specialist Organization:			(Auto Populate)
Previous Unification Specialist
Previous Unification Specialist Name	(Auto Populate)	Assigned On		(Auto Populate)
Previous Unification Specialist Email Address:		(Auto Populate)
Previous Unification Specialist Phone Number:		(Auto Populate)
Previous Unification Specialist Organization:		(Auto Populate)

Location of Child Appendix

Located on the UAC Portal Discharge Tab

UAC Basic Information
	First Name:	(Auto Populate)	AKA:	(Auto Populate)
	Last Name:	(Auto Populate)	Status:	(Auto Populate)
	Date of Birth:	(Auto Populate)	Admitted Date:	(Auto Populate)
	A#:	(Auto Populate)	Length of Stay:	System Generated
	Country of Birth:	(Auto Populate)	Current Program:	<Dropdown Menu>
	Sex:	(Auto Populate)	Portal ID:	(Auto Populate)

Assessments

{+/-}

Current Location of the Child

Location Type	Name	Address	Last Updated
<Dropdown Menu> (-Select One- Post Release Address Update1; Program2; Reported Missing Post Release3)	AUTOPOPULATE WHEN LOCATION TYPE = “PROGRAM”	AUTOPOPULATE WHEN LOCATION TYPE = “PROGRAM”	AUTOPOPULATE

{+/-}

Location History (AUTOPOPULATE WITH EACH NEW CURRENT LOCATION OF THE CHILD ENTRY)

Location Type	Name	Address	Last Updated
AUTOPOPULATE	AUTOPOPULATE	AUTOPOPULATE	AUTOPOPLATE

>| Print

{+/-}

Transfer Request

>| Add New

{+/-}

Release Request

>| Add New

{+/-}

Discharge Notification

>| Add New

Program Exit

>| Add New

{+/-}

Trigger Reports

CONDITIONAL LOGIC: Additional Fields - Post Release Address Update

Update Current Location of Child

Location Type:

<Dropdown Menu> (SELECTED: Post Release Address Update)

Living with Sponsor?

c Yes c No⁴

(CONDITIONAL LOGIC IF “NO”)

Living with a caregiver?

c Yes⁵ c No

(CONDITIONAL LOGIC IF “YES”)
Primary Caregiver Type:	<Dropdown Menu> (-Select Type- Assigned Alternate Caregiver6 /AUTOPOPULATE NAME/; Other Family Member; Family Friend; UAC’s Domestic Partner; Sponsor’s Domestic Partner; Unknown; Other7) (Open Text for” Other”)
Primary Caregiver Name:	(Open Text)	(Open Text)

Address Known?

c Yes⁸ c No

(CONDITIONAL LOGIC IF “YES”)
Search for an Address:	<Search Field> (Open Text)
Current Address Line 1:	(Open Text)
Current Address Line 2:	(Open Text)
City:	(Open Text)
State:	<Dropdown Menu> (-Select One- See Reference Table 1)
Zip Code:	(Open Text)
Country:	<Dropdown Menu> (-Select One- See Reference Table 2)

Notes:

(Open Text)

Reference Table 1: U.S. States and Territories

Alabama; Alaska; Arizona; Arkansas; American Samoa; California; Colorado; Connecticut; Delaware; District of Columbia; Florida; Georgia; Guam; Hawaii; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Louisiana; Maine; Maryland; Massachusetts; Michigan; Minnesota; Mississippi; Missouri; Montana; Nebraska; Nevada; New Hampshire; New Jersey; New Mexico; New York; North Carolina; North Dakota; Northern Mariana Islands; Ohio; Oklahoma; Oregon; Pennsylvania; Puerto Rico; Rhode Island; South Carolina; South Dakota; Tennessee; Texas; Trust Territories; Utah; Vermont; Virginia; U.S. Virgin Islands; Washington; West Virginia; Wisconsin; Wyoming

Reference Table 2: Countries

Afghanistan; Aland Islands; Albania; Algeria; American Samoa; Andorra; Angola; Anguilla; Antarctica; Antigua and Barbuda; Arabian Peninsula; Argentina; Armenia; Aruba; Australia; Austria; Azerbaijan; Bahamas; Bahrain; Bangladesh; Barbados; Belarus; Belgium; Belize; Benin; Bermuda; Bhutan; Bolivia; Bonaire, Sint Eustatius and Saba; Bosnia and Herzegovina; Botswana; Bouvet Island; Brazil; British Virgin Islands; Brunei; Bulgaria; Burkina Faso; Burundi; Cambodia; Cameroon; Canada; Cape Verde; Cayman Islands; Central African Republic; Chad; Chile; China; Chinese Taipei; Christmas Island; Cocos Islands; Colombia; Comoro Islands; Congo; Cook Islands; Costa Rica; Cote D'Ivoire; Croatia; Cuba; Curaçao; Cyprus; Czech Republic; Czechoslovakia; Dem Rep Of The Congo; Denmark; Djibouti; Dominica; Dominican Republic; East Timor; Ecuador; Egypt; El Salvador; Equatorial Guinea; Eritrea; Estonia; Ethiopia; Falkland Islands; Faroe Islands; Fiji; Finland; France; French Guiana; French Polynesia; French Southern And Antarctic; Gabon; Gambia; Georgia; Germany; Ghana; Gibraltar; Greece; Greenland; Grenada; Guadeloupe; Guam; Guatemala; Guernsey; Guinea; Guinea-Bissau; Guyana; Haiti; Heard Island and McDonald Islands; Holy See; Honduras; Hong Kong; Hungary; Iceland; India; Indonesia; Iran; Iraq; Ireland; Isle of Man; Israel; Italy; Ivory Coast; Jamaica; Japan; Jersey; Jordan; Kazakhstan; Kenya; Kiribati; Korea; Kosovo; Kuwait; Kyrgyzstan; Laos; Latvia; Lebanon; Lesotho; Liberia; Libya; Liechtenstein; Lithuania; Luxembourg; Macao; Macedonia; Madagascar; Malawi; Malaysia; Maldives; Mali; Malta; Mariana Islands; Northern Maritime; Marshall Islands; Martinique; Mauritania; Mauritius; Mayotte; Mexico; Micronesia; Moldova; Monaco; Mongolia; Montenegro; Montserrat; Morocco; Mozambique; Myanmar; Namibia; Nauru; Nepal; Netherlands; Netherlands Antilles; New Caledonia; New Zealand; Nicaragua; Niger; Nigeria; Niue; Norfolk Island; North Korea; Norway; Oman; Pakistan; Palau; Palestinian Territory, Occupied; Panama; Papua New Guinea; Paraguay; Peru; Philippines; Pitcairn Islands; Poland; Portugal; Puerto Rico; Qatar; Reunion; Romania; Russia; Rwanda; ST. Pierre And Miquelon; Saint Barthelemy; Saint Kitts and Nevis; Saint Lucia; Saint Martin (French part); Saint Vincent And the Grenadines; Samoa; San Marino; Sao Tome and Principe; Saudi Arabia; Senegal; Serbia; Seychelles; Sierra Leone; Singapore; Sint Maarten (Dutch part); Slovakia; Slovenia; Solomon Islands; Somalia; South Africa; South Georgia and the South Sandwich Islands; South Korea; South Sudan; Spain; Sri Lanka; St. Helena; Sudan; Suriname; Svalbard and Jan Mayen; Swaziland; Sweden; Switzerland; Syria; Taiwan; Tajikistan; Tanzania; Thailand; Togo; Tokelau; Tonga; Trinidad and Tobago; Tunisia; Turkey; Turkmenistan; Turks And Caicos Islands; Tuvalu; USSR; Uganda; Ukraine; United Arab Emirates; United Kingdom; United States of America; Unknown; Uruguay; Uzbekistan; Vanuatu; Venezuela; Vietnam; Virgin Islands, U.S.; Wallis And Futuna Islands; West Bank; Western Sahara; Western Samoa; Yemen; Yugoslavia; Zambia; Zimbabwe

1 Conditional Logic: “Post Release Address Update” triggers additional fields

2 Conditional Logic: Address will auto-populate (see above)

3 Conditional Logic: No address Fields populate

4 Conditional Logic: Living with Sponsor “No” triggers additional fields

5 Conditional Logic: Living with a Primary Caregiver “Yes” triggers additional fields

6 Conditional Logic: Primary Caregiver Type “Assigned Alternate Caregiver” will auto populate Primary Caregiver Name and Address Fields; address fields are editable if updates required.

7 Conditional Logic: Primary Caregiver Type “Other” triggers additional field

8 Conditional Logic: Address Known “Yes” will trigger additional fields.

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S-27 | Version #.#

Valid Through MM/DD/YYYY