Form ORR 5 ORR 5 ORR 5

		OMB #: 0970-0043
		Expiration Date: 05/31/2027
Refugee Data Submission System for Formula Funds Allocations (ORR-5)
Row Number	ORR5 Data	Format
1	Alien Number	8 or 9 digits
2	Status	Refugee, SIV, VOT, Asylee, C/H Entrant
3	Name	Last, First, Middle
4	Date of Birth	mm/dd/yyyy
5	Sex	M or F
6	State	State Code
7	County	County Name
8	Nationality	Country Name
9	Organization providing the support	State Name or Replacement Designee Name
10	Date eligible for ORR benefits	mm/dd/yyyy
11	Medical Screening Initial Enrollment Date	mm/dd/yyyy or Null if not enrolled
12	Medical Screening Exit Date	mm/dd/yyyy or Null if not enrolled or still active
13	Social Services Program Initial Enrollment Date	mm/dd/yyyy or Null if not enrolled
14	Social Services Program Exit Date	mm/dd/yyyy or Null if not enrolled or still active
15	RCA Initial Enrollment Date	mm/dd/yyyy or Null if not enrolled
16	RCA Exit Date	mm/dd/yyyy or Null if not enrolled or still active
17	RMA Initial Enrollment Date	mm/dd/yyyy or Null if not enrolled
18	RMA Exit Date	mm/dd/yyyy or Null if not enrolled or still active
19	Migration Status	In, Out, or No change
20	Date of Migration	mm/dd/yyyy - In/Out date based on Migration Status
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].
In immediate response to priorities of the current administration, this form has been updated with the following changes prior to approval by the Office of Management and Budget (OMB), as required by the Paperwork Reduction Act (PRA) of 1995 (44. USC. 3501 et seq.). The PRA requires that agencies obtain OMB approval before requesting information from the public, and OMB review and approval for most changes to an approved information. ACF is working to process these changes through OMB to come into compliance with the PRA but has implemented changes to the OMB-approved form to ensure compliance with the following Executive Orders: Executive Order(s) 14168 and/or 14151, 14173, 14224. Other than these changes, this form is approved under OMB #: 0970-0043.