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Family Reunification Application - Sponsor Experience App
ICR 202611-0970-003 · OMB 0970-0278 · Object 174496200.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | Family Reunification Application - Sponsor Experience App |
| Conversion State | complete |
Extracted Text
New Sponsor application <FRA> Form Section 3-6 Sect 4 Sect 3 An official website of the United States government Here’s how you know Sponsor Application for Family Unification MENU 3: Sponsor information This section has not been started. 3.1 Sponsor’s relationship to child Child Maria Ricardo Sponsor-child relationship Your relationship to this child - Select - Proof of relationship Upload one of the following documents to provide proof of a relationship between you and the minor. Expired documents are acceptable. Parent document selection - Select - Sect 6 Sect 5 An official website of the United States government Here’s how you know Sponsor Application for Family Unification An official website of the United States government Here’s how you know Sponsor Application for Family Unification MENU 4: Household information 5: Alternative caregiver Progressive disclosure for address when answer = no This section has not been started. 4.1 Where will you and the child (children) live? Address 8721 River Bend Street Apt 811 Jupiter, IN 90521 This section has not been started. 4.1 Where will you and the child (children) live? 5.1 Adult who will Address 8721 River Bend Street Apt 811 Jupiter, IN 90521 Same as your current address? Same as your current address? Yes Yes No No Proof of your current address Country Upload at least one form of documentation verifying your current address. United States Street address If you are unable to provide this documentation, please contact your Case Manager. City New conditional logic on whether or not an ACG is an adult HHM age >= 18yrs ol Question responses If Yes - User is required to select which HHM from the droplis If No - Do not ask the next question - Select - Upload front of birth certificate Upload files 4.2 Household members Upload back of birth certificate Is the Alternative caregiver an adult household member (greater than 18 years old)? Yes Which adult household member would be the alternative caregiver? Adult household member selection - Select - First name Please explain why this varies from your current address Last name Background information Your country of origin (where you were born) Back Delete Proof of alternative caregiver’s identity Upload the alternative caregiver’s government issued ID. You may present one selection from List A or two or more selections from List B. If you present selections from List B, at least on selection must contain a photograph. Expired documents are acceptable. Household member’s last name Household member’s date of birth mm/dd/yyyy - Select - - Select - Household member's relationship to Child 1, Maria Ricardo Language 2 (optional) - Select - Household member's relationship to Child 2, Anna Ricardo - Select - - Select - + Add another household member Your contact information Mobile phone number Secondary phone number (optional) Email address (optional) 4.3 Health information How will you financially support the child (children)? Please explain. Include all sources and amounts of your income (for example, the amount you are paid each week) as well as explaining any financial support from others who will help with financial support. Need Help? See Frequently Asked Questions or contact your Case Manager. Family Reunification Packet | Version 13 FRP-3 Family Reunification Application Revised 12/28/2022 List B document 1 selection - Select - Progressive disclosure for Health information questions when answer = yes Serious contagious diseases Does any person in your household have any serious contagious diseases? e.g. TB, AIDs, hepatitis, etc. Does any person in your household have any serious contagious diseases? e.g. TB, AIDs, hepatitis, etc. Yes Yes No No 5.2 About the alternative caregiver Contact information No Child health conditions Yes Alternative caregiver’s address Country United States Street address Progressive disclosure for Criminal history questions when answer = yes Yes Have you or any person in your household ever been charged with or convicted of a crime (other than a minor traffic violation)? e.g. speeding, parking ticket, etc. Alternative caregiver’s phone number Please explain. Are you aware of any health conditions the child (children) may have? e.g. disabilities, allergies, diseases, etc. Crime Submit for Case Manager review Are you aware of any health conditions the child (children) may have? e.g. disabilities, allergies, diseases, etc. Yes No Please explain. 4.4 Criminal history Crime Have you or any person in your household ever been charged with or convicted of a crime (other than a minor traffic violation such as a speeding or parking ticket)? Yes No Abuse or abandonment Have you or any person in your household ever been investigated for the physical abuse, sexual abuse, neglect, or abandonment of a minor? Incident 1 Add Delete Name of household member(s) involved State - Select - Zip code Relationships Alternative caregiver's relationship to you, the sponsor - Select - Alternative caregiver's relationship to Child 1, Maria Ricardo Alternative caregiver's relationship to Child 2, Anna Ricardo - Select - 5.3 Alternative Yes child care Place of the incident Save for later City - Select - No No If you become unable to care for the child (children), how will this alternative caregiver care for the child (children)? Date of the incident Submit for Case Manager review ORR National Call Center 1 (800) 203-7001 Revised 12/28/2022 1 (800) 203-7001 List B (upload two) Serious contagious diseases 4.4 Criminal history Save for later FRP-3 Family Reunification Application ORR National Call Center OR 4.3 Health information Child health conditions Your financial information Family Reunification Packet | Version 13 List A document selection Household member's relationship to you, the sponsor - Select - Language 3 (optional) Submit List A (upload one) Language 1 - Select - I will provide for the physical and mental well-being of the minor(s). I will also comply with my state's laws regarding the care of this minor including Enrolling the minor(s) in school Providing medical care when needed Protecting the minor(s) from abuse, neglect, and abandonment; an Any other requirement not herein contained Your signature Please type your name below to indicate your electronic signature. Need Help? See Frequently Asked Questions or contact your Case Manager. Date of birth mm/dd/yyyy - Select Language(s) you speak I further attest that I will abide by the care instructions contained in the Sponsor Care Agreement. No Zip code Household member’s first name 3.2 About you, Raul Miguel Castillo This section has not been started. I attest that all documents I am submitting or copies of those documents are free of error and fraud. Who currently lives at this address? Household member 1 Upload files 6: Application signature Who will care for the child(ren) if you become unable to care for the child(ren)? Alternative caregiver’s name Household members MENU care for the child(ren) if you cannot Proof of child’s identity Upload the child's birth certificate Sponsor Application for Family Unification I, Raul Miguel Castillo, declare and affirm under penalty of perjury that the information contained in this application is true and accurate to the best of my knowledge. State - Select - Proof of current address document selection MENU An official website of the United States government Here’s how you know Need Help? See Frequently Asked Questions or contact your Case Manager. Explanation of the incident Family Reunification Packet | Version 13 FRP-3 Family Reunification Application Revised 12/28/2022 Save Disposition of the incident e.g., charges dropped, fined, imprisoned, probation Submit for Case Manager review Return to top ORR National Call Center 1 (800) 203-7001 Abuse or abandonment Have you or any person in your household ever been investigated for the physical abuse, sexual abuse, neglect, or abandonment of a minor? ORR National Call Center Yes Call for questions, to change an address, or report a missing child No 1 (800) 203-7001 Abuse or abandonment Add Name of household member(s) involved Place Date Explanation of the incident Disposition of the incident e.g., charges dropped, fined, imprisoned, probation Save for later Submit for Case Manager review Need Help? See Frequently Asked Questions or contact your Case Manager. Family Reunification Packet | Version 13 FRP-3 Family Reunification Application Revised 12/28/2022 ORR National Call Center 1 (800) 203-7001