ORR-4 Instructions
Unaccompanied Refugee Minor
Outcomes Report
What the ORR-4 Report is:
The ORR-4 Report is an annual outcomes report for children and youth in the Unaccompanied Refugee Minor (URM) program.
It provides information on the status and personal functioning of youth.
It also provides information on services received and youth outcomes, similar to information tracked on other foster youth and former foster youth via the National Youth in Transition Database (NYTD).
The ORR-4 Report assists the Office of Refugee Resettlement (ORR) to assess the youths’ progress and to meet reporting requirements in the Immigration and Nationality Act (8 U.S.C. 1522, Section 412(d)).
It also assists ORR in understanding program effectiveness and broader planning for the URM program.
Note 1: Failure to provide these reports may result in delay, suspension, or termination of grant support.
Note 2: When referring to “minors” or “youth,” this ORR-4 form and instructions means both children under the age of 18 and youth over the age of 18 who are receiving and/or have received placement including independent living and ETV benefits and services funded by ORR.
Who Fills Out and Submits the ORR-4:
The form needs to be filled and reviewed by both the URM Provider and the State Agency.
A caseworker or program manager fills out the form initially.
Once it is completed, it is then sent to the State Refugee Coordinator (SRC).
The SRC reviews, endorses and submits the form to ORR.
When the ORR-4 is to be Submitted:
Annual Outcomes Report: Submitted annually on or around the anniversary of initial placement for youth, while the youth receives ORR-funded placement and/or services. This annual report includes submission for youth receiving ORR-funded independent living benefits and services consistent with the State’s Title IV-B or IV-E plan, including the equivalent of an education or training voucher, even if they have emancipated from placement services.
Sections V: Independent Living Services, and VI: Independent Living Outcomes, are not required in standard reports for youth who have not yet turned 17 years old.
Baseline report -- Youth 17 and above: Submitted within 30 days of placement into the URM program, in conjunction with an ORR-3 initial placement report for youth who enter the program at age 17 and above, in order to establish a baseline of information for the youth. Please complete all sections as best as possible in this baseline report.
Follow-up Annual Report -- Former URM clients who are 17 to 21 years old and have terminated all ORR-funded services: Submitted annually on or around the anniversary of initial placement for youth age 17 to 21 years old who have terminated all ORR-funded services, including placement, independent living services, and education or vocational benefits. The goal is to gather information on how youth transition to independence. Such youth may be receiving independent living services and/or education and training benefits from a State Title IV-B/IV-E agency rather than through URM funding, or may have chosen to terminate all services. Efforts should be made to locate and obtain information from such former URM clients through the age of 211. If it is not possible to locate a former URM or the former URM declines to participate, report these circumstances in Section VI, Independent Living Outcomes under ‘1. Outcomes reporting status.’
Sections III: Education, Medical Coverage and Personal Functioning, and IV: Family Reunification Activity, are not required in follow up reports.
Instructions for Completing the ORR-4 Report |
At the top of the page, enter the information for the following:
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SECTION I: REPORT ACTION
Check the appropriate box to indicate the type of report being submitted:
Annual Outcomes Report.
Baseline report -- Youth 17 and above and submitted in conjunction with an initial ORR-3 placement report.
Follow-up Annual Report -- Former URM clients who are 17 to 21 years old and have terminated all ORR-funded services.
SECTION II: IDENTIFYING DATA
Date of Birth: The youth’s date of birth. Include month, day, and year from official document such as birth certificate or immigration documents (i.e., I-94). See ORR policy on age redetermination if needing to change a date of birth (State Letter # 01-27).
Sex: Self explanatory.
SECTION III: EDUCATION, MEDICAL COVERAGE and PERSONAL FUNCTIONING of the YOUTH
Education Information
Current school grade level: Provide the youth's school grade level in the available space. If the youth is not currently in school, give most recent grade level.
Current school level: Check the appropriate box for primary, middle school/junior high, secondary education and provide additional curricular information, as appropriate, in the space provided. If the youth is in a post-secondary placement, please list the type of degree program and the estimated completion date. If the youth is not in school, please explain.
Check the appropriate box to indicate if the youth required and received educational remedial services, defined as additional educational services, including special testing, tutorial, bilingual or translation services, etc. Check the appropriate box. If the response is “yes,” specify the services received by the youth during this reporting period.
Educational or vocational skills, certificates or diplomas: Check the appropriate box indicating “yes” or “no.” This question is to be completed for youth age 16 and below; Section V will capture this information for youth 17 and older. If the response is “yes,” provide specific educational accomplishments achieved during this reporting period.
Medical Coverage: Check the appropriate box for medical coverage and provide more information if “Other” is checked.
Medicaid
ORR-funded medical coverage: Select if URM funds are used to cover medical coverage for the youth, this may include private insurance or reimbursements to Medicaid.
Other
None
Caseworker/Provider Assessment: Provide an age-appropriate assessment of the youth’s personal functioning in the reporting period, based on the following scale: 1 for poor, 2 for below average, 3 for average, 4 for above average, and 5 for excellent. Rate the youth’s functioning in the following areas:
English Language Skill
Education (other than English language)
Social Adjustment
Health
Mental Health
Preservation of Ethnic and Religious Heritage
Youth’s Adherence to Safety Plan (Leave blank if youth does not have or need a safety plan.)
Note: If indicating that the child has either poor or excellent functioning, enter in the space provided an explanation of impediments to the youth’s progressive development in the areas in question, and actions detailed in the youth's plan to support improvement in these areas.
SECTION IV: FAMILY REUNIFICATION ACTIVITY2
Describe efforts in the reporting period to reunify a youth with his or her parents or other relatives, and to maintain or develop family connections. Continue to reassess family reunification options over time, as a relative’s ability to provide care for a youth may change.
Refer to ORR policy guidance in ORR’s Statement of Goals, Priorities, Standards and Guidelines for the Unaccompanied Minor Refugee and Cuban/Haitian Entrant Programs regarding reunification with parents who arrive in the U.S. following a youth’s placement in the URM program (see section III. Program Standards, Legal Considerations, B. Family Reunion), and assistance to youth applying for their parents’ admission to the U.S.
Note that per 45 CFR 400.113, URM services terminate if a youth reunifies with a parent or non-parental adult willing and able to provide care and to whom legal custody and/or guardianship is granted under State law.
For this section, when providing information on relationships with family, please be specific if possible; for example, aunt, grandfather, cousin. If the relationship is not clear to the youth and URM provider agency, indicate ‘female family member,’ or ‘male family member.’ Also include reunification efforts with unrelated adults; describe the relationship as well as possible; for example, friend of mother, former neighbor, etc. To the extent possible when providing locations, specify the city and state for family members in the U.S., or the city or refugee camp name and country for family members in other countries.
Current Permanency Plan
Indicate whether the youth has a current permanency plan by checking “yes” or “no,” and provide the date of the most recent permanency plan review. If the youth has emancipated from placement services and is in independent living, check the box for emancipated.
Family Reunification Efforts in the U.S.
Provide information parents or relatives in the U.S. who were being assessed, in the reporting period, for reunification. Indicate whether such assessment was conducted by checking “yes” or “no.” Provide the name(s), relationship(s), and location(s) of parents or relatives contacted.
Indicate if there have been significant developments, in the reporting period, in family reunification efforts with parents or relatives in the U.S., by checking “yes” or “no.” Describe efforts and significant developments in the reporting period.
Explain any explicit decisions or outcomes in the reporting period not to reunify a youth under the age of 18 with a parent or relative in the U.S.
Family Tracing and Reunification with Relatives in Other Countries
Provide information on contacts with parents or relatives in other countries who were being assessed, in the reporting period, for reunification. Indicate whether such assessment was conducted by checking “yes” or “no.” Provide the name(s), relationship(s), and location(s) of parents or relatives contacted.
Indicate if there have been significant developments, in the reporting period, in family reunification efforts with parents or relatives in other countries, by checking “yes” or “no.” Describe efforts and significant developments in the reporting period, including any efforts of the youth to assist a relative to obtain immigration status to come to the U.S.
Explain any explicit decisions or outcomes in the reporting period not to reunify a youth under the age of 18 with a parent or relative outside of the U.S.
Communication with Family Members
Indicate if the youth is in communication with parents or relatives, in the U.S. or other countries, with whom reunification is not feasible or appropriate at this point in time by checking “yes” or “no.”
Include contact with siblings or relatives who are too young to serve as caregivers.
Provide the name(s), relationship(s), location(s) and the youth’s frequency of contact with the relatives in question.
When describing frequency of communication between a youth and family members, select the best fit from among the following options: weekly, monthly, quarterly, semi-annually (once every six months), and annually.
If a youth is in communication with more family members than the available space allows, include any communication with parents and then select the relatives with whom the youth communicates most frequently.
SECTION V: INDEPENDENT LIVING SERVICES
This section must be completed regardless of whether the youth is in foster care or not, and is designed to collect information on a follow-up basis, including youth who have left URM foster care and are no longer receiving URM-funded independent living services. Such youth may be receiving independent living services and benefits from a State title IV-B/IV-E agency rather than through URM funding, or may have chosen to terminate all services. This should be completed for youth 17 and older only.
This section should be completed based on the URM provider agency’s knowledge of services provided to the youth. If the youth has terminated all ORR-funded services, the URM provider may ask the youth for information about services provided through a State title IV-B/IV-E agency or other source, in order to respond.
Youth residence: Provide the residential address for youth no longer in foster care or other placement but continuing in ORR-funded educational or independent living services, or for youth who have terminated all ORR-funded services but are 17-21 years old and in the follow-up outcomes reporting period. Leave this field blank if youth remains in foster care.
Services Types: Select funding source(s) for the following services.
Youth remains in foster care. The youth receiving services is in foster care under the placement and care responsibility of the State, county or URM provider agency in a 24-hour substitute care placement on the date of outcomes data collection. Placement includes but is not limited to foster family homes, foster homes of relatives, group homes, emergency shelters, residential facilities, and child care institutions. Indicate whether the youth is in foster care.
Adjudicated delinquent. Adjudicated delinquent is when a State or Federal court of competent jurisdiction has adjudicated the youth as a delinquent.
Special education. Special education, at no cost to parents, has been specifically designed to meet the unique needs of a child with a disability.
Independent living needs assessment. Independent living needs assessment is a systematic procedure to identify a youth’s basic skills, emotional and social capabilities, strengths, and needs to match the youth with appropriate independent living services. An independent living needs assessment may address knowledge of basic living skills, job readiness, money management abilities, decision-making skills, goal setting, task completion, and transitional living needs.
Academic support. Academic support includes services designed to help a youth complete high school or obtain a General Equivalency Degree (GED). Such services include: academic counseling; preparation for a GED, including assistance in applying for or studying for a GED exam; tutoring; help with homework; study skills training; literacy training; and help accessing educational resources. Academic support does not include a youth’s general attendance in high school.
Post-secondary educational support. Post-secondary education support includes services designed to help a youth enter or complete postsecondary education and includes: classes for test preparation, such as the Scholastic Aptitude Test (SAT); counseling about college; information about financial aid and scholarships; help completing college or loan applications; or tutoring while in college.
Career preparation. Career preparation includes services that focus on developing a youth’s ability to find, apply for, and retain appropriate employment including: vocational and career assessment (career exploration and planning, guidance in setting and assessing vocational and career interests and skills, and help in matching interests and abilities with vocational goals); job seeking and job placement support (identifying potential employers, writing resumes, completing job applications, developing interview skills, job shadowing, receiving job referrals, using career resource libraries, understanding employee benefits coverage, and securing work permits); retention support, e.g., job coaching; learning how to work with employers and other employees; understanding workplace values such as timeliness and appearance; and understanding authority and customer relationships.
Employment programs or vocational training. Employment programs or vocational training are designed to build a youth’s skills for a specific trade, vocation, or career through classes or on-site training. Employment programs include an apprenticeship, internship, or summer employment programs and do not include summer or after-school jobs secured by the youth alone. Vocational training includes a youth’s participation in vocational or trade programs and the receipt of training in occupational classes for such skills as cosmetology, auto mechanics, building trades, nursing, computer science, and other current or emerging employment sectors.
Budget and financial management. Budget and financial management assistance includes the following types of training and practice: living within a budget; opening and using a checking and savings account; balancing a checkbook; developing consumer awareness and smart shopping skills; accessing information about credit, loans and taxes; and filling out tax forms.
Housing education and home management training. Housing education and home management training is assistance or training in locating and maintaining housing (filling out a rental application and acquiring a lease, handling security deposits and utilities, understanding practices for keeping a healthy and safe home, understanding tenants’ rights and responsibilities, and handling landlord complaints). Home management includes instruction in food preparation, laundry, housekeeping, living cooperatively, meal planning, grocery shopping and basic maintenance and repairs.
Health education and risk prevention. Health education and risk preparation can provide information about: hygiene, nutrition, fitness and exercise, and first aid; medical and dental care benefits, health care resources and insurance, prenatal care and maintaining personal medical records; sex education, abstinence education, and HIV prevention (education and information about sexual development and sexuality, pregnancy prevention and family planning, and sexually transmitted diseases and AIDS); substance abuse prevention and intervention (education and information about the effects and consequences of substance use--alcohol, drugs, tobacco--and substance avoidance and intervention). Health education and risk prevention does not include the youth’s actual receipt of direct medical care or substance abuse treatment.
Family support and healthy marriage education. Family support and healthy marriage education include education and information about safe and stable families, healthy marriages, spousal communication, parenting, responsible fatherhood, childcare skills, teen parenting, and domestic and family violence prevention.
Mentoring. Mentoring refers when youth has been matched with a screened and trained adult for a one-on-one relationship that involves the two meeting on a regular basis. Mentoring can be short-term, but it may also support the development of a long-term relationship. While youth often are connected to adult role models through school, work, or family, this service category only includes a mentor relationship that has been facilitated, paid for or provided by the State agency or its staff.
Supervised independent living. Supervised independent living is when a youth is living semi-independently under a supervised arrangement that is paid for or provided by the State, county, or URM provider. A youth in supervised independent living is not supervised 24 hours a day by an adult and often is provided with increased responsibilities, such as paying bills, assuming leases, and working with a landlord, while under the supervision of an adult. For purposes of reporting to ORR, a supervised independent living placement is distinguished by the state, county, or URM provider agency itself: 1) arranging and directly paying for placement as a custodial responsibility or in response to a voluntary agreement with a youth, with increasing opportunity for self-care. Placement may occur in a variety of settings, including in an apartment, a family home, a traditional care program or another transitional living arrangement. A supervised independent living placement may also be referred to as semi-independent living placement.
Room and board financial assistance. Room and board financial assistance includes payment that is paid for or provided by the State agency for room and board, including rent deposits, utilities, and other
Education financial assistance. Education financial assistance includes payment that is paid for or provided by the State agency for education or training, including allowances to purchase textbooks, uniforms, computers, and other educational supplies; tuition assistance; scholarships; payment for educational preparation and support services (i.e., tutoring), and payment for GED and other educational tests. This financial assistance also includes vouchers for tuition or vocational education or tuition waiver programs paid for or provided by the State agency.
Other financial assistance. Other financial assistance includes any other payments that are not mentioned above and made or provided by the State agency to help the youth live independently. List type of financial assistance.
SECTION VI: INDEPENDENT LIVING OUTCOMES
This section must be completed as a result of surveying the youth (URM or former URM) using survey questions from the NYTD which correspond to questions 4 – 26 in this section3. Responses are not based on the URM Provider’s assessment of the child’s outcomes. Rather, responses should be based on the perception and self-report of the youth when surveyed by the URM Provider. This should be completed for youth 17 and older only.
This section must also be completed regardless of whether or not the youth is in foster care, and is designed to collect information on a follow-up basis, and includes youth who have left URM foster care and are no longer receiving URM-funded independent living services.
For data elements 4 - 26, indicate whether the following outcomes apply with a ‘‘yes’’ or ‘‘no’’ as appropriate, based on the youth’s response. If the youth does not answer a question, indicate ‘‘declined.’’ An exception is data element 13, where options are provided to indicate the highest educational certification received; only one element is to be selected.
For data elements 9 – 11, indicate “not applicable” if the youth remains in foster care. For data element 20 of this section, indicate “not applicable” if the answer to 19 is “no.” Data elements 21-26 include a “don’t know” option and a “not applicable” option.
Outcomes reporting status. Represents the youth’s participation, or lack thereof, in the outcomes data collection. If information is collected via survey of the youth on any of the data elements in 4 – 26 of this section, indicate that the youth participated. If unable to collect the information by surveying the youth, indicate the reason and leave the data elements in 4 – 26 of this section blank.
a. Youth participated. The youth participated in the outcome survey, either fully or partially.
b. Youth declined. The youth was successfully located and his or her participation was invited, but the youth declined to participate in the data collection.
c. Incapacitated. The youth has a permanent or temporary mental or physical condition that prevents him or her from participating in the outcomes data collection.
d. Incarcerated. The youth is unable to participate in the outcomes data collection because of his or her incarceration.
e. Runaway/missing. A youth in foster care is known to have run away or be missing from his or her foster care placement.
f. Unable to locate/invite. The State agency could not locate a youth who is not in foster care or otherwise invite such a youth’s participation.
g. Death. The youth died prior to his participation in the outcomes data collection.
Date of outcome data collection. The latest date that data was collected from a youth for the elements described in 4 – 26 of this section. Indicate the month, day and year of the outcomes data collection.
Foster care status—outcomes. Indicate if the youth is in foster care under the placement and care responsibility of the State, county or URM provider agency in a 24-hour substitute care placement on the date of outcomes data collection. This includes but is not limited to placement in foster family homes, foster homes of relatives, group homes, emergency shelters, residential facilities, and child care institutions. Indicate whether the youth is in foster care with a ‘‘yes’’ or ‘‘no’’ as appropriate.
Current full-time employment. A youth is employed full-time if employed at least 35 hours per week in one or multiple jobs as of the date of the outcome data collection.
Current part-time employment. A youth is employed part-time if employed between one and 34 hours per week in one or multiple jobs as of the date of the outcome data collection.
Employment-related skills. A youth has obtained employment-related skills if the youth completed an apprenticeship, internship, or other on-the-job training, either paid or unpaid, in the past year. The experience must help the youth acquire employment-related skills, e.g., specific trade skills such as carpentry or auto mechanics, or office skills such as word processing or use of office equipment.
Social Security. A youth is receiving some form of Social Security if receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), either directly or as a dependent beneficiary as of the date of the outcome data collection. SSI payments are made to eligible low-income persons with disabilities. SSDI payments are made to persons with a certain amount of work history who become disabled. A youth may receive SSDI payments through a parent, although this would be an unusual occurrence for a URM or former URM.
Educational aid. A youth is receiving educational aid if using a scholarship, voucher (including education or training vouchers pursuant to section 477(h)(2) of the Social Security Act), grant, stipend, student loan, or other type of educational financial aid to cover educational expenses as of the date of the outcome data collection. Scholarships, grants, and stipends are funds awarded for spending on expenses related to gaining an education. ‘‘Student loan’’ means a government-guaranteed, low-interest loan for students in post-secondary education.
Public financial assistance. A youth is receiving public financial assistance if receiving ongoing cash welfare payments from the government to cover some of his or her basic needs, as of the date of the outcome data collection. Public financial assistance does not include government payments or subsidies for specific purposes, such as unemployment insurance, child care subsidies, education assistance, food stamps or housing assistance.
Public food assistance. A youth is receiving public food assistance if receiving food stamps in any form (i.e., government-sponsored checks, coupons or debit cards) to buy eligible food at authorized stores as of the date of the outcome data collection. This definition includes receiving public food assistance through the Women, Infants, and Children (WIC) program.
Public housing assistance. A youth is receiving public housing assistance if the youth is living in government-funded public housing, or receiving a government-funded housing voucher to pay for part of his/her housing costs as of the date of the outcome data collection. Chafee Foster Care Independence Program (CFCIP) room and board payments are not included in this definition.
Other financial support. A youth has other financial support if receiving any other periodic and/or significant financial resources or support from another source not listed in the elements described in elements 8 -11 of this section as of the date of outcome data collection. Such support can include payments from a spouse or family member (biological, foster or adoptive), child support that the youth receives for him or herself, or funds from a legal settlement. This definition does not include occasional gifts, such as birthday or graduation checks or small donations of food or personal incidentals, child care subsidies, child support for a youth’s child, or other financial support which does not benefit the youth directly in supporting himself or herself.
13. Highest educational certification received. A youth has received an education certificate if the youth has a high school diploma or general equivalency diploma (GED), vocational certificate, vocational license, associate’s degree (e.g., A.A.), bachelor’s degree (e.g., B.A. or B.S.), or a higher degree as of the date of the outcome data collection. Indicate the highest degree that the youth has received. Please select ONLY one.
a. A GED is a certificate a student receives if they have passed a high school equivalency test.
b. A high school diploma is a diploma awarded for the completion of high school.
c. A vocational certificate is a document stating that a person has received education or training that qualifies him or her for a particular job, e.g., auto mechanics or cosmetology.
d. A vocational license is a document that indicates that the State or local government recognizes an individual as a qualified professional in a particular trade or business.
e. An associate’s degree is generally a two-year degree from a community college.
f. A bachelor’s degree is a four-year degree from a college or university.
g. A higher degree indicates a graduate degree, such as a Master’s Degree or a Juris Doctor (J.D.).
h. None of the above means that the youth has not received any of the above educational certifications.
Current enrollment and attendance. Indicate whether the youth is currently enrolled in and attending high school, GED classes, or postsecondary vocational training or college, as of the date of the outcome data collection. A youth is still considered enrolled in and attending school if the youth would otherwise be enrolled in and attending a school that is currently out of session.
Connection to adult. A youth has a connection to an adult if, as of the date of the outcome data collection, the youth knows an adult who he or she can go to for advice or guidance when there is a decision to make or a problem to solve, or for companionship when celebrating personal achievements. The adult must be easily accessible to the youth either by telephone or in person. This can include but is not limited to adult relatives, parents or foster parents. The definition excludes spouses, partners, boyfriends or girlfriends and current caseworkers.
Homelessness. A youth is considered to have experienced homelessness if the youth had no regular or adequate place to live. For a 17-year-old youth, the data element relates to a youth’s lifetime experiences. Many URMs have lifetime experiences of having no regular or adequate place to live for at least a portion of their lives, but may not have experienced the NYTD definition of situations where the youth has lived in a car or on the street, or staying in a homeless or other temporary shelter. The youth’s perception of whether their lifetime experience includes a period of no regular or adequate place to live determines whether the answer to this element is “yes” or “no.” For a youth 18 years or older, the data element relates to the youth’s experience in the past year.
Substance abuse referral. A youth has received a substance abuse referral if the youth was referred for an alcohol or drug abuse assessment or counseling. For a 17-year-old youth, the data element relates to a youth’s lifetime experience. For a youth 18 years or older, the data element relates to the youth’s experience in the past year. This definition includes either a self-referral or referral by a social worker, school staff, physician, mental health worker, foster parent, or other adult. Alcohol or drug abuse assessment is a process designed to determine if someone has a problem with alcohol or drug use.
Incarceration. A youth is considered to have been incarcerated if the youth was confined in a jail, prison, correctional facility, or juvenile or community detention facility in connection with allegedly committing a crime (misdemeanor or felony). For a 17-year-old youth, the data element relates to a youth’s lifetime experience. For a youth 18 years or older, the data element relates to the youth’s experience in the past year.
Children. A youth is considered to have a child if the youth has given birth herself, or the youth has fathered any children who were born. For a 17- year-old youth in the baseline population, the data element relates to a youth’s lifetime experience. For a youth 18 years or older, the data element relates to the youth’s experience in the past year. This refers to biological parenthood.
Marriage at child’s birth. A youth is married at the time of the child’s birth if he or she was united in matrimony according to the laws of the State to the child’s other parent. Indicate whether the youth was married to the child’s other parent at the time of the birth of any child reported in the element described in 19 of this section. This does not include common law marriages or customary marriages which did not result in documentation of the marriage recognized by the State or country of residence at the time of the marriage.
Medicaid. A youth is receiving Medicaid if the youth is participating in a Medicaid-funded State program, which is a medical assistance program supported by the Federal and State government under title XIX of the Social Security Act as of the date of outcomes data collection.
Other health insurance coverage. A youth has other health insurance if the youth has a third-party pay (other than Medicaid) for all or part of the costs of medical care, mental health care, and/or prescription drugs, as of the date of the outcomes data collection. This definition includes group coverage offered by employers, schools or associations, an individual health plan, self-employed plans, inclusion in a parent’s insurance plan, or ORR-funded medical coverage. This also could include access to free health care through a college, Indian Health Service, or other source. Medical or drug discount cards or plans are not insurance.
Health insurance type: Medical. If the youth has indicated that he or she has health insurance coverage in the element described in 22 of this section, indicate whether the youth has insurance that pays for all or part of medical health care services.
Health insurance type: Mental health. If the youth has indicated that he or she has medical health insurance coverage as described in 23 of this section, indicate whether the youth has insurance that pays for all or part of the costs for mental health care services, such as counseling or therapy.
Health insurance type: Prescription drugs. If the youth has indicated that he or she has medical health insurance coverage as described in 23 of this section, indicate whether the youth has insurance coverage that pays for part or all of the costs of some prescription drugs.
Health insurance type: Other. If the youth has indicated that he or she has medical health insurance coverage as described in 23 of this section, indicate whether the youth has insurance coverage that pays for part or all of the costs of other medical services, e.g., dental or vision. Enter the other type of coverage in the blank provided.
SECTION VI — FORM SUBMISSION AUTHORITY
This section will populate from the first page. However, please fill in all missing information i.e. phone number and email address of the person(s) preparing and submitting the report.
Unaccompanied Refugee Minor (URM) Provider Agency: Provide the name and address of the URM provider agency; and the name, title, phone number and email address of the person preparing the report and the date of the report was prepared.
State Agency: Provide the name and address of the state agency; and the name, title, phone number and email address of the state official submitting the report, and the date the report was submitted to ORR.
DISTRIBUTION of REPORT:
The appropriate state agency representative should send the Form ORR-4 to the Office of Refugee Resettlement via the ACF electronic URM mailbox: URMProgram@acf.hhs.gov.
The appropriate state agency representative may choose to send the ORR-4 form to the National Voluntary Agency.
"THE PAPERWORK REDUCTION ACT OF 1995"
Public reporting burden for this collection of information is estimated to average 1.5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
1 Starting October 1, 2010, states began to collect data for National Youth Transitional Data (NYTD) and report it to ACF semiannually.
2 Family reunification is a required case planning activity; see 45 CFR 400.118.
3 ORR created similar data elements of NYTD that states collects and reports to Children’s Bureau in ACF.
Revised Aug 2012
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | ORR-4 Instructions--Outcome and Progress Report |
| Author | ypark |
| File Modified | 0000-00-00 |
| File Created | 2021-10-19 |