1 Orr-5 - Fy2020

Refugee Data Submission System for Formula Funds Allocations (ORR–5)

2. ORR-5 Form_current.xlsx

OMB: 0970-0043

Document [xlsx]
Download: xlsx | pdf


OMB #: 0970-0043



Expiration Date: XX/XX/XXXX

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 Gender M, F, or U for Unknown

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 draprograms@acf.hhs.gov.

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