ORR-6 Schedule F

Schedule F: Refugee Medical Assistance (RMA) and Medical Screening Programs			ORR-6 OMB Control No. 0970-0036 Expires XX/XX/XXXX
1. Annual Report, Fiscal Year:		2. Date:
3. State/Grantee:
Part I: Refugee Medical Assistance Recipients and Benefits
A. RMA Enrollment Caseload	Total	C. RMA Recipient Use by Cost Range	Total
1. Previous RMA recipients enrolled in this reporting period		1. No costs incurred
2. New RMA recipients enrolled during this reporting period		2. $1−$10,000
3. Total number of RMA recipients enrolled during this reporting period	0	3. $10,001−$150,000
B. RMA Termination Reason	Total	4. $150,001−$350,000
1. Reached time-eligibility limit		5. Over $350,000
2. Transitioned to Medicaid
3. Out-migrated
4. Other
5. Total number of RMA terminations	0
Part II: Medical Screening Recipients
A. Timeliness of Medical Screenings	Total	C. Funding Source of Medical Screening Completions	Total
1. Recipients who completed a medical screening within 30 days from the date of eligibility for ORR benefits		1. Recipients who completed a medial screening funded ONLY by CMA
2. Recipients who completed a medical screening within 31-90 days from the date of eligibility for ORR benefits		2. Recipients who completed a medical screening partially funded by CMA
3. Recipients who completed a medical screening beyond 90 days from the date of eligibility for ORR benefits		3. Total recipients who completed a medical screening in this reporting period
4. Total recipients who completed a medical screening in this reporting period	0	D. Medical Screening Recipient Completions by Eligibility Status	Total
B. Class A and Class B Tuberculosis (TB) Cases Domestic Medical Screening Completions	Total	1. Refugee
1. Class A and Class B TB cases arrived		2. Asylee
2. Class A and Class B TB cases who completed a domestic medical screening		3. SIV Holders (including SI/SQ Parolees and Conditional Permanent Residents)
3. Class A and Class B TB domestic medical screening completion rate	#DIV/0!	4. Cuban/Haitian Entrant
		5. Afghan Humanitarian Parolee
		6. Ukrainian Humanitarian Parolee
		7. Victims of Trafficking
		6. Other
		E. Medical Screening Recipient Completions by Age	Total
		1. Child < 18 years
		2. Adult ≥ 18 years
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Schedule F: RMA and Medical Screening Programs continue
Part III: Medical Screening Services
A. Lead Screening	Total	E. HIV Screening	Total
1. Recipients tested for lead (first test)		1. Recipients tested for HIV
B. Domestic Mental Health Screening	Total	F. Domestic Tuberculosis Screening	Total
1. Recipients provided a domestic mental health screening		1. Recipients who completed a TST domestically
a. Recipients referred for further evaluation and counseling		2. Recipients tested with IGRA domestically
C. Parasite Screening	Total	G. Domestic Hepatitis B Screening	Total
1. Recipients who completed tests for parasitic infections		1. Recipients tested for hepatitis B (surface antigen) domestically
a. Recipients tested for strongyloidiasis		H. Hepatitis C Screening	Total
b. Recipients tested for schistosomiasis		1. Recipients tested for hepatitis C (HCV antibody test)
c. Recipients tested for soil-transmitted helminths		I. Domestic Syphilis Screening	Total
d. Recipients tested for malaria		1. Recipients tested for syphilis (VDRL/RPR) domestically
D. Domestic Presumptive Treatment	Total	J. Chlamydia Screening	Total
1. Recipients presumptively treated domestically		1. Recipients tested for chlamydia
a. Recipients presumptively treated for strongyloidiasis domestically		K. Domestic Gonorrhea Screening	Total
b. Recipients presumptively treated for schistosomiasis domestically		1. Recipients tested for gonorrhea domestically
c. Recipients presumptively treated for soil-transmitted helminths domestically		L. Primary Care Referrals	Total
d. Recipients presumptively treated for malaria domestically		1. Recipients referred to primary care
Part IV: Data Explanations and Trends
A. Explain Anomalies in Parts I, II, and III (e.g., missing data due to reporting issues)
B. Report Emerging Health Trends (e.g., new or increasing cases of certain health conditions)
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