Proposed MG Data Collection Instructions - (Final Cleared)

Voluntary Agencies Matching Grant Program Data Reporting

Proposed MG Data Collection Instructions - (Final Cleared)

OMB: 0970-0624

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OMB #: 0970-XXXX

Expiration Date: XX/XX/XXXX


OFFICE OF REFUGEE RESETTLEMENT


Voluntary Agencies Matching Grant Program Data Reporting

Instructions1




PURPOSE AND OVERVIEW:

The purpose of these instructions is to describe the standardized process and format for data submission by resettlement agencies (hereinafter referred to as ‘agencies’), to the Office of Refugee Resettlement (ORR) for the Voluntary Agencies Matching Grant (MG) Program Data Reporting. The data submission provides ORR with invaluable information, including client demographics, services utilized, and the outcomes achieved by the population served. The data will be used to inform evidence-based policy making. Agencies are required to submit data to ORR through the ORR data collection website, known as the Refugee Arrivals Data System (RADS). Once data are submitted, ORR will match the file against RADS, per an established procedure.


Required Populations Reported


All populations who enrolled in the MG Program must be included in all forms. The first form is the Client Information Form, which captures client demographics, contact information, and certain case management activities and milestones. The second form is the MG Enrollment Form, which captures MG program enrollment information. The third form is the MG Status Form, which captures MG case status information, including employment information.


Data Submission Timelines


Agencies will upload data for the Client Information Form and MG Enrollment Form on a monthly basis. These forms capture client information and program enrollments for clients enrolled in the previous month. Agencies will upload data for the MG Status Form twice a year. The Status Form captures program outcomes. If Client Information changes after enrollment (for example, if a client moves from Temporary Housing to Permanent Housing, or the client receives an Employment Authorization Document), the updated Client Information Form should be re-uploaded with the next MG Status Form.


The following chart provides a sample timeline of the submission process:


Fiscal Year (FY)


Section

Frequency

Data Due Date

FY2024

Served Population

(Oct 2023 - Sep 2024)

Client Information and MG Enrollment

Monthly

By the 2nd business day of the month following the month of enrollment

MG Status Form

Every 6 Months

April 30, 2024; October 30, 2024

FY2025

Served Population

(Oct 2024 - Sep 2025)

Client Information and MG Enrollment

Monthly

By the 2nd business day of the month following the month of enrollment

MG Status Form

Every 6 Months

April 30, 2025; October 30, 2025

FY2026

Served Population

(Oct 2025 - Sep 2026)

Client Information and MG Enrollment

Monthly

By the 2nd business day of the month following the month of enrollment

MG Status Form

Every 6 Months

April 30, 2026; October 30, 2026



INSTRUCTIONS:

  • Review and become familiar with the MG Instructions Attachment. While these instructions discuss various examples of what agencies could enter into a field, the Instructions Attachment lists all possible answers that ORR will accept in various fields.

  • Note that a unique alien number for individuals must only occur on one record (i.e., no duplicate alien numbers across multiple records).



Client Information Form

Field

Data

Notes

1

Alien Number

6 to 9 digits OR 15 digits for Alternative Identifier

2

Corrected Alien Number

If applicable

3

First Name

First name of individual

4

Middle Name

Middle name of individual, if applicable

5

Last Name

Last name of individual

6

DOB

Date of birth, mm/dd/yyyy

7

Immigration Status

Eligible immigration status of individual

8

Gender

Individual’s gender identity

9

Nationality

Nationality or country of origin of individual

10

Street Address

Street address where the individual resides

11

Zip Code

5-digit zip code where individual resides

12

City

City where individual resides

13

State

State where the individual resides

14

County

County where individual resides

15

Email

Individual’s email address

16

Phone Number

Individual’s phone number

17

Eligibility Date

mm/dd/yyyy

18

Entry Date

mm/dd/yyyy

19

EAD Application Submitted

Y, N or N/A

20

EAD Application Submitted Date

mm/dd/yyyy

21

EAD Received

Y, N or N/A

22

EAD Received Date

mm/dd/yyyy

23

Social Security Application Submitted

Y/N

24

Social Security Application Submitted Date

mm/dd/yyyy

25

Social Security Card Received

Y/N

26

Social Security Card Received Date

mm/dd/yyyy

27

SNAP Application Submitted

Y, N or N/A

28

SNAP Application Submitted Date

mm/dd/yyyy

29

SNAP Approval

Y, N or N/A

30

SNAP Approval Date

mm/dd/yyyy

31

Temporary Housing

Y, N or N/A

32

Temporary Housing Type

Type of temporary housing

33

Temporary Housing Date

mm/dd/yyyy

34

Long-term Housing

Y, N or N/A

35

Long-term Housing Date

mm/dd/yyyy



Client Information Form

  1. Alien Number

    • Mandatory: Yes

    • Instruction: Enter the six to nine digit Alien Number without any hyphens or spaces between the numbers. Do not enter an A at the beginning of the number. For clients without an Alien Number or U.S.-born children under 18 years of age receiving ORR benefits, do not enter the child’s social security number or parent’s alien number in the Alien Number field. For these cases, agencies should use the following convention to create an ORR Alternative Identifier: 15 digits total, consisting of: (a) 9 + (b) 2-digit agency ID + (c) 3-digit local office identifier + (d) 9-digit incremental number.

    • Possible values: 111111…999999999999999


  1. Corrected Alien Number

    • Mandatory: No

    • Instruction: See above for general alien number instructions. If individual’s alien number requires correction, enter the new alien number here.

    • Possible values: 111111…999999999


  1. First Name

    • Mandatory: Yes

    • Instruction: Enter the first name of the individual.

    • Possible values: N/A


  1. Middle Name

    • Mandatory: No

    • Instruction: Enter the middle name of the individual. If multiple middle names, separated with a space. Do not use a comma, hyphen, or forward slash (/) between the middle names. Leave the cell blank if there is no middle name(s).

    • Possible values: N/A


  1. Last Name

    • Mandatory: Yes

    • Instruction: Enter the last name of the individual. If the last name is hyphenated, include a hyphen or if there are multiple last names include them and separate them with a space.

    • Possible values: N/A


  1. DOB

    • Mandatory: Yes

    • Instruction: Enter the individual’s birth date in mm/dd/yyyy format.

    • Possible values: Any valid date, not in the future.


  1. Immigration Status

    • Mandatory: Yes

    • Instruction: Enter the eligible immigration status code of the individual: “REF” for Refugee; “SIV” for Special Immigrant Visa holder; “VOT” for Victim of Trafficking; “ASY” for Asylee; “CHE” for Cuban-Haitian Entrant; “AMR” for Amerasian; “AHP” for Afghan Humanitarian Parolee; or “UHP” for Ukrainian Humanitarian Parolee. For children born in the U.S. within 31 days of their parent’s enrollment in the Matching Grant Program, enter “U.S. born” and the parent’s status. For example, “U.S. born REF” or “U.S. born SIV.” If the two parents have two different immigration statuses, use the Principal Applicant’s status.

    • Possible values: Please refer to the list of valid immigration statuses in the Instructions Attachment.


  1. Gender

    • Mandatory: Yes

    • Instruction: Enter the individual’s gender identity, regardless of sex assigned at birth.

    • Possible values: Please refer to the list of valid options in the Instructions Attachment.


  1. Nationality

    • Mandatory: Yes

    • Instruction: Enter the individual’s nationality or country of origin.

    • Possible values: Please refer to the list of valid country names in the Instructions Attachment. Submitted records with an immigration status (field 8) of “CHE” must have Cuba or Haiti as their nationality, otherwise the file will be rejected and returned to the user to be corrected and re-uploaded into RADS. If the nationality is not listed in the Instructions Attachment, provide the nationality through “contact administrator” link of the RADS application (lower right corner) and ORR will add it to the list. An empty cell is not allowed.


  1. Street Address

    • Mandatory: Yes

    • Instruction: Enter the street address where the individual resides.

    • Possible values: An empty cell is not allowed.


  1. Zip Code

    • Mandatory: Yes

    • Instruction: Enter the zip code where the individual resides.

    • Possible values: Any valid 5-digit zip code. An empty cell is not allowed.


  1. City

    • Mandatory: Yes

    • Instruction: Enter the name of the city where the individual resides.

    • Possible values: Please refer to the list of valid city names in the Instructions Attachment. If the city is not listed in the Instructions Attachment, enter the city within the closest proximity. An empty cell is not allowed.


  1. State Code

    • Mandatory: Yes

    • Instruction: Enter the two letter code of the state where the individual resides.

    • Possible values: Please refer to the list of valid state codes in the Instructions Attachment. An empty cell is not allowed.


  1. County

    • Mandatory: No

    • Instruction: Enter the county where the individual resides.

    • Possible values: Please refer to the list of valid county names in the Instructions Attachment. If the county is not listed in the Instructions Attachment, enter the county within the closest proximity. An empty cell is not allowed.


  1. E-mail

    • Mandatory: No

    • Instruction: Enter the e-mail address where the individual can be reached.

    • Possible values: N/A


  1. Phone Number

    • Mandatory: No

    • Instruction: Enter the phone number where the individual can be reached.

    • Possible values: N/A


  1. Eligibility Date

    • Mandatory: Yes

    • Instruction: Enter the date that the individual became eligible for ORR benefits and services based on immigration status listed in Field 8. Detailed information on eligibility for the Matching Grant Program and other ORR-funded projects is available at 45 CFR § 400.43 and in ORR Policy Letters 16-01, 22-01, and 22-13, which can be found on the ORR website at https://www.acf.hhs.gov/orr/policy-guidance/policy-letters.

    • Possible Values: Any valid date, not in the future.


  1. Entry Date

    • Mandatory: Yes

    • Instruction: Enter the date that the individual was admitted to the U.S.

    • Possible Values: Any valid date, not in the future.


  1. EAD Application Submitted

    • Mandatory: Yes

    • Instruction: Indicate whether an I-765 Application for Employment Authorization has been filed for the individual. If the client has an immigration status not requiring an I-765 (for example, SIV status), enter N/A. If the client has a valid I-765 but the application date was prior to MG enrollment and unknown, enter No.

    • Possible Values: Y, N or N/A.


  1. EAD Application Submitted Date

    • Mandatory: Mandatory if response to Client Form Field 19 is “Yes.”

    • Instruction: Enter the date that an I-765 Application for Employment Authorization was filed for the individual.

    • Possible Values: Any valid date, not in the future.


  1. EAD Received

    • Mandatory: Yes

    • Instruction: Indicate whether an I-766 Employment Authorization Document has been received for the individual.

    • Possible Values: Y, N or N/A.


  1. EAD Received Date

    • Mandatory: Mandatory if response to Client Form Field 21 is “Yes.”

    • Instruction: Enter the date that an I-766 Employment Authorization Document was received for the individual.

    • Possible Values: Any valid date, not in the future.


  1. Social Security Application Submitted

    • Mandatory: Yes

    • Instruction: Indicate whether a social security card application has been filed for the individual.

    • Possible Values: Y/N.


  1. Social Security Application Submitted Date

    • Mandatory: Yes

    • Instruction: Enter the date that a social security card application was filed for the individual.

    • Possible Values: Any valid date, not in the future.


  1. Social Security Card Received

    • Mandatory: Yes

    • Instruction: Indicate whether a social security card has been received for the individual.

    • Possible Values: Y/N.


  1. Social Security Card Received Date

    • Mandatory: Yes

    • Instruction: Enter the date that a social security card was received for the individual.

    • Possible Values: Any valid date, not in the future.


  1. SNAP Application Submitted

    • Mandatory: Yes

    • Instruction: Indicate whether a Supplemental Nutrition Assistance Program (SNAP) application has been filed for the individual.

    • Possible Values: Y, N or N/A.


  1. SNAP Application Submitted Date

    • Mandatory: Mandatory if response to Client Form Field 27 is “Yes.”

    • Instruction: Enter the date that a SNAP application was filed for the individual.

    • Possible Values: Any valid date, not in the future.


  1. SNAP Approval

    • Mandatory: Yes

    • Instruction: Indicate whether SNAP benefits have been approved for the individual.

    • Possible Values: Y, N or N/A.


  1. SNAP Approval Date

    • Mandatory: Mandatory if response to Client Form Field 29 is “Yes.”

    • Instruction: Enter the date that SNAP benefits were approved for the individual.

    • Possible Values: Any valid date, not in the future.


  1. Temporary Housing

    • Mandatory: Yes

    • Instruction: Indicate whether the individual is residing in temporary housing. Enter “N/A” if housing status is unknown or not available.

    • Possible Values: Y, N, or N/A.


  1. Temporary Housing Type

    • Mandatory: Mandatory if response to Client Form Field 31 is “Yes.”

    • Instruction: Indicate the type of temporary housing where the individual resides.

    • Possible Values: Please refer to the list of valid options in the Instructions Attachment. Note, the term "sponsor" here is used broadly to mean a sponsor, US tie, relative, or friend.


  1. Temporary Housing Date

    • Mandatory: Mandatory if response to Client Form Field 31 is “Yes.”

    • Instruction: Indicate the date the individual began residing in temporary housing.

    • Possible Values: Any valid date, not in the future.


  1. Long-term Housing

    • Mandatory: Yes

    • Instruction: Indicate whether the individual is residing in long-term housing. Enter “N/A” if housing status is unknown or not available.

    • Possible Values: Y, N, or N/A.


  1. Long-term Housing Date

    • Mandatory: Mandatory if response to Client Form Field 34 is “Yes.”

    • Instruction: Indicate whether the individual began residing in long-term housing.

    • Possible Values: Any valid date, not in the future.




MG Enrollment Form

Field

Data

Notes

1

Alien Number

6 to 9 digits OR 15 digits for Alternative Identifier

2

First Name

First name of individual

3

Middle Name

Middle name of individual, if applicable

4

Last Name

Last name of individual

5

DOB

Date of birth, mm/dd/yyyy

6

MG Case ID

Case number assigned by agency, if applicable

7

Principal Applicant (PA) Alien Number

6 to 9 digits OR 15 digits for Alternative Identifier, alien number of PA on case

8

Relationship to PA

Individual’s relationship to principal applicant on case

9

Affiliate Code

Alpha-numeric local office code

10

MG Enrollment Date

mm/dd/yyyy

11

Employable

Y/N




Match Grant Enrollment Form

  1. Alien Number

    • Mandatory: Yes

    • Instruction: Enter the six to nine digit Alien Number without any hyphens or spaces between the numbers. Do not enter an A at the beginning of the number. For clients without an Alien Number or U.S.-born children under 18 years of age receiving ORR benefits, do not enter the child’s social security number or parent’s alien number in the Alien Number field. For these cases, agencies should use the following convention to create an ORR Alternative Identifier: 15 digits total, consisting of: (a) 9 + (b) 2-digit agency ID + (c) 3-digit local office identifier + (d) 9-digit incremental number.

    • Possible values: 111111…999999999999999


  1. First Name

    • Mandatory: Yes

    • Instruction: Enter the first name of the individual.

    • Possible values: N/A


  1. Middle Name

    • Mandatory: No

    • Instruction: Enter the middle name of the individual. If multiple middle names, separated with a space. Do not use a comma, hyphen, or forward slash (/) between the middle names. Leave the cell blank if there is no middle name(s).

    • Possible values: N/A


  1. Last Name

    • Mandatory: Yes

    • Instruction: Enter the last name of the individual. If the last name is hyphenated, include a hyphen or if there are multiple last names include them and separate them with a space.

    • Possible values: N/A


  1. DOB

    • Mandatory: Yes

    • Instruction: Enter the individual’s birth date in mm/dd/yyyy format.

    • Possible values: Any valid date, not in the future.


  1. MG Case ID

    • Mandatory: No

    • Instruction: Enter the case ID assigned by the agency, if applicable.

    • Possible values: N/A


  1. Principal Applicant (PA) Alien Number

    • Mandatory: Yes

    • Instruction: Enter a six to nine digit number of the PA of the case without any hyphens or spaces between the numbers. For clients without an Alien Number use the following convention to create an ORR Alternative Identifier: 15 digits total, consisting of: (a) 9 + (b) 2-digit national agency ID + (c) 3-digit local office identifier + (d) 9-digit incremental number. In cases without a designated PA, the oldest individual receiving services in the family should be selected as the PA. Do not enter an A at the beginning of the number. “PA” is a term used for service purposes only, not for a legal status purpose.

    • Possible values: 111111…999999999999999


  1. Relationship to PA

    • Mandatory: Yes

    • Instruction: Enter the individual’s relationship to the PA of the case.

    • Possible Values: Please refer to the list of valid relationships in the Instructions Attachment.


  1. Affiliate Code

    • Mandatory: Yes

    • Instruction: Enter the local resettlement office code assigned by the US Department of State’s Bureau of Population, Refugees, and Migration or by ORR.

    • Possible values: Alpha-numeric code. The current list of valid affiliate codes is in the Instructions Attachment, but please note that this list is updated frequently.


  1. Enrollment Date

    • Mandatory: Yes

    • Instruction: Enter the date that the individual first enrolled in the Matching Grant Program.

    • Possible Values: Any valid date before the end of the reporting month.


  1. Employable

    • Mandatory: Yes

    • Instruction: Enter whether the individual is employable according to Matching Grant Program Guidelines.

    • Possible values: Y/N



MG Status Form

Field

Data

Notes

1

Alien Number

6 to 9 digits OR 15 digits for Alternative Identifier

2

Affiliate Code

Alpha-numeric local office code

3

MG Case ID

Case number assigned by agency, if applicable

4

Individual Case Status

Case status, from list of acceptable values

5

180 Day Status

Self-sufficiency status, from list of acceptable values

6

180 Day Status Date

mm/dd/yyyy

7

180 Day Status Comments

Any additional comments

8

240 Day Status

Self-sufficiency status, from list of acceptable values

9

240 Day Status Date

mm/dd/yyyy

10

240 Day Status Comments

Any additional comments

11

Current Employment Status

Y/N

12

Occupation Categories

Job type, from list

13

Has Benefits

Y/N

14

Hourly Wage

$00.00

15

Hours Per Week

0+

16

Job Start Date

mm/dd/yyyy

17

Job End Date

mm/dd/yyyy

18

Employment Status – Job 2

Y/N

19

Occupation Categories

Job type, from list

20

Has Benefits

Y/N

21

Hourly Wage

$00.00

22

Hours Per Week

0+

23

Job Start Date

mm/dd/yyyy

24

Job End Date

mm/dd/yyyy

25

Employment Status – Job 3

Y/N

26

Occupation Categories

Job type, from list

27

Has Benefits

Y/N

28

Hourly Wage

$00.00

29

Hours Per Week

0+

30

Job Start Date

mm/dd/yyyy

31

Job End Date

mm/dd/yyyy


Match Grant Status Form

  1. Alien Number

    • Mandatory: Yes

    • Instruction: Enter the six to nine digit Alien Number without any hyphens or spaces between the numbers. Do not enter an A at the beginning of the number. For clients without an Alien Number or U.S.-born children under 18 years of age receiving ORR benefits, do not enter the child’s social security number or parent’s alien number in the Alien Number field. For these cases, agencies should use following convention to create an ORR Alternative Identifier: 15 digits total, consisting of: (a) 9 + (b) 2-digit agency ID + (c) 3-digit local office identifier + (d) 9-digit incremental number.

    • Possible values: 111111…999999999999999


  1. Affiliate Code

    • Mandatory: Yes

    • Instruction: Enter the local resettlement office code assigned by the US Department of State’s Bureau of Population, Refugees, and Migration or by ORR.

    • Possible values: Alpha-numeric code. The current list of valid affiliate codes is in the Instructions Attachment, but please note that this list is updated frequently.


  1. MG Case ID

    • Mandatory: No

    • Instruction: Enter the case ID assigned by the agency, if applicable.

    • Possible values: N/A


  1. Individual Case Status

    • Mandatory: Yes

    • Instruction: Enter the individual case status.

    • Possible values: Please refer to the list of valid options in the Instructions Attachment.


  1. 180 Day Status

    • Mandatory: Yes

    • Instruction: Enter the 180 day status.

    • Possible values: Please refer to the list of valid options in the Instructions Attachment.


  1. 180 Day Status Date

    • Mandatory: Yes

    • Instruction: Enter the 180 day status date.

    • Possible values: Any valid date, not in the future.


  1. 180 Day Status Comments

    • Mandatory: Yes

    • Instruction: Enter any additional comments on the 180 day status.

    • Possible values: N/A


  1. 240 Day Status

    • Mandatory: Yes

    • Instruction: Enter the 240 day status.

    • Possible values: Please refer to the list of valid options in the Instructions Attachment.


  1. 240 Day Status Date

    • Mandatory: Yes

    • Instruction: Enter the 240 day status date.

    • Possible values: Any valid date, not in the future.


  1. 240 Day Status Comments

    • Mandatory: Yes

    • Instruction: Enter any additional comments on the 240 day status.

    • Possible values: N/A


  1. Current Employment Status

    • Mandatory: Yes

    • Instruction: Indicate whether the individual is employed.

    • Possible values: Y/N.


  1. Occupation Categories

    • Mandatory: Mandatory if response to Status Form Field 11 is “Yes.”

    • Instruction: Indicate the type of employment.

    • Possible values: Please refer to the list of valid categories in the Instructions Attachment.


  1. Has Benefits

    • Mandatory: Mandatory if response to Status Form Field 11 is “Yes.”

    • Instruction: Indicate whether the position offers benefits.

    • Possible values: Y/N.


  1. Hourly Wage

    • Mandatory: Mandatory if response to Status Form Field 11 is “Yes.”

    • Instruction: Indicate whether the position offers benefits.

    • Possible values: Valid number.


  1. Hours Per Week

    • Mandatory: Mandatory if response to Status Form Field 11 is “Yes.”

    • Instruction: Indicate the number of hours worked per week.

    • Possible values: Valid number.


  1. Job Start Date

    • Mandatory: Mandatory if response to Status Form Field 11 is “Yes.”

    • Instruction: Enter the date the individual began working in this position.

    • Possible values: Valid date, not in the future.


  1. Job End Date

    • Mandatory: Mandatory if response to Status Form Field 11 is “Yes” and individual has left the position. If blank, this indicates the individual is still employed in this position.

    • Instruction: Enter the date the individual stopped working in this position.

    • Possible values: Valid date, not in the future.


  1. Employment Status - Job 2

    • Mandatory: Yes

    • Instruction: Indicate whether the individual is/was employed in a second position.

    • Possible values: Y/N.


  1. Occupation Categories

    • Mandatory: Mandatory if response to Status Form Field 18 is “Yes.”

    • Instruction: Indicate the type of employment.

    • Possible values: Please refer to the list of valid categories in the Instructions Attachment.


  1. Has Benefits

    • Mandatory: Mandatory if response to Status Form Field 18 is “Yes.”

    • Instruction: Indicate whether the position offers benefits.

    • Possible values: Y/N.


  1. Hourly Wage

    • Mandatory: Mandatory if response to Status Form Field 18 is “Yes.”

    • Instruction: Indicate whether the position offers benefits.

    • Possible values: Valid number.


  1. Hours Per Week

    • Mandatory: Mandatory if response to Status Form Field 18 is “Yes.”

    • Instruction: Indicate the number of hours worked per week.

    • Possible values: Valid number.


  1. Job Start Date

    • Mandatory: Mandatory if response to Status Form Field 18 is “Yes.”

    • Instruction: Enter the date the individual began working in this position.

    • Possible values: Valid date, not in the future.


  1. Job End Date

    • Mandatory: Mandatory if response to Status Form Field 18 is “Yes” and individual has left the position. If blank, this indicates the individual is still employed in this position.

    • Instruction: Enter the date the individual stopped working in this position.

    • Possible values: Valid date, not in the future.


  1. Employment Status - Job 3

    • Mandatory: Yes

    • Instruction: Indicate whether the individual is/was employed in a third position.

    • Possible values: Y/N.


  1. Occupation Categories

    • Mandatory: Mandatory if response to Status Form Field 25 is “Yes.”

    • Instruction: Indicate the type of employment.

    • Possible values: Please refer to the list of valid categories in the Instructions Attachment.


  1. Has Benefits

    • Mandatory: Mandatory if response to Status Form Field 25 is “Yes.”

    • Instruction: Indicate whether the position offers benefits.

    • Possible values: Y/N.


  1. Hourly Wage

    • Mandatory: Mandatory if response to Status Form Field 25 is “Yes.”

    • Instruction: Indicate whether the position offers benefits.

    • Possible values: Valid number.


  1. Hours Per Week

    • Mandatory: Mandatory if response to Status Form Field 25 is “Yes.”

    • Instruction: Indicate the number of hours worked per week.

    • Possible values: Valid number.


  1. Job Start Date

    • Mandatory: Mandatory if response to Status Form Field 25 is “Yes.”

    • Instruction: Enter the date the individual began working in this position.

    • Possible values: Valid date, not in the future.


  1. Job End Date

    • Mandatory: Mandatory if response to Status Form Field 25 is “Yes” and individual has left the position. If blank, this indicates the individual is still employed in this position.

    • Instruction: Enter the date the individual stopped working in this position.

    • Possible values: Valid date, not in the future.


1 PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, the Office of Refugee Resettlement (ORR) is gathering data to better understand client demographics, services utilized, and the outcomes achieved by the population served. The data will be used to inform evidence-based policy making. Public reporting burden for this collection of information is estimated to average 252 hours per grantee in the initial year and 192 hours per year in subsequent years. This includes the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information [Immigration and Nationality Act, 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. The OMB # is 0970-XXXX and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact DRSPrograms@acf.hhs.gov.

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