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		Program
		Indicators for Office of Refugee and Resettlement (ORR)/Department
		of Unaccompanied Children Operations (DUCO); Home Study (HS) and
		Post Release Service (PRS)
		Grantees
		APPENDIX
		B – PROGRAM INDICATORS
		ACF-OGM-SF-
		PPR 
		
		
		
		
	OMB
	#: 0970-0490
	
	Expiration
	Date: 1/31/2020
	
	
	
	
		| 
			B-01
			
			 | 
			Major
			activities and accomplishments during this period | 
			
 
				
					
					
				
				
					
				
				
					| 
						Home
						Study | 
						Quarter
						
						 | 
						Annual |  
					| 
						TVPRA |  
					| 
						Number
						of New Cases Accepted | 
						  | 
						
 |  
					| 
						Number
						of Cases Cancelled | 
						  | 
						
 |  
					| 
						Number
						of Rollover Cases Being Served from Previous Fiscal Year | 
						
 | 
						
 |  
					| 
						Number
						of Cases Closed | 
						
 | 
						
 |  
					| 
						ORR
						Mandated |  
					| 
						Number
						of New Cases Accepted | 
						  | 
						
 |  
					| 
						Number
						of Cases Cancelled | 
						  | 
						
 |  
					| 
						Number
						of Rollover Cases Being Served from Previous Fiscal Year | 
						
 | 
						
 |  
					| 
						Number
						of Cases Closed | 
						
 | 
						
 |  
					| 
						Discretionary |  
					| 
						Number
						of New Cases Accepted | 
						  | 
						
 |  
					| 
						Number
						of Cases Cancelled | 
						  | 
						
 |  
					| 
						Number
						of Rollover Cases Being Served from Previous Fiscal Year | 
						
 | 
						
 |  
					| 
						Number
						of Cases Closed | 
						
 | 
						
 |  
					| 
						Total
						Number of Children Served through Home Studies 
						 | 
						
 | 
						
 |  
					| 
						Post
						Release Services 
						 | 
						Quarter
						
						 | 
						Annual |  
					| 
						PRS
						Only |  
					| 
						Number
						of New Cases Accepted | 
						  | 
						
 |  
					| 
						Number
						of Rollover Cases Being Served from Previous Fiscal Year | 
						
 | 
						
 |  
					| 
						Number
						of Cases Closed | 
						
 | 
						
 |  
					| 
						PRS
						TVPRA |  
					| 
						Number
						of New Cases Accepted | 
						  | 
						
 |  
					| 
						Number
						of Rollover Cases Being Served from Previous Fiscal Year | 
						
 | 
						
 |  
					| 
						Number
						of Cases Closed | 
						
 | 
						
 |  
					| 
						PRS
						After Discretionary Home Study |  
					| 
						Number
						of New Cases Accepted | 
						  | 
						
 |  
					| 
						Number
						of Rollover Cases Being Served from Previous Fiscal Year | 
						
 | 
						
 |  
					| 
						Number
						of Cases Closed | 
						
 | 
						
 |  
					| 
						PRS
						After Mandated Home Study |  
					| 
						Number
						of New Cases Accepted | 
						  | 
						
 |  
					| 
						Number
						of Rollover Cases Being Served from Previous Fiscal Year | 
						
 | 
						
 |  
					| 
						Number
						of Cases Closed | 
						
 | 
						
 |  
					| 
						Total
						Number of Children Served for ALL Post Release Services | 
						  | 
						
 |  
					| 
						TOTAL
						NUMBER OF CHILDREN SERVED in HS and PRS | 
						  | 
						
 |  
 
 
 
				
				
				
				
					| 
						Home
						Study | 
						Quarter
						
						 | 
						Annual |  
					| 
						Total
						Number of Reports submitted to ORR within 10 business days
						(beginning Dec. 1, 2015) | 
						  | 
						  |  
					| 
						Number
						of Reports granted an extension by ORR/DCS/Federal Field
						Specialist | 
						  | 
						  |  
					| 
						Total
						Number of Addendums requested by ORR/DCS/Federal Field
						Specialist | 
						  | 
						  |  
					| 
						Total
						Number of Reports canceled or remanded by ORR/DCS/Federal Field
						Specialist | 
						  | 
						  |  
 
				
				
				
				
					| 
						Post
						Release Services | 
						Quarter
						1 | 
						Annual |  
					| 
						Primary
						Reason for Closure (Select One) |  
					| 
						UAC
						turned 18 | 
						  | 
						  |  
					| 
						Legal
						Case- Status Achieved | 
						  | 
						  |  
					| 
						Legal
						Case Closed Without Status | 
						  | 
						  |  
					| 
						Sponsor
						DECLINED Services | 
						  | 
						  |  
					| 
						PRS
						Assessment deemed services completed / no longer needed | 
						  | 
						  |  
					| 
						Unable
						to Contact Sponsor / UAC 
						 | 
						  | 
						  |  
					| 
						Transferred
						to another PRS Provider | 
						  | 
						  |  
					| 
						UAC
						Ran Away | 
						  | 
						  |  
					| 
						UAC
						Arrested | 
						
 | 
						
 |  
					| 
						Other 
 | 
						
 | 
						
 |  
					| 
						
 
 | 
						
 | 
						
 |  
					| 
						PRS
						Needs (By type) | 
						Original
						reason for referral to PRS (New Cases)  | 
						Ongoing
						Primary Needs PRS Identified (After Initial Assessment) |  
					| 
						Placement
						Stability and Safety | 
						
 | 
						
 |  
					| 
						Guardianship | 
						
 | 
						
 |  
					| 
						Legal
						Services | 
						  | 
						  |  
					| 
						School
						Enrollment / Education | 
						  | 
						  |  
					| 
						Medical
						Services | 
						  | 
						  |  
					| 
						Individual
						Mental Health Services | 
						  | 
						  |  
					| 
						Family
						Stabilization/ Counseling | 
						  | 
						  |  
					| 
						Substance
						Abuse | 
						  | 
						  |  
					| 
						Gang
						Prevention | 
						
 | 
						
 |  
 
 | 
	THE
	PAPERWORK
	REDUCTION
	ACT
	OF
	1995
	(Pub.
	L.
	104-13): Public
	reporting
	burden
	for
	this
	collection
	of
	information
	is
	estimated
	to
	average
	10
	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.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| File Title | ACF-OGM-PPR Cover Page and Form B Program Indicators and Instructions | 
| Subject | ACF-OGM-PPR Cover Page and Form B Program Indicators and Instructions | 
| Author | Latasha N. Abney | 
| File Modified | 0000-00-00 | 
| File Created | 2023-07-29 |