Copy of ORR-6 SCHEDULES B, C, D

Schedule B: Cash and Medical Assistance and Medical Screening								Form ORR-6
Reporting Period:							Fiscal Year:
State:							Date:
I. Refugee Cash Assistance						Cases		Persons
A. Previous RCA enrollees still active in this reporting period
B. New RCA enrollees during this reporting period
C. Total number of RCA recipients during this reporting period						0		0
II. Refugee Medical Assistance								Persons
A. Previous RMA enrollees still active in this reporting period
B. New RMA enrollees during this reporting period
C. Total number of RMA recipients during this reporting period								0
III. Refugee Medical Screening								Persons
A. Total recipients of medical screenings during reporting period
B. Recipients of medical screenings during reporting period funded by RMA
Schedule C: Services Report: Employment Services 45 CFR 400.154 (a)
Reporting Period:							Fiscal Year:
State:							Date:
Grant #:					Grant Name:
A. RCA Employment Data: Number of refugees between 18 and 65 who are not exempt under §400.76 and who reached the eight month time limit for RCA this trimester					1. Total Number		2. Grant Terminations due to income from employment prior to the eight month limit
B. Entered Employment and Cash Assistance Status				Time in U.S.		2. FT	3. PT	4. Grant Terminations
Participants by type		1. Total Number	1
a. RCA				0 - 4 months
			2	5 - 8 months
b. TANF			1	0 - 12 months
			2	> 12 months
c. Other CA			1	0 - 12 months
			2	> 12 months
d. No CA			1	0 - 12 months
			2	> 12 months
e. Total Caseload for Employment Services		0	TOTAL			0	0	0
C. Average Hourly Wage Employment Entry
D. Health Benefits Available
E. Employed 90 Days Later
a) RCA at entered employment
b) TANF at entered employment
c) Other CA at entered employment
d) No CA at entered employment
Total
Schedule C: Services Report: Employability Services, 45 CFR 400.154 (b) – (k)								Form ORR-6
Reporting Period:							Fiscal Year:
State:							Date:
Grant #:					Grant Name:
1. Active participants this period		Total		AGE		SERVICES
1. English Language Training				18-50	51-65	Beginner	Intermediate	Other
0 - 12 mos in U.S.
> 12 mos in U.S.
2. On the Job Training				18-50	51-65	0-30 days training	> 1 month training	> 3 months training
0 - 12 mos in U.S.
> 12 mos in U.S.
A. Completions (unduplicated)
3. Skills Training				18-50	51-65	0-30 days training	> 1 month training	> 3 months training
> 12 mos in U.S.
0 - 12 mos in U.S.
A. Completions (unduplicated)
4. Case Management				18-50	51-65	New case	Follow-up	Referred
> 12 mos in U.S.
0 - 12 mos in U.S.
5. Other Employability Services				Employability assessment	Child Care	Transportation	Interpreting & translation	EAD assistance
0 - 12 mos in U.S.
> 12 mos in U.S.
Schedule D: Unaccompanied Refugee Minors Program
Reporting Period:							Fiscal Year:
State:							Date:
I. Current Population:
1. Minors in care at end of previous reporting period
2. Entered care
3. Left care
4. Minors in care at end of this reporting period
TOTAL							0
II. Placement Capacity Chart	Location 1:				Location 2:			Total
	Foster Homes	Therapeutic Foster Homes	Group Homes	Semi Independent Living	Independent Living	Residential Treatment Centers	Other
1. Minors currently in care								0
2. Available placements								0
3. Placements in development								0
Comments:
III. Expenditures	Trimester Expenditures (col. 1)				Cumulative Expenditures for FFY (col. 2)
1. Services for minors
2. Program Administration
3. State Administration
4. Total	0				0
Comments: