Form P-4 Notice of Placement in a Restrictive Setting (P-4)

OMB 0970-#### [Valid through MM/DD/2020]

Notice of Placement
in a Restrictive Setting
Office of Refugee Resettlement
You are in the custody of the Office of Refugee Resettlement (ORR), and have been placed in a restrictive setting - a secure or staff
secure facility, or a Residential Treatment Center (RTC). The reason you have been placed in a restrictive setting is listed below.
If you have any questions about this placement, please discuss them with your case manager, your attorney, or an ORR-funded
legal service provider.

UAC Name

Alien Number

Country of Birth

Name of Care Provider Facility

Date of Birth

Gender

Type of Facility

Secure Care: ORR has determined that you pose a danger
to self or others; or have been charged with having
committed a criminal offense. ORR considered that you:

Staff Secure Care: ORR has determined that you require
close supervision, but do not require placement in a secure
care provider facility. ORR considered that you:

Are charged with a crime, are chargeable with a crime,
or have been convicted of a crime; or are the subject of
delinquency proceedings, have been adjudicated
delinquent, or are chargeable with a delinquent act 1;

Have been unacceptably disruptive to the normal
functioning of a shelter care facility such that transfer is
necessary to ensure the welfare of others;

Have committed, or have made credible threats to
commit a violent or malicious act while in ORR custody;
Have committed, threatened to commit, or engaged in
serious, self-harming behavior that poses a danger to
self while in ORR custody;
Have engaged in conduct that has proven to be
unacceptably disruptive of the normal functioning of a staff
secure facility in which you were placed such that transfer
may be necessary to ensure your welfare or the welfare of
others;
Have self-disclosed violent criminal history prior to placement
in ORR custody that requires further assessment; and/or,
Have a history of or display sexual predatory behavior, or
have inappropriate sexual behavior.
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to allow ORR to document and inform UAC of the reason
they have been placed in a restrictive setting. Public reporting burden
for this collection of information is estimated to average 0.33 hours per
response, 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 (Homeland
Security Act, 6 U.S.C. 279). 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
UACPolicy@acf.hhs.gov.

1

Are an escape risk;
Have reported gang involvement (including prior to placement
in ORR custody) or displayed gang affiliation while in care; 2
Have non-violent criminal or delinquent history not warranting
placement in a secure care provider facility, such as isolated
or petty offenses; or,
Could be stepped down from a secure facility.
Residential Treatment Center: ORR has determined that you
have a serious psychiatric or psychological issue that cannot be
addressed in an outpatient setting and you are a danger to self
or others. A licensed psychologist or psychiatrist has indicated
that you:
Have not shown reasonable progress in the alleviation of your
mental health symptoms after a significant period of time in
outpatient treatment;
Demonstrate behavior that is a result of your underlying
mental health symptoms and/or diagnosis and cannot be
managed in an outpatient setting;
Require therapeutic-based intensive supervision as a result of
mental health symptoms and/or diagnosis that prevent you
from independent participation in the daily schedule of
activities; and/or,
Present a continued and real risk of harm to self, others, or
the community, despite the implementation of short-term
clinical interventions.

Excluding: isolated offenses that (1) were not within a pattern or practice of criminal activity and (2) did not involve violence against a person, or the use or carrying of
a weapon (e.g., breaking and entering, vandalism, DUI, etc.); or petty offenses which are not considered grounds for a stricter means of detention in any case (e.g.,
shoplifting, joy riding, disturbing the peace, status offenses).
2
“Displays gang affiliation” refers to any objective indication that a UAC is involved with or is a member of a gang. For example, it may refer to the presence of
identifying characteristics such as gang tattoos, confirmed acts such as vandalizing property with a gang’s “tag”, other confirmed participation in gang activities, and/or
any indications from the UAC’s behavior while in government custody.

Notice of Placement in a Restrictive Setting, rev. 10/26/2018
ORR UAC/P-4

Notice of Placement in a Restrictive Setting

Summary of placement decision or case review (additional pages may be added):

ORR will review your placement, at a minimum, every 30 days to determine whether your placement in a restrictive level of care is
still necessary. If you remain in a secure facility or RTC after 30 days, you may request that the ORR Director reconsider your
placement. For more information on this process, please ask your case manager.
If you believe you have not been properly placed or that you have been treated improperly you may also ask a Federal District
Court to review your case. You may call a lawyer to assist you.

UAC’s acknowledgement of receipt:
______________________________________
UAC’s Signature

__________
Date

Care provider-issuing official:
______________________________________
Signature

Notice of Placement in a Restrictive Setting, rev. 10/26/2018
ORR UAC/P-4

__________
Date