Form P-14 Notice of Transfer to ICE Chief Counsel - Change of Addr

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

ORR has determined that the Juvenile Respondent named below should be transferred to another ORR funded facility.
The Director of the Office of Refugee Resettlement, U.S. Department of Health and Human Services requests that the
Chief Counsel, Immigration and Customs Enforcement, U.S. Department of Homeland Security, file a Motion for
Change of Venue and/or Change of Address with the Executive Office for Immigration Review for this minor.

Date of Request
Requestor Info:

Name
Request:

Tel. No

Title

þ

¨

Change of Address

Change of Venue

I. CHANGE OF ADDRESS
1. Juvenile respondent's biographical information

First Name

Last Name

Aliases (if any)

Date of Birth

Alien Number
Country of Origin

2. Juvenile respondent's originating address (insert mailing address if different ):

Originating ORR facility name (if applicable):
Street

Street
City

State

City

Zip

Telephone Number

State

Zip

State

Zip

Alternate Tel. Number

3. Juvenile respondent's new address:

Receiving ORR facility name (if applicable):
Street
City

Street
State

Zip

City

Telephone Number

Alternate Tel. Number #

Receiving ORR facility point of contact info:*

Name

Title

Tel. No

4. The Transfer is scheduled to take place on
5. The next scheduled court apperearance for this juvenile is
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
notify the Department of Homeland Security (DHS) of the transfer of a UAC within the ORR care provider network so that DHS may may file a Motion for Change of
Venue and/or Change of Address with the Executive Office for Immigration Review to ensure the UAC’s immigration case is transferred to the local immigration court, if
applicable. Public reporting burden for this collection of information is estimated to average 0.17 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 contactPage 1 of 2
UACPolicy@acf.hhs.gov.

6. For non-emergency transfers, notification should be made at least48 hours before the juvenile respondent is
physically transferred. If notification is not made at least 48 hours in advance of transfer, please explain reason(s) below:

*In cases where the child remains in an ORR funded facility, the facility staff is responsible for notifying the child of all correspondence
from the U.S. Department of Homeland Security (DHS) and for filing all DHS documents in the child's case file.
II. ChANGE OF VENUE (fill out only if alse requesting a Change of Venue)
1. Good cause exists to change venue in this matter pursuant to 8 C.F.R 1003.20(b) for the following reason(s):

¨

Facility bed space is limited. ORR has decided to relocate the respondent to an area where space is available/appropriate
services can be provided.

Facility name (if above box is checked)

¨

The minor has special needs (e.g., pregnancy of juvenile, medical needs, etc.)

Please specify:

¨

Juvenile respondent is suitable for a less restrictive level of care.

¨

Juvenile respondent requires a more restricted level of are.

¨

Other

If Other, please specify:

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