R&P CORE SERVICES CHECKLIST

This form is optional and intended to assist resettlement staff with ensuring the provision of all core services.

Case #:

Date of Arrival:

Case Manager assigned: (Please print name)

A.

PRE-ARRIVAL AND RECEPTION SERVICES

Date of
Service

Name of Provider (caseworker,

family member, volunteer or other)

Date of
Service

Name of Provider (caseworker,

family member, volunteer or other)

Date of
Service

Name of Provider (caseworker,

family member, volunteer or other)

Verification to USCCB/MRS (via BIO-DATA Acceptance Form)

Sponsorship Assurance to USCCB/MRS
Orientation of anchor relative, parish or other assisting group
Share information with health providers and/or state and local officials
to plan for provision of services for those with health care requirements
Airport reception
B.

BASIC NEEDS SUPPORT

Housing that is safe, sanitary, in good repair, and affordable

(see home safety checklist)
Essential household goods and furnishings (see supply documentation)
Food and/or food allowance (see supply documentation)
Appropriate and seasonal clothing (see supply documentation)
C.

POST-ARRIVAL SERVICES

Home visit next calendar day after date of arrival (see home visit
report)
Housing and personal safety orientation next calendar day after arrival
Intake interview within 5 working days of arrival
Service Plan developed within 10 working days of arrival
Assist to enroll in employment services, as appropriate, within 10
working days
Assist to enroll in ESL, as appropriate, within 10 working days of arrival
Assist to enroll in other services, as appropriate, within 10 working days
of arrival
Assist with and provide information about change of address to U.S.
Department of Homeland Security within 10 days (AR-11)
Application for Social Security Card within 14 working days of arrival
Assist children in meeting school enrollment requirements and register
for school within 30 days of arrival
Assist with Selective Service registration within 30 days of arrival
Transportation to job interviews and job training for 30 days after arrival
Second home visit within 30 days of arrival (see home visit report)
Third home visit for cases that have moved to permanent housing from
temporary housing during R&P service period (see home visit report)

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Provide information on permanent resident alien status and family

reunion and assist with filling Affidavit of Relationship (AOR).
Provide information regarding travel loan
Community Orientation (see orientation checklist)
Document refugee understanding of community orientation
D.

HEALTH

Date of
Service

Name of Provider (caseworker,

family member, volunteer or other)

Date of
Service

Name of Provider (caseworker,

family member, volunteer or other)

If class A health condition exists, assist to secure appointment date

within 7 days of arrival
If class A mental disorder has been previously identified, assist to
secure evaluation within 30 days of arrival by designated health care
provider
Assist to obtain health screening within 30 days of arrival
Assist in accessing appropriate providers of continued therapy or
preventative treatment during the R&P period
Assist in obtaining immunizations required in preparation for adjustment
of status
E.

PUBLIC ASSISTANCE

Assist with applying for medical benefits within 7 working days of arrival
Date assistance began:
If appropriate, assist with applying for food stamps within 7 working
days of arrival
Date assistance began:
If appropriate, assist with applying for public cash assistance within 7
working days of arrival
Date assistance began:
Type of public assistance (check appropriate)

RCA

TANF

SSI

Food Stamps

RMA

Medicaid

Other (Please explain)

F.

SERVICES TO MINORS AND REQUIRED REPORTING

Date of
Service

Name of Provider (caseworker,

family member, volunteer or other)

Date of
Service

Name of Provider (caseworker,

family member, volunteer or other)

Home Assessment (Suitability Determination) before Assurance for M3, M5,

M6 and within one week of arrival for M2, M3
Orientation re/nature and expectations of U.S practices and legal requirements
respecting child care for M3, M5, M6
Statement of Legal Responsibility for M2, M3, M6
30-Day Home Visit/Assessment, within 30 days of arrival for M2, M5, M6, M7
th

Home Visit within 14 days of the 90 day after arrival to assess continued
suitability for M2, M3, M5, M6, M7
Minor 90-Day Report for M2, M3, M5, M6, M7 to be submitted 30 days after the
th
90 day after arrival
Notice of Secondary Migration of Minor for M2, M3, M5, M6, M7--to be sent to
MRS Childrens Services and receiving diocese (if applicable)

G.

REQUIRED REPORTS

R&P Period Report

With support of the United States Department of State/Bureau of Population, Refugees and Migration

Note: Appropriate language interpretation and translation must be provided. Defined as communication with the refugee in his/her
native language, if possible, or in a common language in which the refugee is fluent.
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MRS/RF-3 04/2014