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["DEPARTMENT OF HUMAN RESOURCES"]
["MARYLAND OFFICE FOR REFUGEES AND ASYLEES"]
["311 West Saratoga Street; Baltimore, MD 21201"]
["Case Closing Compliance Check List  for  Refugee Transitional Cash Assistance (RTCA)"]
[]
["PPP Site:","      SWRC                                    BRC"]
[]
["1. Assistance Unit Members (list all names starting with CASE HEAD)"]
["Last Name","First Name","Middle ","DOB MM/DD/YY","Alien Number"]
[]
[]
[]
[]
[]
[]
[]
["2.Immigration status :",null,"(select one from dropdown)"]
[]
["3.Documentation presented:",null,"(select one from dropdown)"]
[]
["4.Ineligible for other public assistance:   YES                  NO"]
[]
["5. Date of entry into U.S.  __/__/______",null,"6. Resettlement Agency:"]
["(for asylees, date asylum was granted)",null,"(select one from dropdown)"]
[]
["7.Is this person an out of state secondary migrant?   YES            NO          "]
[]
["8.Was this previously a part of a matching grant case?   YES         NO"]
[]
["9.Date PPP eligibility/payment ended:  ___/___/______"]
[]
["10. Has a redetermination been conducted for this case ?   YES         NO"]
[]
[" If YES, provide date of eligibility redetermination:   ____/___/__________  "]
[]
["11.Indicate the primary reason the cash assistance ended:",null,"(select one from dropdown)"]
[]
[null,"      If other, specify _________________________"]
[]
["12. If client(s) employed, provide date(s) of placement : "]
[]
["Principal Applicant: ___/___/________"]
["Spouse: ___/___/________"]
["Other: ___/___/________"]
[]
["13.Comments:_________________________________________________________________________"]
["_____________________________________________________________________________________"]
["_____________________________________________________________________________________"]
["_____________________________________________________________________________________"]
["_____________________________________________________________________________________"]
["_____________________________________________________________________________________"]
[]
["14. Completed by:_________________________________________",null,null,"Date: _____/_____/_____________"]
["(Print  Name)"]
[]
["15. Signature:____________________________________________________"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"REFUGEE",null,"I-94","IRC","End of eight month eligibility period "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ASYLEE",null,"EAD","LSS","Income exceeds PPP eligibility ceiling"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PAROLEE",null,"Asylum Approval Letter","ECDC","Out-migration"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ENTRANT",null,"Immigration Judge Asylum Grant Letter","WR","Other"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TRAFFICKING",null,"I-730 Approval Letter","HIAS Baltimore"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SIV",null,"Passport","HIAS Rockville"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"OTHER",null,"Letter for Victims of Trafficking","Other"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Other"]