PUB 388-11/19 - Domestic Violence, You have the Right to be Safe
PUB 388-S-11/19 - Spanish - You & Your Children have the Right to be Safe
POS 172.3 - Does the Person you Love, Threaten to Hurt or Kill You
POS 172.3-S Spanish - Does the Person you Love, Threaten to Hurt or Kill You
POS 172.4 - You Have a Right to be Safe from Family Violence
POS 172.4-S Spanish - You Have a Right to be safe from Family Violence
Additional Palm Cards and Posters can be ordered through your CAO Forms Requestor.
The following brochures and forms are available through DocuShare or at the link provided, as follows:
CM 305-11/19, CM 305-S 11/19, CM 305-CH 11/19, CM 305-C 11/19, CM 305-R 11/19, CM 305-V 11/19, CM 305-A 11/19 “Domestic Violence, You Have A Right To Be Safe”: To be available in the reception area for all clients.
PA 1723 Authorization for Release of Information: Disclosure of a recipient address to law enforcement pursuant to 42 U.S.C. 608(a)(9).
PA 1747 Family Safety Notice and Domestic Violence Verification Form: Provides information about domestic violence waivers for families facing denial, termination, reduction, or suspension of benefits or sanction.
PA/CS 173WP Support and Good Cause Notice: Used to document good cause due to domestic violence.
PA/CS 173GC “Good Cause” Determination Based on Factors Other Than Domestic Violence for Child Support or Paternity: A good cause claim for reasons other than domestic violence, such as rape, incest or pending adoption proceedings.
PA/CS 647.1 10/01 Child Support Information Sheet
ACP ID Card Address Confidentiality Program Identification Card: Contains the ACP mailing address in place of the client’s physical address.
PA 1851 Written Authorization for Disclosure of Information: This form is used whenever an outside agency or individual requests information about an applicant or recipient who has disclosed domestic violence, has a protection from abuse order or is at risk of further domestic violence.
OSIG 12 Office of State Inspector General (OSIG) field investigation referral form. (OSIG DV Policy), (OSIG 12), (OSIG 12 Instructions).
Updated November 21, 2019, replacing June 21, 2019