108.8 Specific Policies and Procedures Applicable to Good Cause Waivers of TANF Program Requirements

108.81 Verification: Domestic Violence Verification Form (PA 1747)

An individual who requests a good cause waiver of a TANF  program requirement based on domestic violence shall complete the Domestic Violence Verification Form (PA 1747) provided by the CAO. The CAO will provide the verification form in person or by mail to an individual who requests the form and will instruct the individual to provide verification that may include one of the following:    55 Pa. Code § 108.10

Documentation or third-party verification should be obtained, if possible, but self-affirmation will suffice to establish eligibility for a good cause waiver based upon domestic violence.

One verification form will suffice for one or more waivers.

The CAO may not, under any circumstance, have an individual who claims good cause based on domestic violence to do the following:

Such contact could endanger the safety of a victim, the family or household.

108.82 Time Frames for Authorization of Assistance and Waiver Determinations

A good cause waiver determination based on domestic violence will be made within 15 calendar days from the date the claim was initiated by the applicant or recipient.     55 Pa. Code § 108.11

108.83 Notice of Waiver Determination

The CAO will provide written notice of its determination of the waiver request to the applicant/recipient. The CAO will follow the notice requirements in Cash Assistance Handbook Chapters 104, Application, and 177, Notices. No denial notice shall be issued without prior review by both the CAO supervisor and manager. The notice to the applicant/recipient shall include the following information:      55 Pa. Code § 108.12

As soon as the determination is made on a good cause waiver of child or spousal support requirements, the CAO will send a copy of the PA 1747 establishing entitlement to the waiver to the Bureau of Child Support Enforcement Area Office. The PA 1747 must be accurately completed and must include the county code with the case number.

108.84 Six-Month Review/Redeterminations

Waiver of a TANF program requirement is granted for as long as necessary, subject to review every six months. The review may be face-to-face or by telephone.       55 Pa. Code § 108.13

Example: In June, an individual provided copies of police records indicating domestic violence. A waiver was granted, and a referral was made to the local domestic violence agency. The following January, at the six-month review, the individual’s circumstances have not changed, and the individual wants the waiver to continue. The waiver continues for an additional six months because the need for a waiver continues. No additional verification is required.

Example: In June, an individual completed Section 4 and self-affirmed domestic violence and the need for a waiver. A waiver was granted. The following January, at the six-month review, the individual requested that the waiver continue and informed the CAO of continuing inability to provide verification listed in Sections 2 or 3. The individual re-affirms in Section 4 that domestic violence is an issue. The waiver continues on this basis.

NOTE: Individuals who are having difficulty obtaining verification in addition to their self-affirmation should be referred to domestic violence agencies or legal services for assistance in obtaining a third-party statement.

Twelve-Month Review

Example: An individual received a domestic violence waiver from January to June based on self-affirmation. The waiver was extended six more months, to the following January based upon a second self-affirmation. At the January review (12 months following the initial granting of the wavier), the individual states that circumstances have not changed and they want the waiver to continue. The individual is still not able to provide any verification listed in Sections 2 or 3. The client completes Section 4 of the PA 1747 and the case is referred to the Area Manager for a waiver determination to be completed in coordination with the Bureau of Policy. The Area Manager reviews the circumstances and approves or denies the continuation of the waiver. The Area Manager does not have to review the case record again if circumstances do not change.


Updated August 9, 2021, replacing September 18, 2012