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STATE OF HAWAII BENEFIT, EMPLOYMENT DEPARTMENT OF HUMAN SERVICES AND SUPPORT SERVICES DIVISION DHS 1247 (REV 06/2022) Page 1 of 1 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES PROGRAM NOTICE OF REQUIREMENT TO COOPERATE WITH CHILD SUPPORT ENFORCEMENT AGENCY AND RIGHT TO CLAIM GOOD CAUSE Name of Applicant / Recipient Case Number Processing Center Date This notice explains the requirement for families to cooperate in obtaining child and/or spousal support for you and your child(ren), and the right to claim good cause for not cooperating with this requirement. Please read this notice and keep for your records. If there are any questions regarding this notice, please call the Public Assistance Information Line at 1-855-643-1643. BENEFITS OF CHILD SUPPORT ENFORCEMENT Your cooperation to obtain child support from your child(ren)’s absent parent may be important to you and your child(ren) because it may help to: 1) Locate the absent parent; 2) Establish paternity; 3) Set up child support payments; 4) Determine rights to future Social Security, veterans or other government benefits; and/or 5) Establish medical coverage for your child(ren) from the absent parent. COOPERATION WITH CHILD SUPPORT ENFORCEMENT AGENCY In accordance with federal laws and as a condition of eligibility, your family is required to cooperate to obtain any support owed to you and your child(ren) for whom you want financial benefits unless you have good cause not to do so. Cooperating with the Child Support Enforcement Agency, you may be asked to do one or more of the following: 1) Identify the absent parent of any child applying for or receiving financial benefits and give information to help locate the absent parent; 2) Establish paternity if your child(ren) were born out of wedlock; 3) Help to obtain financial support and medical coverage owed to you and/or your child(ren) who are receiving assistance, including any past due child support; and 4) Reimburse the State any money given directly to you by the absent parent as you continue to receive your eligible financial benefit amount. You may be required to go to the appropriate Child Support Enforcement Agency office in-person to sign papers and/or provide necessary information. GOOD CAUSE You may have good cause not to cooperate in the State’s efforts to obtain child/spousal support and medical coverage. You may be excused from cooperating if you believe that it would not be in the best interest of your family and if you can provide evidence to support this claim. NON-COOPERATION WITHOUT GOOD CAUSE If you refuse to cooperate without good cause, your entire family will be ineligible for financial benefits. GOOD CAUSE CLAIM If you want to claim good cause: 1) You must inform the Processing Center whenever you think you have good cause not to cooperate; and 2) You must be given a second notice explaining the circumstances under which the eligibility worker may find good cause and the type of evidence or other information needed to justify your claim of good cause. Auth: Hawaii Administrative Rules, Chapter 17-653, and Sections 17-656.1-8, 17-656.1-11, and 17-676-32 Attachment B-4, Page 1 of 1