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harm to the child, recipient parent/caretaker relative, non-recipient parent/caretaker relative or child’s parent(s) not in the household is claimed: • The present emotional state of the person subject to emotional harm. • The emotional health history of that person. • The intensity and probable duration of the emotional upset. • The degree of cooperation required by the recipient parent/caretaker relative or non- recipient parent/caretaker relative; and • The extent of involvement of the child in paternity establishment or support enforcement activities. 2436.10.10.15

CHILD SUPPORT GOOD CAUSE CORROBORATIVE EVIDENCE (C)

The policy stated in this section only applies to Two-Parent TANF and Regular TANF.

The SF 4149 Notice of Right to Claim Good Cause should be provided to any recipient parent/caretaker relative or non- recipient parent/caretaker relative claiming or inquiring about good cause. (The information contained on the form is also included in the Application for Assistance in Section 3 of the Rights and Responsibilities.) The recipient parent/caretaker relative or non-recipient parent/caretaker relative is to provide a signed statement regarding the reasons good cause is claimed and provide corroborative evidence to establish the claim.

Evidence is to be submitted no more than 20 days from the date on which the good cause claim was made. A good cause claim may be corroborated with the following types of evidence: • Birth certificate or medical or law enforcement records which indicate that the child was conceived as the result of incest or forcible rape. • Court documents or other records which indicate that legal proceedings for adoption are pending before a court of competent jurisdiction. • Court, medical, criminal, child protective services, social services, psychological, or law enforcement records which indicate that the absent parent might inflict physical or emotional harm on the child or caretaker. • Medical records or records of a mental health professional which indicate emotional health history or the present emotional state of the caretaker or child subject to emotional harm. • A written statement from a public or licensed private social agency that the applicant/recipient is being assisted by the agency to resolve the issue of whether to keep the child or relinquish him for adoption; or • Sworn statements from individuals other than the caretaker with knowledge of the circumstances which provide the basis for the good cause claim.

In addition, if the evidence submitted is insufficient to establish good cause, the Division of Family Resources is to: • Promptly notify the recipient parent/caretaker relative or non-recipient parent/caretaker relative that additional evidence is required. • Advise him of the type of documents needed and how to obtain the necessary documents; and