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873 Chapter 5:Temporary Assistance for Domestic Violence Survivors (TA-DVS) Program • Section 2: Application (07/2026) Form When required DVS-077 Notice about your TA-DVS Eligibility Automatically generated in ONE when TA-DVS eligibility is approved DVS-068 TA-DVS Case Summary Automatically generated in ONE for TA-DVS applications. DVS-110 Notice of Action: TA-DVS Automatically generated in ONE when TA-DVS eligibility is denied, payment is denied, ODHS 7802 TA-DVS Safety Screening Within eight hours of filing date, at time of safety assessment DVS-135 We Need Proof for TA-DVS Notice Automatically generated in ONE for TA-DVS applications that must be pended ODHS 1543 Self-Sufficiency Domestic Violence Assistance Agreement At TA-DVS eligibility determination ODHS 1543M Self-Sufficiency Domestic Violence Motel Use Agreement At time of motel payment request ODHS 1540 “You have been approved for TA-DVS. What happens now?” Flyer After TA-DVS eligibility determination. Note that this flyer is not required, though discussion of how to access the benefit is required. Oregon Administrative Rule(s) 461-175-0200 — Notice Situations; General Information Approval notice – Notice about your TA-DVS eligibility (DVS-077) When TA-DVS program eligibility is approved, the Notice about your TA-DVS eligibility (DVS-077) is automatically generated in ONE. This notice includes the dates of certification as well as information about how the program operates. The notice also explains participants’ hearing rights. If the program remains open for the entire 90 days, there is no additional notice generated at the end of the 90- day certification to close or end TA-DVS. The DVS-077 includes the program certification dates and, as such, meets the requirements of both an approval and closure notice. Denial notice – Notice of Action -TA-DVS (DVS-110) The Notice of Action- TA-DVS (DVS-110) is automatically generated for TA-DVS cases resulting in denial of program eligibility or payment(s). The document will include the reason for the denial. When ending or closing the TA-DVS Program prior to the end of the 90-day period, the Notice of Action - TA-DVS (DVS-110) will be generated. Document in data collection and case notes the reason the program is ending early (e.g., no eligible child; moved out of state; reconciled with the abuser). TA-DVS Safety Screening (ODHS 7802)