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874 Chapter 5:Temporary Assistance for Domestic Violence Survivors (TA-DVS) Program • Section 2: Application (07/2026) Screening for domestic violence happens in several ways in Oregon. On all agency approved applications, generic questions on safety are asked. The TA-DVS Safety Screening (ODHS 7802) asks questions on safety. Use the ODHS 7802 to help determine immediate safety concerns, their level of safety, and if they may need a referral to the co- located DV advocate. The TA-DVS Safety Screening (ODHS 7802) is mandatory when a signed application for the TA-DVS Program is received, and must be completed within eight hours of receiving a signed application or establishing a filing date. TA-DVS Safety Plan (ODHS 1543) Click here for Safety plan. In April 2004, the TA-DVS Safety Plan (ODHS 1543) became a mandatory form for use in case planning with survivors of domestic violence who are currently experiencing domestic violence or who have been approved for Temporary Assistance for Domestic Violence Survivors (TA-DVS). The ODHS 1543 asks for the immediate plan to address safety concerns, as well as the plan to stay safe from abuse. These sections help guide the conversation in developing the required safety plan and increasing stabilization. The immediate plan should address the actions a survivor feels they need to complete to stay safe when leaving the office. Examples are calling family for resources, connecting with a DV advocate and getting copies of verification of pregnancy. The plan to stay safe should include a more long-term concept of what is needed. Remember that long term could mean two weeks, two months, etc. Things needed could include locating a job, moving out of state or moving into a new housing situation. Signature of both the worker and survivor is required on the Self-Sufficiency Domestic Violence assistance agreement (ODHS 1543). When completing a phone intake, a verbal signature is acceptable and is documented in case notes that it was signed verbally. For support and guidelines around completing the ODHS 1543 to address safety and stability, please refer to the ODHS 1543A Guidelines for Working with Survivors when Filling Out the TA-DVS Safety Plan (ODHS 1543) . This document also includes updated examples of language to use and avoid when working with survivors. TA-DVS Motel Use Agreement (ODHS 1543M) Click here for guidance on approving motels/hotels. The TA-DVS Motel Use Agreement (ODHS 1543M) was created in 2013 for guidance around access to motels. This serves as the survivor and agency agreement and is not intended to be provided to a motel as the information on the form is confidential and may not be shared without a release of information. The ODHS 1543M is required when approving a motel/hotel payment and must include the need for motel/hotel and the expected length of stay. Payments can be paid directly to the motel as a vendor or dual payee check when possible, If the vendor needs confirmation the payment has been sent, utilize the payment confirmation letter.