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877 Chapter 5:Temporary Assistance for Domestic Violence Survivors (TA-DVS) Program • Section 2: Application (07/2026) • Interview hardship details* • Case Composition*

Š Abuser in the home

Š Children out of the home • Address details

Š Physical address details when in a temporary living situation

Š Mailing address details when there is no safe address • Verification of domestic violence* • Subsequent request* • Domestic violence information

Š Abuser name (not an eligibility requirement)

Š Relationship to abuser

Š How the situation meets the SSP definition of DV

Š Current or future DV safety concerns

Š Referrals • TA-DVS safety plan details • Forms completed and how they were provided • Mandatory report made - if applicable* *Items only situationally required For more details see the TA-DVS Case Note Guide QRG Payment requests or ongoing conversations about their DV situation should be a separate case note. Click here for examples: Narration. Determining when it might not be safe to case note in ONE When determining it might not be safe to case note in ONE, we need to establish what is unsafe about case noting. The safety reason must pose a risk of further domestic violence. We want to have a conversation with the survivor to explain the safety of our systems. Our systems have securities and protections already in place. There are times when some information is unsafe, but it is still safe to case note in ONE. In these situations, the unsafe information can be protected in another way. • Address is unsafe.

Š The address can be protected by coding DND in the system and have mailing address. We do not need to protect case notes for this reason. • Naming abuser in case note is unsafe.

Š Keep hard file for name of abuser. The remaining eligibility and conversations can be case noted.