108.11 Completing the Domestic Violence Agreement of Mutual Responsibility and Referral to Services

The Agreement of Mutual Responsibility (AMR) will be completed by CAO staff trained in domestic violence. The AMR serves as the Federal service plan for domestic violence waivers.

55 Pa. Code § 108.17(c)

45 CFR 260.55

The purpose of the AMR is to direct DV victims/survivors efforts toward family economic security by identifying reasonable goals and determining what activities the individual could complete to achieve those goals. In addition, the AMR explains how the Department of Human Services (DHS) supports the person’s efforts with supportive services and referrals to community agencies.

55 Pa. Code § 165.2

Developing the AMR

The AMR is a service plan to help an individual to become self-sufficient. The AMR should list specific activities to reduce barriers that the individual agrees to complete and the time frame for completing each activity.

The AMR also offers the individual and caseworker the opportunity to address personal and family issues that may interfere with their progress to achieve goals.

Completing the AMR

The caseworker must explain:

Responsibilities both for the person and for the CAO assisting the person.

Right to appeal and have a fair hearing.

Good cause.

Penalties for noncompliance with eligibility requirements.

Case Summary: See CAH 107.61 AMR Section: Case Summary

Goals should be completed with long term goals and first steps that are obtainable.

Example: Long Term: obtain GED. First Steps: enroll in GED classes.

Barriers To Goal Achievement: To ensure confidentiality, specific information about domestic violence will not be recorded on the AMR. Enter the phrase “Referred for supportive services” in this section on the AMR. Document the circumstances and information regarding domestic violence in the case record comments.

55 Pa. Code § 108.17

NOTE: Complete the AMR Job Readiness Assessment checklist when reviewing the Barriers To Goal Achievement section with the individual. See CAH 135.11 RESET Enrollment Status, The Job Readiness Assessment for the checklist.

Record any specific requirement that is being waived, including dates for the time period that a waiver is in effect.

Example: Support Cooperation is being exempt for 6 months, 1/1/23 through 6/30/23.

Note the basis for the waiver in the case record comments. For DV victims and survivors barriers can include transportation, employment, childcare, and housing. Include all barriers relating to goal achievement so goals can be reviewed every six-months. Attaining goals, how to attain goals, and support to attain goals is critical to support DV victims and survivors.

55 Pa. Code § 108.17(a)

55 Pa. Code § 108.17(c)

Employment & Training Status: Will be checked mandatory, unless otherwise exempt, a DV victim/survivor is a mandatory RESET participant. An individual could receive a good cause waiver from participating in RESET based on DV.

Participation Status: Will be checked approved if a good cause waiver has been granted. The Reason section will list what program requirements have been waived and for how long, including dates for the time period that a waiver is in effect.

Example: Support Cooperation is being exempt for 6 months, 1/1/23 through 6/30/23.

Agency Assistance and Referrals: Document all services, assistance, and referrals the individual is being provided. Special Allowances may be granted for an individual who participates in RESET including childcare, transportation, and other supportive services. Domestic violence agency and provider referrals should be noted as “referred for local county supportive services”. The local county domestic violence agency referral including address and phone number should be documented in the case record comments.

Participation Activities: If the individual is granted a good cause waiver of RESET requirements, enter “participate in supportive services plan” which include all AMR goals and activities, enter the date the good cause waiver is in effect.

If the individual is granted a good cause waiver for RESET, and chooses to participate in education, training, or other work-related activities, record the hours of participation.

The AMR should reflect activities the individual is participating in to resolve domestic violence like safety planning, counseling, therapy, and other related programs.

If the individual is participating in an activity through an approved contractor, such as MPP, it may be important for contractors to know of the potential problems that may occur at the training/employment site due to the domestic violence. However, the CAO will inform the client it is the individual’s decision to share this information with the contractor.

Review the AMR Responsibilities, Rights, Good Cause, and Agreement Penalties with the individual. The AMR must be initialed, signed and dated by all parties on each page to complete the form.

To promote and encourage self-sufficiency when good cause is granted for domestic violence, the Job Readiness Assessment form will be attached to the AMR. See CAH 107.6 Completing the AMR .

Agreement of Mutual Responsibility (AMR) Review

At renewal, the IMCW must review the status of the individual’s activities and goals on the AMR. If the individual has failed to complete the agreed-upon goals and or activities, the IMCW must determine the reasons and then take appropriate action.

A review of the AMR will be completed to assess the progress of how the individual is continuing to meet or work on their goals and achieve removal of barriers. The IMCW must update the changes to the AMR. If the individual’s plan on the existing AMR has not changed, the CAO must narrate in case comments why there are no changes, and the caseworker reviewed and revised the AMR with the individual. Goals on the AMR may have changed, if necessary, depending on the circumstances of the case. If the conditions for the good cause waiver no longer continues to prevent participation in RESET, enroll the individual in the appropriate E&T program. Together, the IMCW and the individual must discuss future actions that the person and agency must take to meet the goals.

CAH 107.71

108.111 Referral to Services

Each CAO should be familiar with all local and county domestic violence agencies, shelters, and providers.

When domestic violence is identified or a referral is requested, the CAO will provide the individual with names, phone numbers, and information about the services of the local domestic violence or other appropriate social service agencies, which may include shelter, safety planning, and counseling. The CAO will offer the individual both the PUB 388 palm card, and CM 305 brochure, “Community Resources for Supportive Services, You have a right to be safe”, found in CAH 108 Appendix A, Domestic Violence Brochures and Forms . The CAO should have hardcopies of the palm card and brochures available in the office to be given to individuals in person. Additional programs can be found at CAH 108.12, Other Assistance Programs Available to Domestic Violence Victims and Survivors , which promote support and assistance.

55 Pa. Code § 108.18

Updated September 16, 2025, replacing January 16, 2025