108.42 Individual Notice

The CAO will provide oral notification to applicants and recipients of the right to claim good cause based on domestic violence as follows:

55 Pa. Code § 108.5(e)

At the application and renewal interviews .

Prior to a referral to the DRS .

At an Employment and Training compliance review, in which the recipient participates. See Cash Assistance Handbook Section 135. 71 ;

If there is a reason to believe a n individual, family member or household member has been subjected to or is at risk of further domestic violence.

Signs of abuse may include visible injuries, reluctance to share information about the non-custodial parent of the children, missed appointments, difficulty meeting work requirements, anxious behavior, or controlling or abusive behavior on the part of an accompanying partner.

CAO ' s will provide applicants or individuals who have not previously disclosed domestic violence with written notification . The Family Safety Notice and Domestic Violence Verification Form ( PA 1747 ) is provided to inform the individual of the right to claim good cause based on domestic violence:

55 Pa. Code § 108.4

55 Pa. Code § 108.5

At the application interview .

Prior to referral to the DRS for child support .

When teen parent requirements are discussed .

When Employment and Training requirements are discussed .

When the Agreement of Mutual Responsibility (AMR) is developed .

Prior to imposing a reduction for noncooperation with child support requirements .

Prior to denying, terminating, reducing , or suspending benefits due to failure to comply with a TANF program requirement.

The Family Safety Notice is on the front and the Domestic Violence Verification form is on the back of the PA 1747. Information from the Family Safety Notice is also included on the PA 600 , 600 R applications, and COMPASS applications .

NOTE: The PA 1747 is included with system-generated PA/FS 162 A or PA /FS 162 C notices and all manual notices sent to individuals in a non-DV case (DV indicator is checked No) who are subject to grant reduction, sanction , or budget closing for the following reasons:

Failure to comply with support requirements .

Failure to comply with RESET requirements .

Failure to provide information to verify conditions of eligibility .

Failure to keep reapplication interview appointment .

Failure to comply with TANF Work Support .

Failure to sign, return a mailed AMR for ETANF .

Requests that TANF cash assistance be discontinued .

This notice shall include an explanation of:

55 Pa. Code § 108.5(d)

The availability of referrals for assistance with domestic violence .

The availability of good cause waivers of TANF program requirements based upon domestic violence; and

Confidentiality protections.

The PA 1747 is the written notice that provides information about domestic violence waivers for families facing denial, termination, reduction, or suspension of benefits or sanction.

NOTE: The PA 1747 is handed to the individual in person prior to adverse action on the case. When this is not possible, the CAO confirms whether the individual has elected to use an alternate address (see Section 108.102 , Alternate Address) before sending the notice. If it is not possible to hand the notice to the individual, there is no alternate address, and the individual has disclosed domestic violence, do not proceed with the adverse action.

Please refer to Section 108.81, Verification: Domestic Violence Verification Form (PA 1747) for instructions on how to complete the verification process.

The PA/CS 173 WP (Support and Good Cause Notice), must be provided to all applicants, provides information to assist individuals in evaluating whether they can pursue support safely or want to seek a waiver.

The PA/CS 647 (Child Support Information Sheet), provides written notice of support requirements and includes Family Violence information.

The PA/CS 173 GC “Good Cause” Determination Based on Factors Other Than Domestic Violence for Child Support or Paternity: A good cause claim for reasons other than domestic violence, such as rape, incest or pending adoption proceedings.

The PA/CS 173 WP, PA/CS 173 GC, PA/CS 647, and PA 1747 are available in APPENDIX A , and in DocuShare.

Updated September 16, 2025, replacing May 22, 2024