POS 172 Series Domestic Violence posters placed in the CAO reception area.

POS 172.3 - Domestic Violence, Are You Safe?

POS 172.3-S Spanish - Domestic Violence, Are You Safe?

POS 172.4 - Domestic Violence, Your Safety Matters to Us.

POS 172.4-S Spanish - Domestic Violence, Your Safety Matters to Us.

Additional Palm Cards and Posters can be ordered through your CAO Forms Requestor. They are also in Docushare.

The following brochures and forms are available through DocuShare or at the link provided, as follows:

CM 305 -4/24, CM 305-S , CM 305-CH , CM 305-C , CM 305-R , CM 305-V , CM 305-A “Community Resources for Supportive Services, You have a right to be Safe”: To be available in the reception area for all clients.

Additional brochures can be oredered through your CAO Forms Requestor.

PA 1723 Authorization for Release of Information: Disclosure of a recipient address to law enforcement pursuant to 42 U.S.C. 608(a)(9).

PA 1747 Family Safety Notice and Domestic Violence Verification Form: Provides information about domestic violence waivers for families facing denial, termination, reduction, or suspension of benefits or sanction.

PA/CS 173WP Support and Good Cause Notice: Used to notify applicants and reapplicants of their right to claim good cause due to domestic violence.

PA/CS 173GC “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.

PA/CS 647 Child Support Information Sheet .

ACP ID Card Address Confidentiality Program Identification Card: Contains the ACP mailing address in place of the client’s physical address.

ACP Flyer Address Confidentiality Program Flyer: Contains information about the ACP program and enrollment.

ACP Flyer Spanish Address Confidentiality Program Flyer: Contains information about the ACP program and enrollment.

PA 1851 Written Authorization for Disclosure of Information: This form is used whenever an outside agency or individual requests information about an applicant or recipient who has disclosed domestic violence, has a protection from abuse order or is at risk of further domestic violence.

OSIG 12 Office of State Inspector General (OSIG) field investigation referral form. ( OSIG DV Policy ), ( OSIG 12 ), ( OSIG 12 Instructions ).

Updated September 16, 2025, replacing June 11, 2025