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• Medical records that give the emotional health history and present emotional health status of the member or the child. • A written statement from a mental health professional indicating a diagnosis of or prognosis on the emotional health of the member or the child. • A written statement from a public or private social agency that the agency is assisting the parent to decide whether or not to terminate parental rights. • A sworn statement from someone other than the member with knowledge of the circumstance on which the claim is based. • Authorization card or other proof from Safe at Home confirming the person’s status as a program participant in the Safe at Home program. Safe at Home can be contacted by calling 608-266-6613 or emailing Error! Hyperlink reference not valid.. • Any other supporting or corroborative evidence. When a claim is based on emotional harm to the child or the member, the IM agency must consider all of the following: • Person's present emotional state • Person's emotional health history • Intensity and probable duration of the emotional impairment • Degree of cooperation required • Extent of the child's involvement in the paternity or the support enforcement activity to be undertaken. If the member submits only one piece of evidence or inclusive evidence, you may refer them to a mental health professional for a report relating to the claim. When a claim is based on their undocumented statement that the child was conceived as a result of incest or sexual assault, it should be reviewed as one based on emotional harm. The IM agency must conduct an investigation when a claim is based on anticipated physical harm and no evidence is submitted. The member has 20 days, from the date the claim is signed, to submit evidence. The IM agency, with supervisory approval, may determine that more time is needed. There must be at least one document of evidence, in addition to any sworn statements from the member. The IM agency should encourage the provision of as many types of evidence as possible and offer any assistance necessary in obtaining necessary evidence. When insufficient evidence has been submitted: 1. The member must be notified, and the specific evidence needed must be requested. 2. The IM agency must advise that person on how to obtain the evidence, and 3. The IM agency must make a reasonable effort to obtain specific documents that are not reasonably obtainable without assistance. If the parent or caretaker continues to refuse to cooperate or the evidence is still insufficient, a 10-day notice must be sent informing the parent or caretaker that, if no further action is taken within 10 days from the notification date, good cause will not be found and that they may first: