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Request for a Waiver of TAFDC Program Requirement(s) due to domestic violence

Produced by Massachusetts Department of Transitional Assistance
Reviewed May 2008

These are the Department of Transitional Assistance's (DTA) instructions for how to fill out the Request for a Waiver of TAFDC Program Requirement(s) Due to Domestic Violence



Please be sure you have read this page or that it has been read to you before completing the Request for a Waiver of TAFDC Program Requirement(s) due to Domestic Violence form.

Domestic violence is a crime! It comes in many forms. It includes any or all of the following acts by a current or former intimate partner, relative or household member:

  • physical abuse, such as pushing, hitting, shoving, kicking, biting, choking;
  • being forced to have sex;
  • threats of physical or sexual abuse; or
  • serious emotional abuse.

You may be excused from certain Transitional Aid to Families with Dependent Children (TAFDC) program requirements if you or your children have been hurt by domestic violence, and meeting these requirements may hurt you or your children. When you ask to be excused from a requirement, you are asking for a "waiver." You may receive a waiver if a requirement:

  • might lead you or your children to be physically or emotionally harmed by domestic violence;
  • makes it harder for you or your children to escape domestic violence; or
  • unfairly penalizes you or your children because of past domestic violence.

To help the Department decide if you are eligible for a waiver, you must answer the questions on this form. Attach more paper if you need to. Try to give as much information as possible. You will be asked to tell us [DTA] when the domestic violence happened. If you can't remember the exact dates, write the month and the year you think is correct. You will also need to provide some proof. (Examples of proof are on the last page of this form.)

In applying for a waiver, you should show two things:

  1. that you or your children have suffered from domestic violence; and
  2. why the domestic violence you or your children experienced makes it difficult for you to meet a Department requirement; or
  3. if you are asking to waive the family cap rule for one or more of your children, that the child was conceived as a result of the domestic violence.

You may ask one of the Department's Domestic Violence Specialists (DVS), your worker or a battered women's program for help answering these questions or getting the proof you need. You may also ask your worker for a referral to people who can help you. You may also take the form home with you to complete. The Department understands how hard it can be to tell others about what happened to you and your children; however, Department of Transitional Assistance (DTA) staff have been trained regarding domestic violence and its effects on families, and will treat you with understanding and respect.

Required Verifications (or Proof):

Attach at least one of the following verifications relating to your waiver request:

  1. court, medical, criminal, child protective services (DSS), social service, psychological, school or law enforcement records; and/or
  2. documents showing that you have: a restraining order; taken legal steps against the abuser; asked to be placed in a domestic violence shelter or other shelter due to domestic violence; or
  3. if you are unable to provide any of the verifications listed in 1 or 2, a statement from at least one other individual with knowledge of your circumstances.
If your waiver is approved, it will be for a specific time period. During that time, we [DTA] want to help you get the services you need to be safe and reduce the effects of domestic violence on you or your children.  It is important that you obtain services which can help you during the waiver period. Failure to obtain services may affect any requests for additional waivers.
Ask your Domestic Violence Specialist or your worker for a list of services.

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