PM 03-13-02-e
Requesting a Family Violence Exclusion
If a person wants to file a written request, they may sign Request for Status Review (Form 2826)
Example 1: A TANF recipient was sexually assaulted two years ago by a man she did not know. She has been employed for the last year, working at least 30 hours a week. Her employer moved to a location close to where the perpetrator lives. The recipient was fearful that her assailant would see her and experienced anxiety attacks, affecting her performance and causing her to lose her job. She requests a Family Violence Exclusion while receiving medical and psychological help to recover from her anxiety attacks.
Example 2: An adult and her two children are domestic violence survivors. All are receiving counseling from a domestic violence service provider. The adult must pick up each of her children from school and take them to counseling sessions. The victim services organization is a significant distance from their home and the children's school. Because the children are of different ages, they are scheduled for counseling on different days of the week. This schedule interferes with the adult's ability to participate in work and training activities for 30 hours per week. She requests a Family Violence Exclusion for as long as the children are in counseling.
Acceptable Proof
An applicant or client must sign Consent to Release Form (Form 34) before the FCRC may contact a 3rd party to obtain:
- proof of the claim of domestic or sexual violence, or stalking; or
- information related to domestic or sexual violence, or stalking services.
Form 34 must specify the information to be released. Use the following wording when completing the form:
The Illinois Department of Human Services is requesting verification of (name) claim of domestic or sexual violence or stalking. This information will be used in the development of (name) Responsibility and Services Plan and to determine eligibility for a Family Violence Exclusion.
Multi-disciplinary Staffing (MDS)
Use Notice of Decision on Status (Form 2827) to notify an applicant or client of the approval or denial of their request for a Family Violence Exclusion.
Enter Item 80 Code 682 INTRV to indicate that a Multi-disciplinary Staffing (MDS) has taken place. If the exclusion is approved, document and control for the date to be reviewed.
Enter letter N in Item 73 of Form 552 when a person's request for a Domestic Violence Exclusion is approved. Entry of letter N stops the TANF 60-month counter for the person if the counter is 60 or less.
When the Domestic Violence Exclusion ends, remove letter N from Item 73 of Form 552 for the next month that can be affected. Do not adjust the person's TANF 60-month counter if removal of letter N in Item 73 does not coincide with the exclusion period. For example, Ms. V was approved for a Domestic Violence Exclusion for the months of August and September. In September an MDS is held and it is decided that she is no longer eligible for the exclusion. The caseworker removes letter N for the payment month of November because it's too late to make the change for October. Do not adjust the TANF 60-month counter because the change cannot be made for October.
