Get Diversion Agreement Form - Services Dpw State Pa

The Diversion Agreement Form is an essential document for individuals seeking diversion benefits instead of ongoing cash assistance. This guide will provide clear instructions on how to complete this form online, ensuring users understand each component involved.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the Diversion Agreement Form and open it in your preferred editor.
2. Begin by entering the client name in the designated field. Ensure that the spelling is accurate and reflects the user's official identity.
3. In the Co/Record# section, input the corresponding record number if applicable. This helps to uniquely identify the client within the County Assistance Office.
4. Review the responsibilities outlined for both the County Assistance Office (CAO) and the user. Take note of the eligibility requirements and objectives of the Diversion Program.
5. Provide a detailed explanation of your short-term financial needs in the relevant field. Include verification documents if required to support your claims.
6. Indicate how you plan to financially support your family without applying for ongoing TANF cash assistance. This is crucial for maintaining eligibility for diversion benefits.
7. Choose between receiving the Diversion benefit or ongoing TANF cash assistance by placing a checkmark next to the appropriate statement.
8. Sign in the 'Client Signature' section to confirm your understanding of the Diversion Program and your responsibilities.
9. Enter the date of signing in the specified field to validate your agreement.
10. If applicable, the CAO representative will then sign and date the form as well, finalizing the agreement.
11. Once all fields are completed, you can save your changes, download the form for your records, print it, or share it as needed.

Complete your documents online today for a smoother application process!