Pennsylvania Family Court Dependency Payment Voucher Form 30-1084C is a form used by the Pennsylvania Department of Human Services (DHS) for disbursement of payments to families who receive Dependency Assistance Program (DAP) benefits. The form is used to document the amount of money transferred to the family and the date on which the transfer was made. There are two types of Pennsylvania Family Court Dependency Payment Voucher Form 30-1084C: Form 30-1084C-1, which is used for regular payments, and Form 30-1084C-2, which is used for emergency payments. Both forms must be completed by the DHS and signed by both the person receiving the payment and the person making the payment. The form must be submitted to the court in order to be approved.