Effective Date
2/2026
Instructions
Updated: 03/2026
Purpose
- To document that the client read Explanation of Child Support, Eligibility Requirements, Family Violence and Good Cause FAQs or had family violence option and good cause explained to them.
- To document that the client is claiming good cause.
- Allows the client to self-attest good cause due to family violence.
- To document that the client has been referred to family violence resources.
Procedure
When to Prepare
The advisor prepares Form H1713 at each application when a client requests a good cause exemption from child, medical or dental support.
Detailed Instructions
Good Cause Acknowledgement
The client reads and signs:
- acknowledging that Explanation of Child Support, Eligibility Requirements, Family Violence and Good Cause FAQs or its information was shared;
- yes or no to a good cause claim;
- selection of good cause reason; and
- perjury statement.