950 CMR 130.04 - Program Participant Application and Certification Process

(1) Each Program Participant must be certified by the Program Manager to participate in the Program.
(2) Program Participant certification will be granted only where the prospective Program Participant:
(a) is a current Massachusetts resident;
(b) is a victim of domestic violence, rape, sexual assault or stalking;
(c) provides specific evidence that the applicant
1. is a survivor of domestic violence, sexual assault, rape or stalking, including certified law enforcement, court, federal and/or state agency records or files or
2. the applicant provides other specific evidence deemed acceptable in the sole discretion of the Program Manager and General Counsel of the Office of the Secretary of the Commonwealth.
(d) affirms under penalties of perjury that the disclosure of their address will threaten the safety of the applicant or applicant's minor children or the minor or the incapacitated person on whose behalf the application is made;
(e) completes, signs, dates and provides all necessary information required under M.G.L. c. 9A, § 2 and the standard application form and the authorization card form provided by the Program;
(f) agrees in writing to use the applicable substitute addresses designated by the Program for use by Program Participants;
(g) agrees in writing to abide by 950 CMR 130.00 and all other written Program rules, policies and procedures;
(h) provides the residential address and mailing address, if applicable, where the applicant may be contacted by the Program Manager or their designee and the telephone number(s) where the applicant may be called by the Program Manager or their designee; and
(i) provides one or more addresses the applicant requests not be disclosed for the reason that disclosure will jeopardize the applicant's safety or increase the risk of violence to the applicant or members of the applicant's household.
(j) demonstrates custody or guardianship of any minor children or incapacitated persons also being admitted to the Program and agrees not to use to use the Program to evade law enforcement or to avoid establishing or following child custody or visitation orders.
(3) Prior to certification of the application, the Program Manager may request additional documentation from the Program applicant relevant to a determination of eligibility, including, but not limited to, identification documents such as birth certificates or passports and evidence of any relevant judicial proceeding, criminal complaint, or proceeding brought under M.G.L. c. 209A.
(4) A properly completed application shall be effective on the day that it is certified by the Program Manager.
(5) An individual who is certified as a Program Participant shall be issued a Program Participant's identification card which includes their name, identification code, substitute address, certification expiration date, and applicant's signature.
(6) The term of a Program Participant's certification shall be four years following the effective date of their application certification unless the certification is withdrawn or canceled before that date pursuant to M.G.L. c. 9A, § 3 or 950 CMR 130.09.

Notes

950 CMR 130.04
Amended by Mass Register Issue 1498, eff. 6/23/2023.

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