TANF Affidavit

Temporary Assistance to Needy Families (TANF) Affidavit


(Updated November 2012)



As of October 1, 2012, all programs receiving TANF dollars through DVP are required to complete a TANF affidavit for all clients served in whole or in part with TANF dollars administered by the DVP.  In the event of an audit, a program may be asked to produce a copy of the affidavit to verify clients served with these dollars.  Funded programs must keep a signed copy of the affidavit in each client’s official file or in a general file with all affidavits filed together.  Copies of the affidavits must be kept for a minimum of three years.  There may be circumstances such as prolonged audits or lawsuits that require funded programs to keep these documents longer.


Redacting Information

For the purposes of conducting an audit or a site visit, funded programs must redact all identifying client information from each affidavit audited or reviewed.  This includes client name, address, race/ethnicity, or other information that could be used to recognize an individual as a client of the program.


Use of an Intake Form in Lieu of the Affidavit

Funded programs may use their intake form in lieu of the affidavit if it meets these two qualifying conditions:


1)     The intake captures the same information as required on the affidavit, and,


2)     The client signs an attestation to their income level and children.


Electronic and Telephonic Documentation

Funded programs may document the required information on the affidavit electronically or collect the information via telephonic communications so long as the following conditions are met:


1)     The electronic documentation includes attestation regarding client income level and children, and,


2)     The client verbally attests income level and children to the individual providing services and the worker providing services signs the affidavit in the client’s place.


TANF Affidavit

TANF Affidavit (Spanish)