Domestic Abuse Victim Reporting Option Statement
This form allows domestic abuse victims to report incidents confidentially or to initiate an investigation. It provides options for both restricted and unrestricted reporting, along with information on available services. Read the Privacy Act Statement before completing the form.
Edit, Download, and Sign the Domestic Abuse Victim Reporting Option Statement
Form
eSign
Add Annotation
Share Form
How do I fill this out?
To fill this out, carefully read the instructions and privacy act statement before you begin. Make sure you understand each type of reporting option available. Complete the form with the necessary details and consult a Domestic Abuse Victim Advocate (DAVA) or FAP clinical provider if you have any questions.
How to fill out the Domestic Abuse Victim Reporting Option Statement?
1
Read the Privacy Act Statement and instructions carefully.
2
Discuss reporting options with a DAVA, FAP clinical provider, or healthcare provider.
3
Indicate your understanding of restricted and unrestricted reporting options by initialing the appropriate sections.
4
Select your desired reporting option and fill out the necessary fields.
5
Sign and date the form and ensure a provider and supervisor, if required, also sign and date the form.
Who needs the Domestic Abuse Victim Reporting Option Statement?
1
Military personnel who are victims of domestic abuse need this form to report incidents.
2
Civilian spouses or partners of military personnel who experience domestic abuse and need to document the incident.
3
Healthcare providers who handle cases of domestic abuse and need to complete the form with the victim.
4
Family Advocacy Program (FAP) clinical providers who support victims of domestic abuse.
5
Domestic Abuse Victim Advocates (DAVA) assisting victims with reporting and resources.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the Domestic Abuse Victim Reporting Option Statement along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.
Edit your Domestic Abuse Victim Reporting Option Statement online.
You can edit this PDF on PrintFriendly using our seamless PDF editing tool. Add or modify text, initials, and dates directly on the form. Save your progress and make necessary changes until the document is complete.
Add your legally-binding signature.
You can sign the PDF on PrintFriendly by adding your digital signature using our PDF editor. Simply click on the signature field, create or upload your signature, and place it in the relevant sections. Ensure all required parties have signed before finalizing the document.
Share your form instantly.
Share the PDF on PrintFriendly by using our sharing options. You can email the PDF directly, copy a shareable link, or save and upload it to your preferred cloud storage. Easily share the finalized document with relevant parties for further processing.
How do I edit the Domestic Abuse Victim Reporting Option Statement online?
You can edit this PDF on PrintFriendly using our seamless PDF editing tool. Add or modify text, initials, and dates directly on the form. Save your progress and make necessary changes until the document is complete.
1
Open the PDF in the PrintFriendly PDF editor.
2
Navigate through the form and locate the fields that require editing.
3
Click on each field to add or modify text, initials, or dates.
4
Save your progress frequently to avoid losing any data.
5
Once all edits are complete, review and finalize the document.
What are the instructions for submitting this form?
To submit this form, contact your Domestic Abuse Victim Advocate (DAVA) or Family Advocacy Program (FAP) clinical provider. You can email your completed form to osd.pentagon.ousd-p-r.mbx.forms@mail.mil. Alternatively, you can submit it physically to the appropriate office or through your healthcare provider. Ensure all required signatures and dates are included before submission. Advice: Always keep a copy of the submitted form for your records.
What are the important dates for this form in 2024 and 2025?
This form is valid until 2026-06-30. Ensure all reports are submitted as soon as possible to access timely support and services.
What is the purpose of this form?
The purpose of this form is to provide domestic abuse victims with the option to report incidents confidentially or to initiate an investigation. By completing this form, victims can access medical treatment, advocacy services, counseling, and legal support tailored to their reporting choice. The form ensures that necessary steps are taken to protect the victim and hold the alleged abuser accountable if an unrestricted report is chosen.
Tell me about this form and its components and fields line-by-line.
- 1. Reporting Process and Options: Discusses the reporting process and options with the Domestic Abuse Victim Advocate (DAVA) or FAP clinical provider.
- 2. Unrestricted Reporting: Allows the victim to report a crime, initiate an investigation, and access services such as medical treatment and counseling.
- 3. Restricted Reporting: Allows the victim to report the crime confidentially without initiating an investigation, while still receiving medical treatment and counseling.
- 4. Exceptions to Restricted Reporting: Lists scenarios where restricted reporting cannot prevent information disclosure, such as imminent threats or child abuse.
- 5. Services: Information on available services such as legal advocacy, expedited transfer, and more.
- 6. Reporting Options: Victim selects and initials their preferred reporting option (unrestricted or restricted).
- 7. Signatures: Fields for victim, provider, and supervisor to sign and date the form.
- 8. Retaliation Report: Section to report any retaliation experienced after reporting domestic abuse.
What happens if I fail to submit this form?
Failing to submit this form may impede your ability to receive necessary support and protection. It is crucial to complete and submit the form to ensure proper documentation and access to available services.
- Lack of Protection: Without the form, necessary protection measures such as military protection orders may not be implemented.
- Limited Access to Services: Failure to submit the form may limit access to medical treatment, counseling, and advocacy services.
- Incomplete Documentation: Not submitting the form means your abuse incident may not be officially documented, affecting future legal actions.
How do I know when to use this form?
- 1. Immediate Threat: If you are in immediate danger, use this form to report the incident and receive necessary protection.
- 2. Access to Services: When you need medical treatment, counseling, or advocacy services, complete this form to access them.
- 3. Legal Documentation: To officially document the abuse incident for potential legal action, use this form.
- 4. Confidential Reporting: If you prefer to confidentially report the abuse without an investigation, choose the restricted reporting option.
- 5. Retaliation Reporting: If you experience retaliation after reporting domestic abuse, fill out the relevant section of this form.
Frequently Asked Questions
Can I edit this form on PrintFriendly?
Yes, you can use our PDF editor to edit the form, add text, initials, and other necessary information.
How do I save my edited form?
Save your progress frequently by clicking the save button in the PDF editor to avoid losing any data.
Can I sign the form on PrintFriendly?
Yes, you can add your digital signature directly to the form using our signature feature in the PDF editor.
How do I share the completed form?
You can email the PDF, copy a shareable link, or save and upload it to your preferred cloud storage directly from PrintFriendly.
Can I switch between restricted and unrestricted reporting options?
Yes, you can change your reporting option by indicating your new choice and filling out the necessary fields on the form.
Who needs to sign the form?
The victim, a provider, and a supervisor (if required) need to sign and date the form.
What services are available to me after reporting?
You can receive medical treatment, advocacy services, counseling, and legal support depending on your reporting option.
Can this form be used to report retaliation?
Yes, the form includes a section to report retaliation experienced after reporting domestic abuse.
Where can I find the Privacy Act Statement?
The Privacy Act Statement is provided at the beginning of the form. Read it carefully before completing the form.
How do I know if I need this form?
If you are a victim of domestic abuse and need to report the incident and access support services, this form is for you.
Related Documents - Victim Reporting Statement
Andhra Pradesh State Road Transport Corporation Student Bus Pass Application
The Andhra Pradesh State Road Transport Corporation (APSRTC) Student Bus Pass Application form is for students up to SSC who need to apply for a bus pass for the academic year 2024-2025. This form includes personal details, school details, route details, and requires a bonafide certificate. Completing this form allows students to travel on APSRTC buses between their residence and school at a concessional fare.
NYC Section 8 Request to Move Form
The NYC Section 8 Request to Move Form is for participants in good standing to move with continued assistance. Participants must meet specific criteria and obtain necessary approvals. The form includes options for non-emergency and emergency moves.
Cheyenne Transit ADA Paratransit Eligibility Application
This file includes the application and instructions for Cheyenne Transit's ADA Paratransit service. It details the eligibility criteria and provides guidelines on how to complete the form. The document must be filled out in full and submitted to determine eligibility for Paratransit service.
Council-Manager Government Roles and Responsibilities Guide
This file provides detailed information about the roles and responsibilities of key officials in a council-manager government structure, including the mayor, city manager, and elected officials. It also explains how residents can participate in the government decision-making process.
Passenger and School Bus Driver Application
This file provides detailed instructions and forms required for obtaining a Commercial Driver License (CDL) with a passenger or passenger/school bus endorsement in New Jersey. It includes fingerprinting information, medical examiner certificate requirements, and a declaration form. Applicants must complete the form, print, and sign it before visiting an Agency or the New Jersey Motor Vehicle Commission.
Facility Clearance (FCL) Orientation Handbook - March 2021
This handbook provides a comprehensive orientation to the Facility Clearance (FCL) process. It outlines responsibilities, deadlines, and guidance. It includes detailed process information and required forms.
Service Member's Individual Transition Plan Checklist
This file is a checklist intended for service members to document and certify the achievement of career readiness standards as they transition out of the military. It includes sections for personal and family needs assessment, evaluation of military service benefits and acquired skills, career readiness standards, and contact information for supporting agencies. The checklist must be completed and verified by the service member, transition counselor, and unit commander prior to separation.
Bangladesh Judicial Service Commission Form Instructions
This document provides detailed instructions for filling out and submitting the Bangladesh Judicial Service Commission form, including essential deadlines and required fields.
NORKA, RØD S - Government of Kerala Undertaking File
This document is issued by the Government of Kerala and pertains to various government-related undertakings. It provides important instructions and details necessary for various procedures. Users should follow the guidelines carefully to ensure compliance.
GOVERNMENT OF PUNJAB DEPARTMENT OF PERSONNEL MANUAL 2019
This document is a manual by the Government of Punjab's Department of Personnel, outlining various personnel policies and instructions issued in the year 2019. It includes amendments, performance indicators, appointment procedures, and relevant rules for civil services and recruitment. The manual serves as a comprehensive guide for personnel management and related administrative processes.
Oklahoma DOT Roadway Design CADD Standards Manual
The Oklahoma DOT Roadway Design CADD Standards Manual effective April 1, 2015 details the best practices for all related engineering work. Following these standards ensures readability, uniformity, and proficiency in design plans. This manual is essential for designers working with or for the Oklahoma Department of Transportation.
Affordable Connectivity Program Application Form FCC Form 5645
FCC Form 5645 is an application form for the Affordable Connectivity Program (ACP) that provides monthly internet service discounts and a one-time device benefit for qualifying low-income consumers. The form includes sections for personal information, identity verification, and household details. Instructions for submission and required documentation are also provided.
