ApplyING for ACP
If you decide that the Address Confidentiality Program should be a part of your safety plan, applications to the Address Confidentiality Program are available through the local domestic violence, sexual assault, or victim service provider. If you need help finding a program or service in your area, use the PA Victim Service Program list.
You may also call the Address Confidentiality Program for assistance finding a local program. A victim service provider can help you determine if address confidentiality should be a part of your overall safety plan and can also help you come up with other ways to stay safe. They can also explain how the program works and assist in completing the Address Confidentiality Program application.
Address Confidentiality Program applications are not available through e-mail, or on our website. Completed paper applications can only be accepted by mail. The Application packet includes:
A “checklist for ACP Application,” which lists important policies of the program. Please discuss these with your victim service provider and initial that you understand the policies of the Address Confidentiality Program.
A “mailing information” section.
Provide your legal name and date of birth.
We ask for your mother’s maiden name and last four numbers of your Social Security Number as a way to make sure we are talking to you if you call our office. If the perpetrator has access to this information, please talk to your victim advocate about using alternatives and provide a password.
Provide the names and date of birth of all minor children who will be living with you. Please tell us your relationship to the children listed. If the child of a participant turns age 18 while in the program, they will need to apply for participation separate from the primary participant.
You do not have to reside in Pennsylvania to participate in the PA Address Confidentiality Program. If you reside out of state and are eligible for the program, you will be enrolled as a “Non-PA Resident.” This will appear on your Authorization Card. Please remember that agencies outside of Pennsylvania are not required to accept the Pennsylvania substitute address, though many may do so when asked. Please call our office to weigh the benefits of enrolling in Pennsylvania’s program or another state’s program.
Where would you like to receive your mail?
If you want to receive mail at an address that is not your residence, please put the address here. Some participants choose to have their mail forwarded to a PO Box or a friend’s house as an extra layer of safety.
However, the Address Confidentiality Program is required by law to have your actual residential/home address. Your residential address is kept confidential though it can be released in very limited situations. We cannot accept a PO Box or non-residential address in this section. Please be advised that if you are living in an emergency shelter, it is not the appropriate time to enroll in the Address Confidentiality Program. Additionally, if you own your home (your name is on the deed to your home) your address may not be able to be kept confidential. Please call our office to discuss your options.
Please provide phone numbers where we can contact you. If there is another number (in addition to a home or phone number) you would like us to use for safety reasons, please list that in the safe alternate # box. You may also provide to us an e-mail address.
Please provide us with information on any civil or criminal court matters in Pennsylvania courts in which you may be a victim, witness, plaintiff or defendant.
Please list all specific information, including case numbers, requested in the Civil/Criminal Proceedings section of the application. The ACP is required by law to notify the courts of your participation in ACP. This includes involvement in PFA, custody, family court, or domestic relations proceedings.
If you are involved in civil or criminal courts matters in other states, we will notify those courts upon your request. However, please remember that non-PA agencies are not required to accept the ACP substitute address, though many will do so when asked.
If you are under parole or probation supervision, please provide the name and phone number of the agent/officer supervising you. Please remember that you cannot use the ACP substitute address if your supervising agent/officer requires your actual residential address. It may be helpful to explain why you are enrolled in ACP and to discuss ways you can improve your safety while under supervision.
Completing the “ACP Authorization Card” is also a part of the application. Please ONLY sign and print your name on the card. Our office will complete the card and return it to you upon your enrollment into the program.
You must also provide a statement called an “affidavit” with your application. This can be typed or handwritten. Your statement should explain why you need ACP services and should describe past and present acts of violence/stalking by the perpetrator and how that makes you fearful of acts happening in the future. If you are a current ACP participant who is renewing your enrollment, an affidavit is not necessary.
As part of your affidavit, you must “swear and affirm” that you are eligible for ACP participation by selecting one of the categories listed. In this section (Affirmation box), you must check one of the selections. This is an important part of the application as you are legally affirming that the information you provided is true.
This is the section where you make the PA Office of Victim Advocate (OVA) your “agent for service of process.” This means that you are making OVA the agency responsible for accepting formal delivery of a written summons, or other legal process. You need to understand that this does not change your responsibility to respond to legal matters within the time period included in the legal document.
Sign and date the application
The victim service, domestic violence or sexual assault agency who helped you with the application must also sign and date that they have assisted you with safety planning and they believe that you will benefit from the Address Confidentiality Program.
The completed application must be mailed to the Address Confidentiality Program at:
Address Confidentiality Program
PO Box 2465
Harrisburg, PA 17104
If you have any questions about the program or completing your application, please call our office at 1.800.563.6399.