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Special Circumstances Application

The Special Circumstances Application (SPCA) is used to submit applications for cases involving confidential individuals under 19; victims of domestic violence; and medical hardship.

HSN Medical Hardship Application Guidelines (PDF) (Word)

HSN-INET User Agreement

Providers must identify the individuals who are authorized to complete the SPCA on the provider's behalf by filling out an HSN-INET User Agreement.

Individuals already registered for HSN-INET should e-mail the HSN Help Desk in order for the SPCA filing to be added to their HSN-INET account. Individuals not registered for HSN-INET should complete and submit an HSN-INET user agreement, relative to their provider site. See Learn about HSN-INET for more information.


If you have questions or need more information, please contact the HSN Help Desk at 800-609-7232 or e-mail