U.S. Department of Health and Human Services 
Office of Inspector General 
Widespread Pandemic 
Disruption Spurred Innovation 
to State Paternity 
Establishment Practices 
Ann Maxwell  
Deputy Inspector General 
   for Evaluation and Inspections 
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August 2023, OEI-06-21-00150 
Why OIG Did This Review  Widespread Pandemic Disruption Spurred 
In fiscal year (FY) 2020, 41 percent  Innovation to State Paternity Establishment Practices 
of children born in the United 
States were born to unmarried 
What OIG Found 
parents.  Paternity establishment is  Key Takeaways  Paternity establishment services 
the legal determination of 
State child support agencies  were disrupted by the COVID-19 
fatherhood for children born into 
reported that significant  pandemic in every State.  Hospital 
these families.  It serves as the basis 
disruptions due to COVID-19  visitation restrictions made it 
for child support orders and affirms 
forced them to alter processes  difficult for fathers to establish 
the connection between father and 
in ways that modernized  paternity at the time of birth.  
child.  State child support agencies 
paternity establishment  Closures and limited hours for 
facilitate paternity establishment in 
services.  These innovations can  courts and genetic testing sites 
the hospital at the time of birth, or 
continue to benefit the program  disrupted post-birth paternity 
through other administrative and 
and parents, if supported.   establishment services. 
court processes post-birth.  The 
OCSS also assisted States by 
Office of Child Support Services  State child support agencies took 
temporarily lowering 
(OCSS) provides oversight and  numerous actions to maintain 
performance thresholds for 
funding to State child support  paternity establishment services 
paternity establishment to 
agencies.    during the pandemic, which agency 
prevent States from losing 
officials reported resulted in 
The COVID-19 pandemic disrupted  Federal funding.   
improved customer service.  They 
paternity establishment services 
transitioned to telework, offered 
nationwide, resulting in lower 
additional assistance to hospital staff, and increased the use of remote 
paternity establishment rates.  This 
court hearings.  They also increased their outreach to parents via 
study evaluates the effect of the 
telephone, email, and text.  
pandemic on State paternity 
establishment services, State  OCSS temporarily reduced paternity establishment performance 
agency practices to maintain  requirements, which protected State agencies from financial penalties 
services, and efforts by OCSS (then  they might otherwise have incurred.  State agencies called the OCSS 
named the Office of Child Support  action beneficial, but some said they would have also benefited from 
Enforcement) to support State  additional help in maintaining services, such as policy guidance and 
agencies to maintain paternity  sharing of State agencies best practices.  
establishment services during the 
pandemic.   What OIG Recommends 
The lessons learned from the COVID-19 pandemic can be applied to 
How OIG Did This Review  improve paternity establishment services and protect future operations.  
OIG surveyed 54 child support  OIG recommends that OCSS (1) create forums for identifying and sharing 
agencies, from all 50 States, the  State agency best practices in providing paternity establishment services; 
District of Columbia, Guam, Puerto  and (2) bolster State agency resilience during emergencies.   
Rico, and the Virgin Islands, 
The Administration for Children and Families (ACF) concurred with both 
between June and September 2022.  
recommendations.  ACF also stated that OCSS is planning a notice of 
OIG also reviewed documents and 
proposed rulemaking to allow modification of State agency performance 
conducted interviews with 
standards during national emergencies. 
representatives from nine States 
and from OCSS headquarters and 
regional offices. 
   
TABLE OF CONTENTS 
 
 
BACKGROUND ................................................................................................................................................ 1 
Office of Child Support Services .......................................................................................................................................... 1 
OCSS Guidance and Flexibilities for States During the COVID-19 Pandemic .................................................... 4 
Methodology .............................................................................................................................................................................. 4 
Standards ..................................................................................................................................................................................... 6 
FINDINGS ......................................................................................................................................................... 7 
All State agencies reported disruption to paternity establishment services during the COVID-19 
pandemic ...................................................................................................................................................................................... 7 
Most State agencies reported challenges to in-hospital services largely due to COVID-19 precautions 
and visitation restrictions ....................................................................................................................................................... 7 
State agencies reported challenges to post-birth services due to court closures, restricted office 
hours, and lack of virtual services ....................................................................................................................................... 9 
State agencies responded to pandemic challenges by adopting virtual processes, expanding outreach, 
and other actions to modernize services ....................................................................................................................... 11 
OCSS temporarily lowered the State performance threshold for paternity establishment to prevent 
States from losing Federal funding .................................................................................................................................. 15 
State agencies had mixed assessments of OCSSs support during the COVID-19 pandemic, citing the 
lowered performance threshold and other support as beneficial ........................................................................ 16 
CONCLUSION AND RECOMMENDATIONS ........................................................................................... 18 
Create forums for identifying and sharing State agency best practices in providing paternity 
establishment services .......................................................................................................................................................... 18 
Bolster State agency resilience during emergencies ................................................................................................. 18 
AGENCY COMMENTS AND OIG RESPONSE ........................................................................................ 20 
APPENDIX: AGENCY FORMAL COMMENTS .......................................................................................... 21 
ACKNOWLEDGMENTS AND CONTACT ................................................................................................ 23 
Acknowledgments .................................................................................................................................................................. 23 
ABOUT THE OFFICE OF INSPECTOR GENERAL .................................................................................... 24 
ENDNOTES ................................................................................................................................................... 25 
 
   
 
BACKGROUND 
 
OBJECTIVES 
1.  To assess the effect of the COVID-19 pandemic on State paternity 
establishment services. 
2.  To evaluate the actions of the Office of Child Support Services (OCSS) to 
support State agencies in maintaining paternity establishment services. 
 
In fiscal year (FY) 2020, 41 percent of children born in the United States were born to 
unmarried parents.1  Paternity establishment is the legal determination of fatherhood 
for children born into these families.  It serves as the basis for child support orders 
and also affirms the connection between father and child.2, 3  State child support 
agencies facilitate paternity establishment in the hospital at the time of a childs birth, 
or through other administrative and court processes.4  For more than 20 years, most 
unmarried parents established paternity through in-hospital voluntary 
acknowledgment at the time of birth.5  Research shows that fathers who establish 
paternity are more likely to comply with child support orders and be involved in their 
childs life.  Involved fathers are associated with a range of beneficial child outcomes 
including improved cognition, language development, and fewer behavioral 
problems.6  Further, once paternity is legally established, a child qualifies for certain 
forms of public assistance, and gains certain rights and privileges, such as inheritance 
rights and rights to a parents medical and life insurance.7, 8, 9   
The COVID-19 pandemic disrupted paternity establishment services nationwide, 
resulting in lower paternity establishment rates among unmarried parents in most 
States.10  This study assesses the challenges the pandemic caused for paternity 
establishment services, and identifies actions taken by child support agencies to 
maintain services.  We evaluated OCSSs actions in helping State agencies navigate 
the pandemic, including providing flexibilities with program requirements.   
Office of Child Support Services 
The Child Support Enforcement program was established in 1975 through the Social 
Security Act.11  The Office of Child Support Services (OCSS), located within the 
Administration for Children and Families (ACF) administers the program at the Federal 
level.  OCSS had been known as the Office of Child Support Enforcement until June 
2023, when it changed its name to OCSS.12  OCSS provides financial support, policy 
guidance, technical assistance, and some enforcement services to State agencies, such 
as intercepting Federal tax refunds for parents who owe unpaid child support.  Child 
support agencies (also referred to as IV-D agencies because the agencies were 
codified in Part D of Section IV of the Social Security Act) provide services directly to 
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families and facilitate the provision of support payments to custodial parents.  Child 
support agencies are in all 50 States, the District of Columbia, Guam, Puerto Rico, the 
Virgin Islands, and 60 Tribal Nations nationwide.13   
Federal law requires custodial parents to cooperate with State child support 
enforcement agencies.14, 15  In FY 2021, OCSS provided $3.5 billion to States for 
administrative expenditures, which represented 60 percent of total administrative 
expenditures that year.16  Child support was the third-largest income support 
program for children in the United States in FY 2021.17 
State child support agencies have discretion to design their programs to meet 
individual State laws, needs, and characteristics, subject to meeting Federal 
requirements.  State agencies are required to submit to OCSS a State IV-D plan that 
articulates the agencys methods for fulfilling Federal requirements.18  The State IV-D 
plans include State methods for establishing paternity and child support orders; 
collecting child support; disseminating policies and procedures to parents; and 
overseeing local child support offices.19  These plans are approved by OCSS and must 
be in continuous operation.20, 21    
State child support agencies also have a requirement for emergency management of 
automated systems that collect and disburse child support payments.22  The 
requirement specifies that State agencies must have contingency plans to ensure that 
these automated systems continue to operate during periods of short--or long-term 
disruption.23  OCSS does not impose additional emergency preparedness 
requirements to ensure the maintenance of other child support functions, such as 
paternity establishment, during a crisis.  Agency staff informed us that disaster 
recovery plans are maintained at the State level, not by OCSS.   
Federal Laws Promoting Voluntary Paternity Establishment 
Paternity establishment is a core component of child support programs.  The 
Omnibus Reconciliation Act of 1993 required States to create a simplified 
administrative process for parents to voluntarily acknowledge paternity at the time of 
a childs birth.24  The Personal Responsibility and Work Opportunity Reconciliation Act 
of 1996 (PRWORA) increased State responsibilities for establishing paternity and 
encouraged all unmarried parents (whether seeking public assistance or not) to 
establish paternity.  It also imposed a penalty in the form of reduced Temporary 
Assistance for Needy Families (TANF) funding if a State failed to achieve a 90-percent 
paternity establishment percentage (PEP) and had not improved its PEP the 
prescribed amount over the prior year.25, 26  
Building on PRWORA, the Child Support Performance and Incentive Act of 1998 
(CSPIA) established a performance-based incentive and penalty system in which 
States receive incentive funding based on performance in five areas.27  One measure 
is the rate of paternity establishment.28  Since paternity is the first step to establishing 
a child support order, achieving a higher rate of paternity establishment is critical to 
ensuring support for children and custodial parents and meeting the other 
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performance measures, such as support order establishment.  Following 
implementation of these Federal laws, rates of paternity establishment increased 
substantially.  The national IV-D paternity establishment percentage (PEP) rate was  
65 percent in FY 2000 (the year CSPIAs performance measures took effect) and by 
FY 2018, the national rate was above 90 percent.29, 30  (Some States have PEP rates 
above 100 percent, due to counting paternity establishments in the current year for 
children born in prior years.31)  
Paternity Establishment Percentage Rates: Incentives and 
Penalties 
States may earn payment incentives and/or incur penalties based on their PEP rates.  
OCSS awards incentive payments to States with a PEP rate at 50 percent or higher, 
and States with a PEP rate above 80 percent gain the full incentive payment.32  OCSS 
imposes a penalty in the form of reduced TANF funding when States do not meet a 
90-percent PEP threshold.  For States that do not meet the 90-percent threshold, 
OCSS sets a rate the States must meet the following year to avoid a penalty.33  States 
can receive full incentive payments for meeting an 80-percent PEP threshold and still 
be subject to penalties for failing to reach the 90-percent PEP threshold.  PEP data are 
maintained by States and they are audited by OCSS for completeness and accuracy.34   
In-Hospital Voluntary Paternity Acknowledgment 
Federal law requires States to provide services so unmarried fathers can voluntarily 
acknowledge paternity in the hospital.35  In-hospital acknowledgment allows parents 
to establish paternity without visiting an administrative office or court, and to name 
the father on the original birth certificate rather than modifying the certificate after 
birth.   
State agencies have invested considerable resources in supporting in-hospital 
programs, including training hospital staff to facilitate paternity acknowledgment, and 
developing educational materials for parents.  Voluntary acknowledgment requires 
both parents to sign a declaration of paternity, which legally certifies that the father is 
the parent of the child.36   
Post-Birth Paternity Establishment  
In addition to in-hospital voluntary paternity acknowledgment, Federal law requires 
States to operate common paths for establishing paternity post-birth through other 
administrative or judicial processes.37  States must have procedures in effect that 
allow for the establishment of the childs paternity from birth until age 18.38  The 
childs mother or presumed father may request paternity establishment after the 
childs birth through an administrative process that is similar to in-hospital 
acknowledgment.  Parents may also acknowledge paternity at State and local vital 
records offices, within a certain timeframe post-birth, which varies by State.39 
The childs mother or presumed father may also request paternity establishment 
through the courts.  Judicial establishment may require genetic testing, in which a 
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buccal swab is rubbed inside the cheeks to collect DNA material.40  States must allow 
genetic test results to serve as evidence of paternity without the need for additional 
testimony.41   
OCSS Guidance and Flexibilities for States During the COVID-19 
Pandemic 
In its role of supporting State child support agencies, OCSS is responsible for 
providing guidance and technical assistance to help State agencies operate their 
programs according to Federal laws and regulations.  This includes providing the 
agencies with information on practices that may be useful for program improvement 
and interpreting Federal policies, such as actions the agencies must take to comply 
with new and amended Federal laws.42    
The COVID-19 pandemic resulted in fewer paternity establishments nationwide.43  
According to preliminary OCSS data, the national number of paternities established or 
acknowledged decreased between FYs 2019 and 2020 by 13 percent (from 1.4 million 
to 1.2 million).44   
OCSS released a Frequently Asked Questions (FAQ) document to assist agencies in 
the operational, administrative, and programmatic challenges they were facing as a 
result of the pandemic.  Last updated in February 2021, the FAQ included a mix of 
topics, such as extensions to IV-D agencies for reporting performance data and 
discussion of telework policies.45  
In May 2020, OCSS released a memorandum to IV-D directors acknowledging that 
State agencies were encountering significant challenges and that child support 
services nationwide were severely disrupted by the pandemic.  The memorandum 
outlined a plan for granting IV-D agencies flexible accommodations in meeting State 
requirements such as required timeframes for certain child support services.46   
In October 2021, OCSS issued a proposed rule that would temporarily lower the 
required PEP performance threshold from 90 percent to 50 percent in order for a 
State to avoid a financial penalty for FYs 2020 and 2021.47  On May 27, 2022, the final 
rule was published, which lowered the PEP performance threshold from 90 percent to 
50 percent for FYs 2020 through 2022.48 
Methodology 
Scope 
This study assesses how the COVID-19 pandemic has affected paternity establishment 
services provided by IV-D agencies in the 50 States, the District of Columbia, and 
three territories (referred to here as State agencies), and identifies actions taken by 
the child support agencies to maintain those services.49, 50  We did not assess how the      
COVID-19 pandemic affected other services provided by child support agencies, such 
as establishing and enforcing child support orders. 
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We evaluated OCSSs actions to support State agencies in maintaining paternity 
establishment services, and the use of any flexibilities for State performance 
requirements between March 2020 to December 2022.  We did not evaluate State 
performance or compliance with Federal standards.   
Data Sources and Analysis 
We used three data sources for our evaluation: (1) a survey of child support agencies 
in 50 States, the District of Columbia, and three territories; (2) interviews with State 
agency officials and frontline child support staff from nine States, and review of 
supporting documents; and (3) an interview with OCSS officials, and review of OCSS 
supporting documents.  
State Survey.  We administered an online survey between June and September 2022 
to the 54 IV-D agencies including all 50 States, the District of Columbia, Guam, Puerto 
Rico, and the Virgin Islands.  We received survey responses from all  
54 State agencies for a 100-percent survey response rate.  The survey included 
questions about how the COVID-19 pandemic affected paternity establishment 
services throughout the pandemic, the extent to which services were disrupted, and 
challenges with maintaining services.  The survey asked respondents to describe 
actions they took to maintain paternity establishment services and lessons learned in 
addressing paternity establishment challenges and backlogs.  The survey also asked 
State agencies about their experiences with OCSSs guidance and technical assistance 
for maintaining services during the pandemic, and what additional flexibilities they 
needed.        
We used quantitative and qualitative analysis of the survey responses to identify 
challenges and actions taken, and to gain insight on OCSS support.  The survey also 
provided illustrations and context.  We used the survey responses to select a 
purposive sample of nine State agencies for interviews and document reviews.   
State Agency Interviews and Document Reviews.  We conducted interviews with 
State agency officials and frontline staff from nine agencies in September 2022 to add 
context and examples of challenges and actions taken to address those challenges 
during the pandemic.  We also examined agency documents related to policies and 
practices for establishing paternity.    
We used qualitative analysis of our State agency interviews to understand and 
illustrate the strengths and weaknesses of paternity establishment methods from 
multiple agency perspectives.  Our interview analysis examined how State agencies 
used OCSS guidance and flexibilities to improve paternity establishment practices 
from the perspectives of the State agencies and what additional actions could 
improve Federal support to agencies.   
OCSS Interview and Document Reviews.  We conducted an interview with OCSS 
officials in November 2022 to understand their support efforts, including how OCSS 
formulated and distributed guidance, and how it responded to State agency 
questions and concerns during the pandemic.  We analyzed the interview responses 
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to provide context and insights into OCSSs perspective on State agency strategies to 
provide paternity establishment services during the pandemic. 
We also requested and reviewed OCSS documentation provided to State agencies, 
including memorandums outlining flexibilities, actions, and guidance to maintain 
paternity establishment practices.  Our analysis of documents examined how OCSS 
identified and approached challenges and relayed information to State agencies 
related to maintaining paternity establishment services during national emergencies.   
Limitations 
Our analysis included self-reported data that we did not independently verify.  
However, our interviews offered an opportunity to determine the general viability of 
the survey responses.  We also did not evaluate whether actions taken by State 
agencies improved their operations.    
Standards 
We conducted this study in accordance with the Quality Standards for Inspection and 
Evaluation issued by the Council of the Inspectors General on Integrity and Efficiency. 
 
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FINDINGS 
All State agencies reported disruption to paternity 
establishment services during the COVID-19 pandemic 
The widespread nature of the pandemic created unique and unprecedented 
challenges to maintaining paternity establishment services, some of which persist.  All 
54 State agencies reported that they experienced some level of disruption to paternity 
establishment services, with more than half of State agencies (31 of 54) reporting 
significant disruptions.  State agency respondents spoke often of the scale of the 
pandemic and its effect on nearly all aspects of operations for State agencies and 
their partners in establishing paternity, including hospitals and vital records offices.   
[Paternity establishment] involves institutions across government and 
private sectors...[T]here is sharing data, sharing forms, working with the 
courts.  When the pandemic hit, I think we were all taken aback by the 
scale of the emergency.  OCSS Regional Program Manager 
 
These disruptions created challenges for State agency staff.  Nearly three-quarters of 
State agencies (40 of 54) reported that the average time to establish paternity 
increased during the pandemic, and 25 of the 40 agencies with delayed times said the 
average time to establish paternity had not returned to pre-pandemic time frames at 
the time of our data collection in mid-2022.  The difficulty establishing paternity in the 
hospital caused by the pandemic also resulted in increased workloads for State 
agency staff.  More than half of State agencies (33 of 54) reported that their staffs 
workloads increased during the pandemic due to an increase in post-birth paternity 
establishment cases.  An agency official in a large State said staff had to work 
overtime to address the backlog of paternity establishment cases caused by the 
pandemic.  An official in a different State agency said that while their staff did not 
need to work overtime to address the backlog, it was still an intensive effort to 
maintain the paternity establishment caseload during the initial months of the 
pandemic.  
Most State agencies reported challenges to in-hospital services 
largely due to COVID-19 precautions and visitation restrictions   
In response to the COVID-19 pandemic, hospitals took precautions and enforced 
visitation policies that restricted who could be present in birthing units.  Fifty of the  
54 State agencies reported disruption to paternity acknowledgment services that 
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occurred in-hospital.  More than one-third of these agencies (19 of 50) characterized 
the disruption as significant.  (See Exhibit 1 for common challenges.) 
Exhibit 1: State agencies reported that hospital visitation restrictions were 
the most common of the challenges to in-hospital voluntary paternity 
acknowledgment programs during the COVID-19 pandemic. (n=54)  
 
 
Source: HHS-OIG analysis of 54 State agency survey responses, 2022. 
Three-quarters of State agencies (41 of 54) reported that hospital visitation 
restrictions were a challenge to in-hospital paternity establishment.  One State agency 
official wrote, Because many hospitals restricted people other than the mother to 
enter the facility, putative fathers may not have had the opportunity to acknowledge 
paternity during that critical time period. 
Further, hospitals COVID-19 precautions limited the participation of others needed to 
assist parents with completing the paternity acknowledgment forms at the time of 
birth.  Two-thirds of State agencies (34) reported that parents received less support 
from hospital staff to assist with paternity establishment throughout the pandemic, 
and almost half (26) said hospital social services staff were less available to assist 
parents.  In one State, agency officials said the health information management staff 
who handle birth certificates were sometimes restricted from entering the birthing 
centers to assist parents.  Agency officials also reported that, given the intense care 
needs of the pandemic, hospital staff who would normally assist parents with 
paternity acknowledgment were called upon to focus on other priorities.  One State 
agency official said, resources were diverted within hospitals to concentrate on 
critical care and the paternity program took a back seat...   
Hospital precautions during the pandemic also limited the ability of notaries and 
witnesses to be present to complete paternity acknowledgment forms.  Twenty-three 
State agencies reported that visitation policies limited the presence of witnesses 
needed to sign paternity acknowledgment documents.  Twenty-one State agencies 
said notaries were less available to certify in-hospital voluntary paternity 
acknowledgment forms. 
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Most State agencies did not have paternity acknowledgment 
services to engage fathers, notaries, and witnesses remotely   
Use of virtual communication could have resolved limitations on participation from 
fathers, notaries and witnesses, but 43 of the 54 State agencies did not meet with 
parents virtually to complete in-hospital paternity acknowledgment forms.  An official 
from one of the 11 State agencies that met with parents virtually to complete 
in-hospital paternity acknowledgment forms said they created a process so parents 
could upload Acknowledgment of Paternity documentation.  That was quicker than 
through the mail, the official said.  We were trying to adapt our documents and 
forms to have...virtual ways and means of getting to us.  
State agencies reported challenges to post-birth services due to 
court closures, restricted office hours, and lack of virtual services 
COVID-19 also disrupted paternity establishment services that occur outside the 
hospital, via the courts, administrative processes, and genetic testing.  All 54 State 
agencies reported that these post-birth paternity establishment methods were 
disrupted during the pandemic.  Half of the State agencies (27 of 54) characterized 
the disruption to post-birth paternity establishment as significant.  (See Exhibit 2 for 
common challenges to post-birth paternity establishment.) 
Exhibit 2: State agencies reported that court closures or limited hours were 
their most common of the challenges to post-birth paternity establishment 
during the COVID-19 pandemic. (n=54)   
Source: HHS-OIG analysis of 54 State agency survey responses, 2022. 
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Most State agencies reported that court closures and restricted 
court hours hampered post-birth paternity establishment services   
Nearly all State agencies (50 of 54) reported that court closures or restricted court 
hours were a challenge to post-birth paternity establishment during the pandemic.  A 
State agency official said the courts in a major city limited activities to emergency 
proceedings for more than a year and there were no in-person hearings for family 
court.  When the courts reopened, only cases that were deemed emergency 
proceedings would advance through family court.  An official from the State agency 
said child support matters were not deemed essential.  An official from a different 
State agency said that the State had only a small number of child support-related 
court hearings throughout 2020 and into 2021.  Courts did not have anything for 
three solid months, the official continued, and when we did resume the hearings, 
they were very slow.  
Backlogs caused by court closures and long wait times for paternity establishment 
hearings were a challenge for 43 of the 54 State agencies.  One State agency reported 
that the backlogs were particularly severe in larger jurisdictions where some people 
might have had a lack of Internet and telephone access.  The director for one State 
agency estimated that their courts were still working through backlogs of thousands 
of cases, including paternity establishment cases, at the time of our review.   
Closure and restricted hours for genetic testing sites also 
hampered paternity establishment services   
Parents and State agencies use genetic testing to confirm paternity; however, 39 of 
the 54 State agencies reported that the pandemic resulted in genetic testing facilities 
closing or limiting their hours.  State agencies said that before the pandemic they had 
many genetic testing sites located in courthouses, making it a one-stop shop for 
paternity establishment, according to one agency official.  Court closures and 
restricted hours reduced access to these services.  Other State agencies provided 
genetic testing in their child support agency offices before the pandemic, but these 
offices were closed to the public for a period of time during the pandemic.   
It was clear immediately...at the beginning of the pandemic that this 
would be a significant impact on State programs.  State agency director 
 
In addition, more than half of the State agencies (32 of 54) said that restricted access 
to prisons during the pandemic hampered onsite genetic testing of incarcerated 
parents.  OCSS and State agencies also noted that there were challenges to genetic 
testing even when testing sites were open, including with the sufficiency of testing 
supplies and ensuring that staff were properly trained for administering genetic tests 
using COVID-19 precautions.   
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State agency coordination with vital records and TANF offices 
became more difficult   
As with courts, vital records offices closed or restricted hours during the pandemic.  
State agency officials identified two problems related to vital records offices during 
the pandemic: processing delays (23 of 54 State agencies) and limitations in accessing 
vital records offices (17 of 54 State agencies).  One State agency official said, Once 
we request information, theyre supposed to [provide it in] 48 hours.  Some were not 
done in 48 days.   
Public assistance offices had similar closures and restricted hours, with 15 State 
agencies citing challenges coordinating with TANF services.  Because TANF recipients 
must cooperate with the child support program as a condition of receiving benefits, 
State TANF agencies refer custodial parents to the child support agencies.  One State 
agency official said that TANF offices went to remote work during the pandemic, 
which led to backlogs in processing TANF applications and to a significant decrease 
in paternity establishment referrals.   
State agencies responded to pandemic challenges by adopting 
virtual processes, expanding outreach, and other actions to 
modernize services  
State agencies reported that in taking action to maintain paternity establishment 
services during the pandemic, they improved these services moving forward.  Half of 
the State agencies (27 of 54) reported changing their practices to facilitate in-hospital 
paternity establishment, and all of the 54 State agencies said they changed some 
aspect of their post-birth paternity establishment process.  State agencies increased 
the use of virtual services in courts; increased telework; found alternate genetic 
testing sites; and conducted more outreach to parents via phone, email and other 
methods.    
While many State agencies said that these adjustments were challenging during the 
pandemic, agency officials reported that some of these services were more   
customer-centered and allowed more convenience for families.  State agency officials 
said in interviews that the challenges caused by the COVID-19 pandemic transformed 
paternity establishment services for the better.  Officials said that their processes went 
from old fashioned to the 21st century and that the improvements made us more 
valuable to new customers.  (See Exhibit 3 on the next page for actions the State 
agencies took to maintain paternity establishment services during the pandemic.) 
 
 
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Exhibit 3: State child support agencies were asked which of the following 
actions they took to facilitate paternity establishment services during the 
COVID-19 pandemic. (n=54) 
 
Source: HHS-OIG analysis of 54 State survey responses, 2022. 
To mitigate case backlogs, State agencies worked with courts to 
increase virtual hearings and encouraged use of administrative 
tools such as e-filing 
State agencies took actions to facilitate court processes during the pandemic.  Most 
State agencies (46 of 54) reported working with courts to start or expand the use of 
remote court hearings.  An official from one State agency said, We have been leaning 
really hard into virtual court.  It is so much better of a customer experience.  An 
official from OCSS said the rate of parents showing up for court skyrocketed when 
States transitioned to virtual hearings because parents did not have to worry about 
finding a babysitter, going downtown to the courthouse, and finding parking.   
State agencies also reported an increase in the capability to file court documents 
electronically.  Thirty-five State agencies worked with courts to develop and expand 
the use of electronic signing and filing of forms (e-filing).  The officials from one of 
the agencies said their courts were already going through a modernization process 
that allowed electronic orders to be submitted to the court, but e-filing became a 
priority when the pandemic hit.  The officials from a different State agency said         
e-filing helped their courts work through a 6-month backlog of cases caused by court 
closures during the pandemic.   
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150                             Findings | 12   
In one State, agency officials said that before the pandemic they scheduled their 
judicial paternity establishment cases in batches in their courthouses.  Court backlogs 
and restricted hours made it difficult to schedule paternity establishment hearings 
and find time on the docket to batch cases.  Although the State agency reported that 
it did not conduct any virtual court hearings to establish paternity prior to the 
pandemic, it worked with the courts to create a virtual process so families did not 
have to be in person for many cases.   
In another State, officials discovered during the pandemic that some of their offices 
were not using an existing administrative-only paternity establishment process, so 
they provided additional guidance and promoted the administrative process to help 
minimize the number of cases that needed to proceed through the backlogged 
courts.    
Our new customers are truly virtual...They dont want to come into a lobby 
and sit all day... Our [service] has become more enhanced by becoming 
paperless.  Yes, COVID pushed that.  State agency official 
Some State agencies changed their process of notarizing paternity 
establishment documents.  Fifteen of 54 State agencies said they modified the 
process of notarizing paternity establishment documents.  Officials from one State 
agency said that prior to the pandemic, the agency would notarize paternity 
acknowledgment forms in its offices.  When its offices closed during the pandemic, 
the agency allowed the parents to use notaries in other locations and submit the 
documents to the child support agency.   
Most State agencies increased telework and remote technical 
assistance, which helped maintain their services for families  
Most of the State agencies (47 of 54) reported that they purchased equipment and 
increased technical assistance for child support offices to help them perform their 
work remotely.  Representatives from one State agency said they had no 
infrastructure for remote work before the pandemic.  Their staff had been using 
desktop computers anchored to the office, but by mid-summer of 2020 the agency 
had purchased laptops for all staff, which enabled them to maintain services while 
working outside the office.  
Many State agencies developed alternate arrangements to safely 
conduct genetic testing for parents 
Half of the State agencies (27 of 54) reported providing alternate genetic testing 
arrangements or sites.  Officials from one agency said they set up drive by genetic 
testing sites where parents could perform a swab for the genetic test themselves, with 
a child support agency employee serving as a witness for the test.  Witness testing 
allowed us to have physical distancing, one State agency official said.  Its something 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150                             Findings | 13   
we will [use] moving forward in terms of being that close in someones space.  Weve 
learned that we have some flexibility we didnt know [we had] when it came to 
[genetic] testing.  Another State agency moved genetic testing from the courts, 
which were closed, to their regional offices, where the tests were conducted by the 
staff of a national lab-testing chain.  
Some State agencies increased training, technical assistance, and 
communication with hospitals to help maintain services 
Agency officials said that by working with some hospitals and other offices, they were 
able to complete in-hospital voluntary paternity acknowledgments despite visitation 
restrictions.  Thirteen State agencies reported that they increased the technical 
assistance and training they provided to hospital staff, and 11 said they increased 
their communication about paternity establishment with hospital staff.  Examples of 
other enhanced communication included expanded outreach to hospital vital records 
offices to facilitate acknowledgments and filing of birth certificates. 
Half of the State agencies used new forms of outreach to parents 
that promoted paternity establishment  
State agencies developed various methods of outreach to parents for promoting 
paternity establishment during the pandemic.  About half of the State agencies (26 of 
54) conducted enhanced outreach to parents via text, email, or telephone to educate 
them about paternity establishment and promote the process during the pandemic.  
The officials from one State agency said they created a phone hotline and a dedicated 
email address for paternity establishment customer service during the pandemic.  I 
think really during COVID, we became more customer centered, an official from the 
agency said.   
 
The pandemic forced us to be innovative and it pressed fast forward on 
those innovations.  I dont know [if] any of us would have seen these things 
in our careers without the pandemic.   State agency director 
Thirteen of the 54 State agencies reported that they contacted vital records offices to 
identify cases of nonmarital births for which there was not an establishment of 
paternity and conducted outreach to inform the mothers of their services.  Officials 
from one of the State agencies said they worked with vital records to send outreach 
mailings to thousands of mothers and estimated that about 20 percent of the 
mailings resulted in an acknowledgment of paternity. 
Many State agencies (32 of 54) created or updated website content on paternity 
establishment for parents during the pandemic.  One State agency said it created a 
customer service call center and made it possible for parents to contact the agency 
through a mobile application.  Agents would screen cases and respond to customers 
within two days.  Another State agency created postcards with a Quick Response (QR) 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150                             Findings | 14   
code, which hospital staff distributed, to inform new parents of the services available 
to them.  The State agency reported that it also developed a system of sending email 
alerts to parents to remind them of genetic testing appointments.  
OCSS temporarily lowered the State performance threshold for 
paternity establishment to prevent States from losing Federal 
funding  
The disruption to paternity establishment services caused some child support 
agencies to be at risk of losing millions of dollars in TANF funding.  By law, agencies 
that did not meet a 90-percent PEP threshold in a given year were at risk of being 
penalized by OCSS if they did not raise their PEP the prescribed amount in the 
following year.  PEP performance declined for 41 States, according to FY 2020 data, 
and about a third of States faced a possible financial penalty of a reduction of           
1-2 percent of their TANF funding if they did not take sufficient corrective action the 
following year.51, 52 
Child support agencies began requesting relief from performance measures and case 
processing timelines as early as March 2020.  Between March and June of 2020, OCSS 
published FAQs to assist State agencies and provided flexibilities for administrative 
requirements and timeframes.  The flexibilities did not extend to PEP-related financial 
penalties because those penalties are statutorily mandated and OCSS was exploring 
what options may be available.    
OCSS explored numerous legislative and regulatory options over the course of many 
months to address the PEP-related financial penalties.  In March 2021 it moved 
forward with developing a Notice of Proposed Rulemaking (NPRM), relying on 
statutory authority allowing the Secretary to modify the requirements related to PEP 
to take into account such additional variables as the Secretary identifies that affect the 
ability of a State to meet the requirements.53  The NPRM, published on 
October 19, 2021, proposed temporarily lowering the PEP threshold from 90 percent 
to 50 percent for FYs 2020 and 2021.   
The Paternity Establishment Percentage Performance Relief Final Rule was published 
on May 27, 2022, and became effective immediately.  It modified the PEP 
performance threshold from 90 percent to 50 percent for FYs 2020, 2021, and 2022.54  
Therefore, child support agencies whose PEP stayed above 50 percent during that 
timeframe would avoid financial penalties. 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150                             Findings | 15   
State agencies had mixed assessments of OCSSs support during 
the COVID-19 pandemic, citing the lowered performance 
threshold and other support as beneficial  
Most State agencies reported that the support they received from OCSS regarding 
paternity establishment during the pandemic was fully sufficient (9 of 54) or 
somewhat sufficient (20 of 54).   
One State agency explained that, [OCSS] was available for any questions and/or 
concerns we had regarding this issue throughout the pandemic.  Officials in a 
different State agency said their OCSS regional office specialist was extremely 
helpful during the pandemic.  As we implemented the new processes, we ran them 
by him to make sure we were staying in bounds of Federal regulations, the State 
agencys director said.  (See Exhibit 4 for State agency responses regarding support 
from OCSS.) 
Exhibit 4: State agencies were asked: Have OCSSs actions to help your IV-D 
agency maintain paternity establishment services during the COVID-19 
pandemic been sufficient? (n=54) 
 
 
Source: HHS-OIG analysis of 54 State survey responses, 2022. 
State agency officials were particularly supportive of OCSS lowering the paternity 
performance threshold.  We dropped to 82 percent...and we had no idea if we would 
improve the next year or not, one State agency official said, expressing the 
importance of the temporary lowering of the PEP requirement. 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150                             Findings | 16   
Eight State agencies called OCSSs actions to help maintain paternity establishment 
services insufficient.  Some of these State agencies said they would have benefited 
from more rapid action by OCSS.  OCSS was very, very slow to respond to the 
problem of paternity establishment for State programs, even though it was clear 
immediately  and was raised to OCSS immediately, one State agency official wrote 
on their survey.  Another suggestion from State agency officials was that OCSS share 
practical advice and guidance among the agencies.  For example, one State agency 
official suggested that OCSS serve as a central clearinghouse to promulgate best 
practices and practical guidance for maintaining paternity establishment services.   
OCSS officials confirmed that they did not provide formal guidance or technical 
assistance on paternity establishment during the pandemic, but that their regional 
offices were in frequent contact with State agencies.  OCSS officials said that State 
agencies may have emergency preparedness agreements that call for them to assist 
each other during times of disruption, but the agreements typically concern localized 
emergencies, such as fire or water damage, and OCSS does not oversee these State 
agreements.  In their communication with States, the regional offices shared 
information about other State agency practices on an ad hoc basis, OCSS officials 
said, and were aware of State agency efforts to support each other and share 
information.  I really think the States were as inventive as they could be, one OCSS 
official said.  Every single challenge you can imagine was coming at them [during the 
pandemic].   
 
 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150                             Findings | 17   
CONCLUSION AND RECOMMENDATIONS 
State child support agencies reported that significant disruptions due to the     
COVID-19 pandemic led them to alter processes in ways that modernized paternity 
establishment.  These innovations can continue to benefit the program and parents, if 
supported.  We make recommendations to use the lessons learned from the 
unprecedented COVID-19 challenges to sustain these innovations in paternity 
establishment and better prepare for future emergencies. 
We recommend that OCSS:  
Create forums for identifying and sharing State agency best 
practices in providing paternity establishment services 
Spurred by the challenges posed by the COVID-19 pandemic, State agencies adopted 
new practices to maintain paternity establishment services.  In some cases, State 
agencies revolutionized the way they establish paternity, becoming much more 
customer-focused.  Agency officials shared best practices and improvements with 
each other informally and through their member associations, but reported that 
additional knowledge sharing would have been beneficial. 
OCSS should create forums and mechanisms to regularly share promising practices 
across States related to overcoming emergencies and other challenges.  The forums 
should focus on the various innovations made during the pandemic and how those 
innovations can be integrated into paternity establishment work ongoing.  Active 
information sharing should continue in order to help child support agencies learn and 
benefit from the successes of their colleagues.  This practice would provide OCSS with 
an opportunity to vet State agency practices in order to promote those it perceives as 
most useful and in compliance with requirements.  The forums for sharing best 
practices could include newsletters, websites, webinars, conference calls, and in-
person training, providing OCSS with opportunities to engage further with State 
agencies to identify and address emerging challenges.   
Bolster State agency resilience during emergencies 
State agencies were unprepared for maintaining paternity establishment services 
during the COVID-19 pandemic.  Current Federal requirements for State IV-D plans 
do not include provisions for emergencies, either localized or widespread, other than 
requiring States to continuously operate their automated systems that collect and 
disburse child support payments.  OCSS should, through attestation, site visits, or 
other means, ensure that emergency plans account for a range of possible hazards, 
including a viral pandemic, cyber-security attacks, and more.  State agencies need to 
build their capacity for resilience and flexibility and build strong relationships with key 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150                         Conclusion and Recommendations | 18   
stakeholders  including hospitals, courts, vital records offices, and genetic testing 
centers  so services can be maintained in difficult circumstances.  Although it is not 
addressed in this report, the enhanced emergency planning could also address 
maintaining services for other child support enforcement services not covered in this 
report, such as establishment and enforcement of child support orders.  Provisions 
could include planning for State agency office operations, such as telework 
capabilities, and coordination with other entities involved in paternity establishment, 
such as hospitals, courts, vital records offices, and parents.  
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150                         Conclusion and Recommendations | 19  AGENCY COMMENTS AND OIG RESPONSE 
ACF concurred with our two recommendations.  OIG appreciates the efforts of ACF 
and OCSS to support the work of State child support agencies.  The ACF comments 
are summarized below.  For the full text of their comments, see the Appendix.  
Regarding our first recommendation that OCSS create forums for identifying and 
sharing State agency best practices, ACF concurred and stated that OCSS recognizes 
the importance of maintaining communication and will continue to offer forums to 
share best practices, including regular calls and meetings, and its newsletter.  We 
recommend that OCSS enhance these efforts given that State agencies reported that 
they would have benefited from OCSS sharing more practical advice and guidance 
and communicating best practices among the States.  These enhancements should 
include seeking new opportunities for engagement that feature active information 
sharing between OCSS and States about guidance and best practices.  The additional 
forums could include webinars, conference calls, and in-person sessions.   
Regarding our second recommendation that OCSS bolster State agency resilience 
during emergencies, ACF concurred and stated that it is committed to providing 
technical assistance to States to ensure service delivery during emergencies.  OCSS 
will work closely with ACFs Office of Human Services Emergency Preparedness and 
Response to develop materials.  In addition, OCSS reported that it is dedicating time 
during its FY 2024 regional meetings for presentations and discussions around the 
benefits of Continuity of Operations planning.  OIG appreciates these planned efforts 
to bolster State agency resilience during emergencies and looks forward to updates 
from ACF on their implementation.  ACF also said that OCSS is planning a notice of 
proposed rulemaking to allow modification of State agency performance standards 
during national emergencies, which would increase its ability to be flexible with its 
response to an emergency.  
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150       Agency Comments and OIG Response | 20  APPENDIX: AGENCY FORMAL COMENTS
Office of the Assistant Secretary | 330 C Street, S.W., Suite 4034 
Washington, D.C. 20201 | www.acf.hhs.gov 
July 6, 2023 
Ms. Ann Maxwell 
Deputy Inspector General 
U.S. Department of Health and Human Services 
330 Independence Avenue, SW. 
Washington, DC   20201 
Dear Ms. Maxwell: 
I am writing to provide the Administration for Children and Families (ACF) response to the 
Office of Inspector Generals (OIG) draft report titled, Widespread Pandemic Disruption 
Spurred Innovation to State Paternity Establishment Practices, OEI-06-21-00150, which 
contains recommendations for the Office of Child Support Services (OCSS).   
The COVID 19 pandemic required all levels of government to focus on health and safety.  While 
some ACF programs had the authority to provide for emergency relief, OCSS did not have the 
authority or flexibility in the current regulations.   
To address penalty relief due to the impact of the COVID-19 pandemic, ACF issued a final rule 
(87 FR 32090) on May 27, 2022, which provided states relief from performance penalties by 
modifying the Paternity Establishment Percentage performance requirement from 90 percent to 
50 percent for fiscal years 2020, 2021, and 2022.  To solve lack of flexibility going forward, 
OCSS is planning a notice of proposed rulemaking (Modifications to Performance Standards 
During Times of National Calamties) for the modification to performance standards during times 
of national emergencies.  This rule would establish standards allowing OCSS to provide state 
child support programs with relief from certain performance penalties due to natural disasters 
and other calamities.   
We appreciate the opportunity to review and comment on the report.  Below you will find our 
response to each recommendation. 
Recommendation 1:  Create forums for identifying and sharing State agency best practices 
in providing paternity establishment services. 
ACF Response:  ACF concurs with this recommendation.  OCSS recognizes the importance of 
maintaining communication, especially during times of emergency.  OCSS will continue to offer 
forums to share best practices for issues facing the child support agencies.  The OCSS Office of 
Regional Operations hosts calls with state and tribal directors on a regular basis as well as annual 
meetings that provide opportunities for sharing best practices.  Additionally, articles around best 
practices are frequently published in the Child Support Report newsletter reaching a nationwide 
audience.  For example, the September 2022 newsletter featured an article on Oregon changing 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150                    Appendix | 21  Deputy Inspector General Maxwell  Page 2 
its IV-D paternity establishment percentage; the November 2022 newsletter highlighted 
Washingtons virtual trainings on paternity establishment; and the May 2023 newsletter 
highlighted Maine staff being certified in conducting the genetic testing sampling.  
Recommendation 2:  Bolster State agency resiliency during emergencies. 
ACF Response:  ACF concurs with this recommendation.  OCSS is committed to providing 
technical assistance to states to ensure service delivery in times of an emergency.  Continuity of 
Operations Plans (COOP) are not a State IV-D plan requirement.  However, OCSS will work 
closely with ACFs Office of Human Services Emergency Preparedness and Response in 
material development and is committed to dedicating time during the fiscal year 2024 regional 
meetings for presentation and discussion around the benefits of COOP planning.  OCSS will 
share the material when it is developed.   
Again, I appreciate the opportunity to review and comment on this draft report.  Please direct any 
follow-up inquiries to our OIG liaison Scott Logan, Office of Legislative Affairs and Budget, at 
(202) 401-4529.
Sincerely, 
January Contreras  
Assistant Secretary 
Administration for Children and Families 
U.S. Department of Health and Human Services 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150                    Appendix | 22 ACKNOWLEDGMENTS AND CONTACT 
Acknowledgments 
Marshall Allen served as the team leader and Charis Burger served as the project lead 
for this study.  Others in the Office of Evaluation and Inspections Dallas Regional 
Office who conducted the study include Ariel Arguelles and Anthony Soto-McGrath.  
Office of Evaluation and Inspections headquarters staff who provided support include 
Althea Hosein, Jennifer Gist, and Christine Moritz.    
This report was prepared under the direction of Ruth Ann Dorrill, Acting Regional 
Inspector General for Evaluation and Inspections in the Dallas Regional Office. 
Contact 
To obtain additional information concerning this report, contact the Office of Public 
Affairs at Public.Affairs@oig.hhs.gov.  OIG reports and other information can be found 
on the OIG website at oig.hhs.gov. 
Office of Inspector General 
U.S. Department of Health and Human Services 
330 Independence Avenue, SW 
Washington, DC 20201 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices 
OEI-06-21-00150             Acknowledgments and Contact | 23   
ABOUT THE OFFICE OF INSPECTOR GENERAL 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 
95-452, as amended, is to protect the integrity of the Department of Health and 
Human Services (HHS) programs, as well as the health and welfare of beneficiaries 
served by those programs.  This statutory mission is carried out through a nationwide 
network of audits, investigations, and inspections conducted by the following 
operating components: 
The Office of Audit Services (OAS) provides auditing services for HHS, 
either by conducting audits with its own audit resources or by overseeing audit work 
done by others.  Audits examine the performance of HHS programs and/or its 
grantees and contractors in carrying out their respective responsibilities and are 
intended to provide independent assessments of HHS programs and operations.  
These audits help reduce waste, abuse, and mismanagement and promote economy 
and efficiency throughout HHS. 
The Office of Evaluation and Inspections (OEI) conducts national 
evaluations to provide HHS, Congress, and the public with timely, useful, and reliable 
information on significant issues.  These evaluations focus on preventing fraud, waste, 
or abuse and promoting economy, efficiency, and effectiveness of departmental 
programs.  To promote impact, OEI reports also present practical recommendations 
for improving program operations. 
The Office of Investigations (OI) conducts criminal, civil, and administrative 
investigations of fraud and misconduct related to HHS programs, operations, and 
beneficiaries.  With investigators working in all 50 States and the District of Columbia, 
OI utilizes its resources by actively coordinating with the Department of Justice and 
other Federal, State, and local law enforcement authorities.  The investigative efforts 
of OI often lead to criminal convictions, administrative sanctions, and/or civil 
monetary penalties. 
The Office of Counsel to the Inspector General (OCIG) provides 
general legal services to OIG, rendering advice and opinions on HHS programs and 
operations and providing all legal support for OIGs internal operations.  OCIG 
represents OIG in all civil and administrative fraud and abuse cases involving HHS 
programs, including False Claims Act, program exclusion, and civil monetary penalty 
cases.  In connection with these cases, OCIG also negotiates and monitors corporate 
integrity agreements.  OCIG renders advisory opinions, issues compliance program 
guidance, publishes fraud alerts, and provides other guidance to the health care 
industry concerning the anti-kickback statute and other OIG enforcement authorities.
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices   
OEI-06-21-00150                           About OIG | 24   
ENDNOTES 
 
1 Michelle Osterman, Brady Hamilton, Joyce Martin, Anne Driscoll, and Claudia Valenzuela, Births: Final Data for 2020, 
National Vital Statistics Reports, February 7, 2022.  Accessed at https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-17.pdf on 
November 29, 2022. 
2 Paul A. Rebman, Mageen C. Caines, and Patricia A. Harrison, In-Hospital Paternity Establishment: Experiences and Meaning 
Perceived by Unmarried Parents, Journal of Health Care for the Poor and Underserved, Vol. 29, Issue 1, February 2018, 
pp. 497-508.  
3 Chapter 3  Establishing Fatherhood, OCSS, Child Support Handbook, February 28, 2013, p. 15.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/ocse/child_support_handbook_with_toc.pdf on July 21, 2021. 
4 45 CFR  303.5. 
5 Based on pre-inspection interviews with OCSS officials.  Additional support can be found at Fragile Families Research, In-
Hospital Paternity Establishment and Father Involvement in Fragile Families, February 2005.  Accessed at 
http://www.jstor.org/stable/3600192 on July 20, 2021. 
6 Fragile Families Research, In-Hospital Paternity Establishment and Father Involvement in Fragile Families, February 2005.  
Accessed at http://www.jstor.org/stable/3600192 on July 20, 2021. 
7 OCSS, Chapter 3  Establishing Fatherhood, Child Support Handbook, February 28, 2013, p. 15.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/ocse/child_support_handbook_with_toc.pdf on July 21, 2021. 
8 National Responsible Fatherhood Clearinghouse, Paternity Establishment: Information for Practitioners Working with 
Unmarried Fathers.  Accessed at https://www.fatherhood.gov/sites/default/files/resource_files/e000004134.pdf on 
December 9, 2022.  
9 National Responsible Fatherhood Clearinghouse, Working with Fathers to Explain the Importance of Establishing Paternity, 
December 7, 2021.  Accessed at https://www.fatherhood.gov/for-programs/non-residential-fathers/working-fathers-explain-
importance-establishing-paternity on December 9, 2022. 
10 86 Fed. Reg. 57770, 57771 (October 19, 2021).  Accessed at https://www.govinfo.gov/content/pkg/FR-2021-10-
19/pdf/2021-22553.pdf on December 1, 2021. 
11 Part B of P.L. 93-647 (January 4, 1975) amended the Social Security Act to add Section IV-D.  The child support enforcement 
(CSE) statute is found in Sections 451 through 469B of the Social Security Act (42 U.S.C.  651 through  669b).  The CSE 
federal regulations are found in 45 CFR Parts 301 through 310.   
12 During the data collection phase of this report, the agency was known as the Office of Child Support Enforcement, OCSE.  
For more information about the June 2023 name change to the Office of Child Support Services (OCSS), see 
https://www.govinfo.gov/content/pkg/FR-2023-06-05/pdf/2023-11815.pdf.  
13 Throughout this report, we refer to IV-D agencies located only in States, the District of Columbia, and territories.  IV-D 
agencies located in Tribal Nations are not included in our description of IV-D agencies and are excluded from our study. 
  14 Title 42 U.S.C.  608(a)(2) and  654(29). 
15 Federal law links the child support enforcement program with the Temporary Assistance for Needy Families (TANF) 
program for purposes of financial penalties.  States operate their child support programs as a condition to receiving TANF 
block grant funding.  Since the enactment of the child support enforcement program in 1975, child support agencies that do 
not meet Federal performance requirements or are noncompliant with Federal requirements receive a reduction in their 
States TANF funding.  Social Security Act  409(a)(5). 
16 OCSS, FY 2021 Child Support Enforcement Preliminary Report, 2022, pp. 49, 50.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/ocse/fy_2021_preliminary_report.pdf on November 25, 2022. 
 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices   
OEI-06-21-00150                            Endnotes | 25   
 
17 OCSS, 2021 Child Support: More Money for Families.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/ocse/2021_infographic_national.pdf on November 29, 2022. 
18 Social Security Act,  454; 42 U.S.C.  654. 
19 Ibid.  
20 45 CFR  301.13. 
21 45 CFR  302.10. 
22 45 CFR  95.621(f)(2)(G) 
23 ACF, Automated Systems for Child Support Enforcement: A Guide for States, updated 2017, section H-5, pp. 98-99.  Accessed 
at https://www.acf.hhs.gov/sites/default/files/documents/ocse/certification_guide_2017_final.pdf, 2023. 
24 The Omnibus Budget Reconciliation Act of 1993, P.L. 103-66 (enacted August 13, 1993),  13721. 
25 The Personal Responsibility and Work Opportunity Reconciliation Act of 1966 (PRWORA), P.L. 104-193 (enacted August 22, 
1996),  341, incorporated at 42 U.S.C.  652(g)(1).  
26 States have the choice to be evaluated on one of two measures of PEP: the IV-D Paternity Establishment Percentage, or the 
Statewide Paternity Establishment Percentage.  The IV-D Paternity Establishment Percentage is the ratio of the total number of 
children in the IV-D caseload in the fiscal year (or, at the option of the State, as of the end of the fiscal year) who have been 
born out of wedlock and for whom paternity has been established or acknowledged to the total number of children in the IV-
D caseload as of the end of the preceding fiscal year who were born out of wedlock.  The Statewide Paternity Establishment 
Percentage is the ratio of the total number of minor children who have been born out of wedlock and for whom paternity has 
been established or acknowledged during the fiscal year, to the total number of children born out of wedlock during the 
preceding fiscal year.  See 45 CFR  305.2(a)(1). 
27 Child Support Performance and Incentive Act of 1998 (CSPIA), P.L. 105-200 (enacted July 16, 1998),  201. 
28 The other measures include (1) support order establishment; (2) current support collections; (3) cases paying toward 
arrears, and (5) cost-effectiveness.  The amount of incentive payment depends on the funds available in the FY, the reliability 
of the IV-D agencies data, the child support agencies total amount of child support collections, and the relative performance 
of other IV-D agencies.  Penalties are assessed when a states measured level of performance in paternity establishment, 
support order establishment, or current collections falls below the specified level, or when a states data used to compute 
incentive measures are found to be incomplete or unreliable, or when a state is found to be not in compliance with certain 
child support requirements.  Program performance measures, standards, financial incentives, and penalties are detailed at 
45 CFR Part 305. 
29 OCSS, FY 1999 and FY 2000 Annual Report to Congress, December 1, 2000.  Accessed at 
https://www.acf.hhs.gov/css/report/fy-1999-and-fy-2000-annual-report-congress on July 22, 2021. 
30 OCSS, FY 2018 Annual Report to Congress, March 24, 2021.  Accessed at https://www.acf.hhs.gov/css/report/fy-2018-
annual-report-congress on February 3, 2023. 
31 OCSS, The Story Behind the Numbers: The Child Support Program is Focused on Performance, November 2016, pp. 7, 32.  
Accessed at https://www.acf.hhs.gov/sites/default/files/documents/ocse/sbtn_csp_focused_on_performance.pdf on 
February 3, 2023. 
32 42 U.S.C.  658a(b)(6)(A). 
33 42 U.S.C.  652(g)(1) and (2). 
34 45 CFR  305.60. 
35 45 CFR  302.70(a)(5)(iii)(B). 
36 45 CFR  302.70(a)(5)(iii). 
37 42 U.S.C  666(a)(2). 
38 42 U.S.C.  666(a)(5)(A) 
 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices   
OEI-06-21-00150                            Endnotes | 26   
 
39 OCSS, Chapter 3  Establishing Fatherhood, Child Support Handbook, February 28, 2013.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/ocse/child_support_handbook_with_toc.pdf on July 21, 2021. 
40 42 U.S.C.  666(a)(5)(B)(i). 
41 42 U.S.C.  666(a)(5)(F)(iii). 
42 OCSS, Policy Guidance Overview.  Accessed at https://www.acf.hhs.gov/css/policy on July 22, 2021. 
43 86 Fed. Reg. 57770, 57771 (October 19, 2021).  Accessed at https://www.govinfo.gov/content/pkg/FR-2021-10-
19/pdf/2021-22553.pdf on December 1, 2021. 
44 OCSS, FY 2021 Child Support Enforcement Preliminary Report, 2022, p. 8.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/ocse/fy_2021_preliminary_report.pdf on February 4, 2023. 
45 OCSS, COVID-19: Frequently Asked Questions for Child Support Programs, February 10, 2021.  Accessed at 
https://www.acf.hhs.gov/css/covid-19-faqs-child-support-programs#faqs on February 4, 2023. 
46 OCSS, Flexibilities for State and Tribal Child Support Agencies during COVID-19 Pandemic, DCL-20-04, May 28, 2020.  
Accessed at https://www.acf.hhs.gov/css/policy-guidance/flexibilities-state-and-tribal-child-support-agencies-during-covid-
19-pandemic on April 23, 2021. 
47 86 Fed. Reg. 57770 (October 19, 2021).  Accessed at https://www.govinfo.gov/content/pkg/FR-2021-10-19/pdf/2021-
22553.pdf on February 4, 2023. 
48 87 Fed. Reg. 32090, 32091 (May 27, 2022).  Accessed at 2022-11391.pdf (govinfo.gov)2022-11391.pdf (govinfo.gov) on 
February 4, 2023. 
49 Tribal child support agencies were excluded from this study. 
50 This report uses the term States to refer to the child support agencies in the 50 States, District of Columbia, Guam, Puerto 
Rico, and the Virgin Islands. 
51 87 Fed. Reg. 32090, 32091 (May 27, 2022). 
52 45 CFR  305.40(a)(1). 
53 42 U.S.C.  652(g)(3)(A). 
54 87 Fed. Reg. 32090 (May 27, 2022). 
Widespread Pandemic Disruption Spurred Innovation to State Paternity Establishment Practices   
OEI-06-21-00150                            Endnotes | 27