Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

IN-HOSPITAL VOLUNTARY PATERNITY 

ACKNOWLEDGMENT PROGRAM 

Effective Practices in Parent Outreach 

JUNE GIBBS BROWN 

Inspector General 

AUGUST 1997 

OEI-06-95-00163 
OFFICE OF INSPECTOR GENERAL 

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95452, 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 three OIG operating components: the Office of Audit Services, the Office of 

Investigations, and the Office of Evaluation and Inspections. The OIG also informs the Secretary of 

HHS of program and management problems and recommends courses to correct them. 

OFFICE OF EVALUATION AND INSPECTIONS 

The OIG’s Office of Evaluation and Inspections (OEI) conducts short-term management and program 

evaluations (called inspections) that focus on issues of concern to the Department, the Congress, and 

the public. The findings and recommendations contained in these inspection reports generate rapid, 

accurate, and up-to-date information on the efficiency, vulnerability, and effectiveness of departmental 

programs. 

OEI’s Dallas Regional Office prepared 

Regional Inspector General. 

Project Staff included: 

DALLAS REGION 

Ruth Arm Dorrill, Project Leader 

Lisa Lesh, Intern 

Marnette Robertson 

this report under the direction of Chester B. Slaughter, 

HEADQUARTERS 

Ann O’Connor, Program Specialist 

For additional copies of this report, please contact the Dallas Regional Office at (800) 848-8960. 
Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

IN-HOSPITAL VOLUNTARY PATERN ITY 

ACKNOWLEDGMENT PROGRAM 

Effective Practices in Parent Outreach 

JUNE GIBBS BROWN 

Inspector General 

AUGUST 1997 

OEI-06-95-00163 
EXECUTIVE SUMMARY 

PURPOSE 

This report describes State best practices in outreach to and education of unmarried parents 

on voluntary paternity acknowledgment. 

BACKGROUND 

Federal law requires that States implement hospital-based programs for the voluntary 

acknowledgment of paternity, seeking to facilitate at-birth paternity establishment for children 

born to unmarried parents. Paternity researchers agree that the most opportune time for 

paternity establishment is the “happy hour” in the hospital immediately following the birth 

and before the release of the mother and child. State child support agencies are required to 

make available materials for educating parents, and hospital staff must provide mothers and 

fathers with both written materials and oral explanations regarding the rights and 

responsibilities of paternity establishment. In addition, parent outreach materials must be 

made available at vital records and child support offices, and are encouraged to be distributed 

to others who interact with unmarried parents. 

FINDINGS 

In collecting information nationwide for our companion report on State agency and birthing 

hospital implementation of paternity acknowledgment programs, we found that most State 

child support agencies (IV-D) had launched efforts to inform parents of the paternity effort. 

This report describes effective or innovative parent outreach and education practices and 

materials. These highlighted practices in no way represent all efforts nationwide, but give a 

snapshot of practices and materials that have been reported to us by State agencies and 

hospitals in the course of our study. 

Guidelines for Creating and Utilizing Parent Outreach Materials 

Outreach materials should clearly communicate the benefits and consequences of paternity 

acknowledgment, and not just the mechanics of documentation. 

Thoughtful outreach materials should be specifically relevant to the target population, 

reaching unmarried parents of varied languages and backgrounds. 

Multiple outreach opportunities can be used to reach a broader segment of the target group 

and to introduce early, and reinforce through repetition, a clear message on paternity 

acknowledgment. 

Brochures and information sheets may be used effectively to educate parents, but they should 

be brief and engaging and accompanied by interactive outreach methods. 

1 
Hospital staff may be able to enhance acknowledgments by personalizing outreach efforts 

using information from patient surveys or birth certificate worksheets. 

Proactive hospitals offer multiple opportunities for parents to learn about voluntary paternity 

acknowledgment, using pre-registration and hospital admittance to take advantage of early 

contact with parents. 

A few States have begun to place child support employees on-site at high-risk birthing 

hospitals to help hospital staff and to communicate directly with unmarried parents. 

Direct Contact Between Hospital Staff and Unmarried Parents 

Hospitals report parents are largely open to talking about paternity issues, so direct 

discussion appears to be an important tool for encouraging acknowledgment. 

Talking with the mother alone initially may allow for greater privacy and a clearer focus on 

paternity issues. 

Supplementing prepared outreach materials with discussion encourages understanding and 

allows hospital staff to be responsive to individual parent questions. 

Pre-arranging a time for the father to sign or receive information may avoid problems of 

timeliness and coordination, and allow staff to talk with both parents at once. 

Hospital staff should be prepared to make clear the benefits of acknowledging and answer 

related questions not covered in outreach materials, using related topics such as the baby’s 

surname to introduce the idea of acknowledgment. 

Prenatal Education 

Since many hospitals already provide childbirth classes, some States are able to include 

paternity acknowledgment education as part of pre-existing class curriculums. 

Medical clinics, physicians’ offices and schools are valuable venues for addressing paternity 

acknowledgment during prenatal education. 

Follow-Up After Discharge 

Timely follow-up with mothers after hospital discharge reintroduces the idea of 

acknowledgment at a less hectic time and provides a method for supplying additional 

outreach materials and documentation forms. 

ii 
AGENCY COMMENTS 

We have worked in close partnership with the Office of Child Support Enforcement (OCSE) 

throughout the conduct of this inspection. Although we did not receive formal comments 

from ACF on our draft reports, they demonstrated through their collaboration a general 

agreement with this report and the companion reports. We worked with OCSE in developing 

a research methodology, provided extensive briefings on study findings and created additional 

documents to meet agency needs. We appreciate their cooperation and guidance and will 

continue to work with them on the issues raised in these reports. 

. . . 111 
TABLE OF CONTENTS 

PAGE 

EXECUTIVESUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i 

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 

FINDINGS 

Guidelines for Parent Outreach . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 

Direct Contact between Staff and Parents . . . . . . . . . . . . . . . . . . . . . . . . . . 7 

Prenatal Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 

Follow-Up After Discharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 

CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 

APPENDICES 

A. Typical Questions and Answers .......................... A-l 

B. Sheet for Parents’ Initials ............................... B-l 

C. Typical Brochure .................................... C- 1 

D. Parent Information Sheet .............................. D-l 

E. Parent Statements .................................... E-l 

F. Patman Comic Excerpt ................................. F-l 

G. Certificate Worksheet ................................ G- 1 

H. Evaluation ....................................... H-l 

I. Follow-up Letter .................................... I-l 
INTRODUCTION 

PURPOSE 

This report describes State best practices in outreach to and education of unmarried 

parents on voluntary paternity acknowledgment. 

BACKGROUND 

The Omnibus Budget Reconciliation Act of 1993 (OBRA) amends the Child Support IV-D 

Title of the Social Security Act, requiring States to implement hospital-based programs for 

the voluntary acknowledgment of paternity. The objective of these programs is to 

facilitate at-birth paternity establishment for children born to unmarried parents. 

Establishment of paternity at birth has many administrative, financial and emotional 

benefits. Mothers often lack information about the importance of and methods for 

establishing paternity. Consequently, they may not seek to establish paternity until a point 

at which the process becomes more difficult. 

Paternity researchers agree that the most opportune time for paternity establishment is the 

“happy hour” in the hospital immediately following birth and before the release of the 

mother and child. Within this narrow window of exposure to unmarried parents, birthing 

hospital staff must be prepared to inform parents about the option of voluntary 

acknowledgment. Additionally, parent outreach materials must be made available at State 

vital records office, child support agency offices and are encouraged to be distributed to 

other public agencies that interact with unmarried parents. Without an establishment of 

paternity, unmarried mothers may never obtain a child support order and gain access to 

the enforcement services of their child support office. 

Under OBRA, State child support agencies must, among other requirements, make 

available voluntary acknowledgment outreach materials, including information on parental 

rights and responsibilities, and materials for training hospital staff. State child support 

agencies must monitor birthing hospital compliance on at least an annual basis. The 

Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) 

expands the role of hospital staff by requiring them to provide mothers and fathers with 

both written materials and oral explanations regarding the rights and responsibilities of 

paternity acknowledgment. As interpreted by the Office of Child Support Enforcement 

(OCSE), the intent of both OBRA and PRWORA is to make voluntary paternity 

acknowledgment part of the birth registration process. 

This report, which describes State efforts to provide education and outreach to unmarried 

parents is one of four in a series on hospital-based voluntary paternity acknowledgment 

programs. “In-Hospital Voluntary Paternity Acknowledgment Programs: State Agency 

and Birthing Hospital Implementation” (OEI-06-95-00160) details nationwide program 

participation, “In-Hospital Voluntary Paternity Acknowledgment Programs: Hospital 

Experiences in Sample States” (OEI-06-95-00161) describes program usage using survey 

1 
responses from birthing hospitals and State agencies in 15 sample States, and “In-Hospital 

Voluntary Paternity Acknowledgment Programs: Effective Practices In Hospital Staff 

Training” (OEI-06-95-00164) highlights State efforts to educate birthing hospital staff on 

voluntary paternity acknowledgment procedures. 

METHODOLOGY 

After preinspection research, we administered comprehensive mail surveys on the 

voluntary paternity acknowledgment process to State child support and vital records 

agencies in every State and the District of Columbia and to 566 birthing hospitals in a 

sample of 15 States. In addition to completing the surveys, which provided data for our 

primary reports on implementation and hospital experiences, agencies sent examples of 

paternity acknowledgment education and outreach materials, training materials, and 

photocopies of their birth certificates and voluntary paternity acknowledgment forms. We 

received completed surveys and supplemental materials from both agencies in every State 

and from 78 percent of birthing hospitals sampled. 

The supplemental materials for parent outreach and education included brochures, 

information sheets, and videos. We conducted telephone follow-up approximately six 

months after receiving these materials to request any supplemental outreach materials and 

received a number of new or updated items. Content analysis of the materials was 

conducted and a smaller number of materials and innovative ideas were judgmentally 

selected for inclusion in this report. 

This study was conducted in accordance with the Quality Standards for Inspections issued 

by the President’s Council on Integrity and Efficiency. 

2 
FINDINGS 

In collecting information nationwide for our companion report on State agency and 

birthing hospital implementation of voluntary paternity acknowledgment programs, we 

found that most State child support agencies (IV-D) had launched efforts to inform 

birthing hospital staff of the paternity effort and to provide outreach and education 

materials to supplement communications with unmarried parents. This report describes 

effective or innovative parent outreach and education practices and materials. These 

highlighted practices in no way represent all efforts nationwide, but give a snapshot of 

practices and materials that have been reported to us by IV-D and vital records agencies 

and by hospitals in the course of our data collection. 

Parent outreach and education is an important and vital part of the hospital-based paternity 

acknowledgment program. Several States and hospitals have made exemplary efforts to 

educate their unmarried mothers and fathers about establishing paternity. These efforts 

have included prenatal education, guidance for direct contact with mothers in the hospital, 

and the dissemination of written materials. Parent outreach and education helps unmarried 

parents gain knowledge about their rights and responsibilities as parents. It is vital for 

them to have the opportunity to become educated and ask questions before making the 

important decision to acknowledge paternity. 

GUIDELINES FOR PARENT OUTREACH 

Outreach Materials Should Clearly Communicate the Benefits and Consequences of 

Paternity Acknowledgment, Not Just the Mechanics of Acknowledgment Documentation. 

Brochures and information sheets are the most common outreach vehicles created by State 

child support agencies and provide the primary context for parents’ understanding of 

paternity acknowledgment. A typical brochure contains explanatory statements answering 

what, why, and how to establish paternity. Appendix A includes a listing of typical 

questions and answers contained in written materials. 

A complete explanation of why it is important to establish paternity should point out 

benefits the child may be eligible for, such as Social Security, veteran’s funds, health care 

coverage, life insurance, any military allotments or military medical insurance, injured 

worker’s payments, and inheritance. Other benefits to the child in establishing paternity 

are knowing the identity of the father, the family medical history, and securing child 

support. 

Thorough written materials should address not only the benefits to the child but also 

outline paternity rights and responsibilities. For ease of explaining the rights, 

responsibilities and benefits, Massachusetts has an information sheet which parents must 

initial before signing the affidavit (See Appendix B). Outreach materials should also 

provide information on how fathers may undergo genetic testing and any costs associated 

with such a test. Additionally, brochures may briefly address establishing paternity for 

3 
older children and provide contact telephone numbers for information. A typical brochure 

is included in Appendix C and a typical information sheet is included in Appendix D. 

States might also add clarity and better communicate with parents by segmenting their 

brochures into portions which discuss the unique perspectives of the mother and father. 

One State labeled these sections “Questions Mom Ask” and “Questions Dads Ask.” 

Fourteen States sent us separate brochures for the mother and father which emphasize 

concerns unique to each, including Nebraska which created a folder “Paternity for 

Parents” enclosing the two brochures along with the affidavit. The State of Virginia even 

separately outlines the rights and responsibilities statements for each parent on the front of 

the affidavit (Appendix E). Beyond the basics of acknowledging, typical materials for the 

father discuss genetic testing, payment of child support, custody and visitation issues, 

adoption proceedings, and the emotional benefits of fatherhood. Brochures for the mother 

address issues such as eligibility for public assistance, relationship questions such as living 

arrangements or marrying a man other than the father, and paternity acknowledgment for 

siblings. 

Other materials are designed specifically for young parents. For example, the State of 

Washington created a comic book to explain paternity establishment to minors (See 

Appendix F for excerpts). The book, entitled “Patman: Protector of Children’s Bights,” 

illustrates a story of two young parents trying to decide whether or not to acknowledge 

paternity. 

Thoughtful Outreach Materials Should be Specifically Related to the Target Population, 

Reaching Unmarried Parents of All Relevant Languages and Backgrounds, Predicting 

and Addressing Parent Questions About Related Issues. 

Cultural and lingual differences present challenges in outreach efforts, and it is important 

for all unmarried parents to have a clear understanding of the benefits and consequences 

of acknowledging paternity, regardless of their background. Outreach materials should be 

available in languages appropriate to the population and should be sensitive to cultural 

differences. A Colorado hospital uses a telephone translation language line to help parents 

and staff communicate, and some hospitals require their birth registrars to learn prominent 

alternative languages such as Spanish. Outreach materials and any discussion between 

hospital staff and parents should also be sensitive to misinformation about paternity that 

may be communicated through the patient’s social network. For example, one State has 

reported some confusion over whether common law marriages negate the need to 

acknowledge paternity by affidavit. In this case, it is necessary for hospital staff to 

technically distinguish between a common law and legal marriage and to explain to the 

parents the implications of their status pertaining to establishing legal paternity. 

4 
Videos are Useful Supplements to Oral Discussion and Written Materials, especially in 

Cases Where Staff have Limited lime for Interaction with Parents. 

Watching a video can give unmarried parents a better understanding of why 

acknowledging paternity is important and allow them to hear “directly” from other 

unmarried parents who have chosen to establish paternity. Watching role-playing on 

video gives them the sense that they are not the only ones who have faced this kind of 

decision. Because they may not be able to visit all hospitals in their State, videos allow 

State child support agencies to reach a wider audience using an interactive medium. 

Videos can be sent to schools and clinics as well. Videos may be especially helpful for 

outreach to parents with low education levels or poor communication skills who may not 

fully understand written materials and oral discussion. 

Hospital rooms are often equipped with video equipment because they rely on videos to 

provide information on other parent and child issues. Videos received from Arkansas, 

Colorado, Kansas, Nebraska, New Hampshire, and Oregon use a variety of formats, 

usually dramatizing a hospital scenario and emphasizing the emotional and legal benefits 

to acknowledgment. Nebraska’s video includes explanatory segments with a clinical 

psychologist, a judge, an obstetrics/gynecologist physician, and a registered nurse who 

give their various perspectives on the benefits of paternity acknowledgment. 

Hospital Staff May be Able to Personalize Outreach Efforts By Using Information From 

Patient Surveys or Birth Certijicaie Worksheets. 

Because birth certificate worksheets are widelv used, they serve as a valuable source of 

information to hospital staff in targeting the snecific needs of individual narents. 

Often a birth certificate worksheet is the formal tool used to find out whether or not the 

mother is legally married and therefore introduce the paternity acknowledgment program 

(see Appendix G for birth certificate worksheet sample). We found in our companion 

report on hospital experiences that 84 percent of hospitals use birth certificate worksheets. 

These forms may be a barrier to acknowledgment if the parents fill them out alone with 

no interaction. However, if used properly, they can serve as a springboard to discussion 

about paternity. 

For example, a California birth registrar requests that the mother fill out the birth 

certificate worksheet upon arrival when possible so he will have time to review the 

information before talking with the parents post-delivery. Whether hospital staff knew of 

a mother’s unmarried status before or not, they use the occasion of completing the 

worksheet and the mother’s subsequent responses to personalize their outreach to parents. 

Another hospital describes getting as much information as possible from the computer and 

compiling it on the worksheet, then talking with the mother to add other information and 

check for correctness, at which point the paternity information is given to her to read and 

consider. Hospitals which do not use birth certificate worksheets learn the patient’s 

marital status during hospital registration. 

5 
One hospital reports using; a questionnaire to assess parents’ needs before discussing 

paternity acknowledgment. 

An innovative Colorado hospital uses a brief patient evaluation form to determine parents’ 

specific needs and circumstances. The hospital records basic information about the 

parents and baby and whether the father is present at delivery. The idea behind the 

survey is to help open lines of communication with the mother and to consider each 

mother’s situation before discussing paternity with her. The form also serves to monitor 

hospital effort in explaining paternity to parents by recording whether the parent talked 

with a staff member about paternity, watched the paternity outreach video, or took a 

prenatal class. Additionally, the form includes a checklist of possible reasons why parents 

don’t acknowledge. Compiling this information in aggregate could help hospital staff and 

the State child support agency analyze what factors influence parents to acknowledge in 

order to better meet the needs of future clients. The patient evaluation is included in 

Appendix H. 

Proactive Hospitals Offer Multiple Opporfunities for Parents to Learn about Voluntary 

Paternity Acknowledgment, Using Pre-Registration and Hospital Admittance to T&e 

Advantage of Early Contact With Parents. 

Hospitals should use a combination of methods to educate parents, providing multiple 

opportunities for parents to receive paternity information. This is valuable because 

mothers may respond to different methods of outreach. One mother may be willing to 

look at the materials after delivery, but for another the prime time may be before labor or 

even during pre-registration. An Arkansas hospital provides three opportunities for a 

parent to learn about and acknowledge paternity: parents are introduced to the idea of 

paternity by hospital admissions staff and given written outreach materials; nursery staff 

mention acknowledgment in the course of completing the birth certificate with the parents; 

mother and child discharge through the birth registrar’s office and are given a final 

opportunity to sign and notarize the affidavit. These multiple entry points need not unduly 

pressure parents to acknowledge. Rather, they may serve as convenient reminders during 

a busy and confusing time and increase the likelihood that the father will be present when 

signing and notarizing are possible. 

Several hospitals provide information about the program during the admissions or preregistration process. One hospital places paternity brochures and an affidavit in the 

admissions packet to allow parents to consider the issue before the maternity nurse talks 

with them. The nurse said, “Often, by the time I see them they have already made up 

their minds and myself or another person can go ahead and notarize the affidavit.” 

Another hospital with a high rate of acknowledgment confirms that the earlier parents 

learn about acknowledgment the more likely they are to sign. A medical records director 

in Texas contends, “They are not here long, so the mother receives the information at preregistration before admission. ” 

6 
Some hospitals report pre-registering mothers for delivery six months in advance. When 

the mother arrives for the actual delivery, if she is in early labor the nurse will ease her 

into thinking about paternity, saying things like “have you thought about or are you 

planning on claiming paternity?” It is mandatory that the labor and delivery nurse ask if 

the father will attend the birth, so discussing paternity acknowledgment can normally 

follow that line of questioning. Following pre-registration, the mother goes to the motherbaby unit, where a social worker visits to help her in meeting financial and home care 

needs. This staff member also discusses paternity acknowledgment with the mother, 

particularly if she has questions. If the mother has not decided about acknowledgment 

after talking with the social worker, the prenatal secretary is responsible for discussing it 

with parents at admittance. She refers to herself as the “catch-all, ” meaning the final 

person responsible for ensuring paternity has been discussed with all unmarried parents. 

A Few States Have Begun to Place Child Support Employees On-Site at High-Risk 

Birthing Hospitals to Help Hospital Staff and to Communicate Directly with Unmarried 

Parents. 

Two full-time child support employees in Colorado visit hospitals specifically to provide 

outreach and education on paternity establishment. They are instructed to be respectful of 

hospital routines and one respondent refers to herself as a “guest” in the hospital and 

mother’s rooms. This type of “out-stationing” is still unusual but is practiced in a few 

States, including Illinois and Florida. Those who advocate this labor-intensive strategy 

claim that it eases the burden on staff in those hospitals which assist a large number of 

nonmarital births. In addition to out-stationed employees, other child support staff 

communicate via telephone with the hospitals which have questions. 

In Florida, out-stationed child support caseworkers in high-Medicaid hospitals are 

typically officed in the hospital’s medical records or Medicaid payment offices and work 

in conjunction with the birth registrars, who still handle the actual birth registration and 

documentation. A typical experience would be for the birth registrar to give the mother a 

paternity outreach brochure along with the birth certificate worksheet. The child support 

caseworker then approaches the mother later in the day to follow-up and answer questions. 

Whenever possible, the caseworker will try to schedule the visit when the father is 

present. These on-site caseworkers offer a child support connection to the mother for 

other siblings who might also need paternity establishment or help in establishing support 

orders. 

DIRECT CONTACT BETWEEN STAFF AND PARENTS 

Hospitals Report Parents are Largely Open to Talking About Paternity Issues, so Direct 

Discussion Appears to be an Important Tool for Encouraging Acknowledgment. 

When hospital staff discuss acknowledgment with parents, in addition to giving them the 

materials to read, they are more likely to fully grasp their option and to understand the 

implications of signing the paternity affidavit. This oral discussion is not only beneficial 

for parents, but as previously mentioned, is mandated in PRWORA. Although the amount 

7 
of time available for discussion varies, depending on the mother’s hospital stay and 

staffing, hospitals report most mothers are open in asking questions concerning 

acknowledgment and the paternity affidavit, The written materials serve as a catalyst to 

prompt questions and promote discussion. After giving them time to review the materials, 

one nurse schedules herself to be available to talk with parents when both mother and 

father can be there for questions. Hospitals report parents often ask questions, regardless 

of whether they are already familiar with paternity acknowledgment or if it is new to 

them. Hospitals active in attempting to meet the needs of parents provide opportunities to 

discuss paternity acknowledgment in order to encourage parent understanding. 

Hospital staff should be prepared to clarify the numerous benefits of acknowledgment and 

to answer related questions not covered in outreach materials. Predicting and addressing 

issues such as child support helps relieve parents’ anxiety and gives them a clearer 

understanding of paternity. Even when thorough outreach materials are available, parents 

may be unwilling or unable to comprehend various issues and concerns. Parents may 

understand the literature but be confused about how it relates to their particular situation. 

We found in our companion report on hospital experiences that both the child support and 

the vital records agencies rate hospital staff as largely capable and willing to address 

issues with parents, and hospitals report parents are usually receptive to discussion and 

advice. Therefore, hospital staff must be versed on important paternity issues and be 

clear on their responsibility to communicate with parents. 

Hospitals surveyed generally report the same types of questions were asked, regardless of 

the parent’s circumstances, so the body of information to master should not be exhaustive. 

Most commonly asked questions deal with the baby’s surname, eligibility for public 

assistance, paternity establishment for siblings, payment of hospital bills, custody and 

visitation, and issuance of child support. The importance of explaining these corollary 

issues should not be underestimated, as they may have a dramatic effect on decisionmaking. Concern about the baby’s surname, for example, may lead parents to 

acknowledge. At a minimum, staff must be capable of referring parent questions to the 

appropriate public agency. 

Talking with the Mother Alone Initially May Allow for Greater Privacy and a Clearer 

Focus on Paternity Issues. 

A number of hospital respondents prefer to talk first with the mother alone, giving her 

time to broach the subject of paternity with the father privately, and then follow up with 

additional information and discussion with both parents when possible and necessary. 

Talking with the mother alone gives her privacy in assessing her unique concerns related 

to paternity acknowledgment. A birth registration clerk in Texas reports, “The mothers 

tend to be more anxious when the father is in the room, wondering what he’ll say. ” 

Talking with the mother alone may also increase the comfort level of the hospital staff 

member. One respondent said she can better approach the subject and learn the mother’s 

wishes when she is alone, saying “Even sometimes when the father is there I might wait 

8 
for a time when the mother is alone because I’m afraid it might be an abusive situation. ” 

Mothers may also be unsure of the father’s identity and would therefore value private time 

to answer questions. 

Pre-arranging a Time For the Father to Sign or Receive Information May Avoid 

Problems of Timeliness and Coordination, and Allow Staff to Talk with Both Parents at 

Once. 

Most hospitals report the best time to locate the father is right after delivery. At this 

time, hospital staff may choose to pre-arrange a time with both parents present to discuss 

paternity and sign the acknowledgment. An Illinois hospital respondent talks with the 

father if he is present or gives the mother an opportunity to telephone the father and bring 

his picture identification so he can sign the affidavit or at least be given paternity 

information. Another hospital phones the mother in the hospital room and offers to 

arrange a meeting time. Pre-arranging a time for the father to sign or receive information 

is beneficial for both parents as well as hospital staff in cases where a notary is only 

available at certain times. Another obvious advantage to hospital staff in talking with both 

parents together is saving time by making only one contact. 

Hospital Staff Should Recognize and Adapt to the Influence of Others on Parental 

Decision-Making. 

Others present in the hospital setting, such as maternal and paternal grandparents, may 

heavily influence parents when deciding whether or not to acknowledge. Hospital staff 

may be able to use these people to serve as “translators” of the paternity message. 

Discussing paternity with a mother can be a very sensitive issue, and the presence of the 

maternal or paternal grandparents may either hamper or encourage discussion about 

paternity. One health information systems administrator said “Grandparents can make it 

difficult to talk with the mom. It is more uncomfortable talking with her if the 

grandparents are in the room. n Another hospital respondent commented, “Yes, many 

times the girl’s parents are there and they are into the issue and it can get sticky.” 

A number of different strategies may be employed to handle the presence of grandparents. 

Another hospital respondent says she explains the law to the grandparents and adds that it 

is the mother’s responsibility to make decisions for her own child. Sometimes a birth 

registrar may need to ask very personal questions of the mother about past pregnancies. 

A Virginia respondent simply asks the unmarried mother whether or not she wants others 

to be present when she talks to her. When grandparents favor acknowledgment, they can 

be powerful allies for hospital staff and serve in a translation role. For example, a 

California birth registrar likes the grandparents present because the unmarried parents may 

be very young and may not fully understand what ‘paternity’ means. One registrar 

reports, ccA lot of times the mother of the unmarried mom is there and she is a big 

influence in encouraging the mother to acknowledge. ” Because the birth registrar isn’t 

intimately familiar with the parents it makes sense that parents might rely on others, 

especially if the parents are young. Many parents want to use all of their available 

9 
resources in making a decision about paternity, including close friends, grandparents, and 

public assistance caseworkers. 

Where Hospital Staff Choose to Go Beyond Informing Parents to Serving as Advocates 

of Acknowledgment, they Should Be Careful to Preserve its Voluntary Nature. 

While some hospital staff may simply inform parents about the option of acknowledging, 

others perceive their role as that of counselor and advocate. These latter must maintain a 

balance to preserve the voluntary nature of paternity acknowledgment. Although it is 

most important that hospital staff provide parents with timely and accurate information on 

the process of acknowledging paternity, a number of hospital respondents reported more 

personal levels of communication with unmarried parents. Some hospital staff feel 

strongly about the societal benefits of paternity establishment and are therefore especially 

motivated to encourage parents to acknowledge. Those hospital respondents who choose 

to go beyond merely informing parents about paternity by serving as advocates of 

acknowledgment vary in their degree of encouragement. 

In the process of distributing paternity outreach materials, hospital staff who choose to 

serve as advocates may discuss the details of a patient’s circumstances and relate the 

benefits of acknowledgment to their situation. Staff who are involved at this level appear 

to come more often from the obstetrics than the medical records departments. This may 

be due to their greater interaction during the mother’s hospitalization or because obstetrics 

staff members are already heavily involved with patients regarding other highly personal 

issues such as baby care and postpartum recuperation. The decision to take on this 

broader role is likely to vary from patient to patient. When staff determine that it is 

appropriate to take on the role of advocate rather than educator, it is important to not 

mislead or coerce parents into acknowledging or giving advice that goes beyond the 

parameters outlined in staff training and outreach materials. 

PRENATAL EDUCATION 

Nearly All Hospitals Offer Childbirth Classes, and Some Include Paternity 

Acknowledgment Education in their Prenatal Curriculums. 

Prenatal education gives unmarried mothers more time to think and prepare for a decision 

concerning the paternity affidavit prior to delivery. This advance notice allows the mother 

to encourage the father to be present at delivery and to bring identification needed for 

notarization. A number of hospitals include paternity acknowledgment information in 

childbirth education classes. This strategy can reach a large proportion of the target 

population due to widespread acceptance of the importance of childbirth classes. In some 

States, mothers on public assistance or Medicaid are required to take such classes. 

Paternity acknowledgment information may be included in the parent tour of labor and 

delivery facilities required by many hospitals. A Massachusetts hospital offers a separate 

childbirth class just for teenagers which focuses more on paternity acknowledgment than 

the general childbirth course. 

10 
Medical Clinics, Physicians’ Offices and Schools are Valuable Venues for Addressing 

Paternity Acknowledgment Issues Prenatally. 

Once outreach materials are produced, States would be well-served to market them beyond 

the hospital environment. Mothers must, of course, seek medical care during pregnancy, 

and this provides a number of entry points for providing outreach to mothers at a less 

stressful time than the hospital stay. Some States have targeted only high-risk clinics for 

this outreach and some have taken a broader approach by distributing materials and 

presenting workshops at clinics, physician’s offices and schools statewide. Materials may 

also be placed in other social service offices and in child care centers. Outreach to 

schools may be particularly effective because it involves the father as well as the mother 

and because it reaches young people who are not yet pregnant. Colorado’s child support 

agency is currently developing specific curriculum for its public schools on paternity 

establishment so outreach may be conducted within the framework of health or parenting 

classes. Although the regulations written for interpreting OBRA focused primarily on inhospital paternity acknowledgment, there is a clear intention to broaden paternity outreach 

beyond the hospital. 

FOLLOW-UP AFTER DISCHARGE 

Timely Follow-up with Mothers After Discharge Reintroduces the Idea of 

Acknowledgment at a Less Hectic Time and Provides a Method for Supplying Additional 

Outreach Materials and Documentation Forms. 

When hospitals or child support agencies make the effort to follow-up with parents who 

do not acknowledge during the hospital stay, parents are afforded another opportunity to 

acknowledge before the birth certificate is filed. Often, hospitals routinely call all 

mothers anyway to check on the baby’s progress and the mother’s post-par-turn care. The 

mother and child’s hospital stay may be very brief, making a full discussion of the 

paternity acknowledgment process difficult. Through follow-up, hospitals allow parents 

more time to understand the benefits of acknowledgment. 

Follow-up may consist of phone calls, letters or both. When follow-up letters are used, 

they may include the following information: number of days they have to establish 

paternity, the fee for late acknowledgment, and legal information regarding time limits for 

registering the birth and for changing the baby’s surname. An example of a follow-up 

letter is included in Appendix I. Hospitals usually place phone calls within two weeks, 

and may send letters following phone contact. The amount of time allowed depends upon 

when the birth certificate information is due to the vital records agency. Because parents 

may relocate quickly after the time of birth, prompt follow-up is important. 

In some States, privacy statutes prohibit the child support agency from receiving 

information on nonmarital births until they become a part of the IV-D caseload. Indiana’s 

child support agency purchases lists of parents from hospitals as would a diaper service or 

a parenting magazine. They then notify all mothers who have not listed a father’s name 

or have provided different surnames for the father and the child. 

11 
Another common method of encouraging acknowledgment after discharge is holding the 

birth certificate for a few days in case the parents change their minds or if the father was 

not available. Several hospitals give the mother outreach information and/or the paternity 

affidavit and tell her to contact them if she decides to acknowledge or can locate the 

father. One hospital gives a discharge packet of materials containing a form letter stating 

they can still acknowledge paternity without a fee if the parents return within a certain 

number of days. Follow-up may be even more crucial when the birth registration clerk is 

not there on weekends to notarize acknowledgments. 

12 
CONCLUSIONS 

Although many States are still early in their implementation of in-hospital voluntary 

paternity acknowledgment programs, a number of State child support agencies have made 

great strides in addressing parent outreach and education. Based upon our analysis of the 

materials and practices reviewed in this report, we draw the following conclusions about 

parent outreach and education: 

CONTENT OF MATERIALS. Outreach should explain the benefits and consequences 

of paternity acknowledgment as well as the mechanics of acknowledging, and written 

materials should be supplemented with discussion. Not only is oral communication of 

paternal rights and responsibilities mandated by PRWORA, but direct contact between 

hospital staff and parents clarifies the concept of paternity and allows parents to better 

relate issues to their own circumstances. 

INDIVIDUALIZED APPROACH. Hospital staff should attempt to personalize outreach 

efforts, using information about the parents to better meet their needs. Different 

approaches are appropriate in speaking to the parents about paternity according to the 

timing of the presentation, the availability of the father, the visitors in the room, the 

mother’s interest, and cultural or language barriers. 

USE OF MULTIPLE OUTREACH VENUES. Multiple outreach opportunities can be 

used to reach a broader segment of the target group and to introduce early, and 

reinforce through repetition, a clear message on paternity acknowledgment. States 

should use a variety of entry points for introducing paternity acknowledgment information. 

Parents may receive paternity acknowledgment information at the physician’s office, 

during a childbirth class, hospital pre-registration, or upon admittance prior to delivery, 

rather than only during the hospital stay for delivery. 

FOLLOW-UP AFTER DISCHARGE. Timely follow-up with mothers after discharge 

provides additional encouragement to acknowledge, and opportunity to re-distribute 

documentation forms. Many parents may leave the hospital without acknowledging 

because of the unavailability of the father or of a notary. They may also need more time 

to make the decision to acknowledge and would value a reminder and the availability of 

new documentation materials. 

13 
AGENCY COMMENTS 

We have worked in close partnership with OCSE throughout the conduct of this 

inspection. Although we did not receive formal comments from ACF on our draft 

reports, they demonstrated through their collaboration a general agreement with this report 

and the companion reports. We worked with OCSE in developing a research 

methodology, provided extensive briefings on study findings and created additional 

documents to meet agency needs. We appreciate their cooperation and guidance and will 

continue to work with them on the issues raised in these reports. 

14 
Appendix A: Ouestions and Answers 

Typical Questions 

Questions 

Why can’t the father just sign the birth 

certificate? 

Whose name will be on the birth 

certificate? 

What if I am not yet 18 years old? 

What if the mother and child live in a 

different State from the father? 

Genetic testing 

and Answers' 

Answer8 

Having the father’s name on the birth 

certifkate is a good first step, but it does 

not make him the legal father. When the 

father signs the affidavit he is saying that 

he is the baby’s biological father. It is best 

if the father signs both the birth certificate 

and the acknowledgment of paternity. 

Example: If the baby’s mother and father 

complete the affidavit of paternity at the 

hospital, the father’s name will appear on 

the birth certificate based upon the 

information the hospital sends to the Center 

for Health Statistics (Alabama). 

You can still be named as the father. You 

can also be ordered to help the mother 

support the child. Even with limited 

income, fathers should be required to 

provide regular financial support for their 

children. 

States have an agreement which allows the 

mother to prove who the father is even if 

he lives in a different State. The 

agreement also covers coIkcting child 

support from absent parents in other States. 

Genetic tests can be performed to 

determine the paternity of a child. These 

tests will show that a man is not the father 

of a child or indicate the probability that he 

is the child’s father. The test results 

provide reliable information to aid parents 

and judges in parentage decisions. 

1 When m answer is referred to as an “example,” specific State laws appear to dictate the response 

and the answer should not be considered viable for all States. 

A-l 
Who pays for the blood tests? Answer varies by State such as the father, 

AFDC, child support arranged payments, 

or private arrangements with the hospital 

or a paternity testing laboratory. Parents 

may ask hospital staff for information. 

What about Visitation and Custody? Issues concerning custody and visitation are 

not a part of the paternity establishment 

process. If they become an issue then they 

may be resolved by a voluntary 

arrangement between the parents or by 

court action. 

What if the child is receiving government If the child is receiving APDC (welfare) or 

assistance (welfare or Medicaid)? medical assistance, the mother must assist 

the agency to establish paternity. When 

the parents sign the Affidavit 

Acknowledging Paternity, a copy is sent to 

the child support office. 

Can I sign the acknowledgment if I am A father can sign the affidavit is he is 

married to someone else? married to someone else. A denial of 

paternity form is available for a mother 

who is married to someone who is not the 

biological father. 

Why is establishing paternity important? Explanations include identify, benefits, 

money, medical, etc. 

How is paternity established? -Voluntary Acknowledgment of Paternity 

Affidavit in the hospital. 

-Paternity AfElavit after discharge from 

the hospital. 

-Seek State Child Support Agency 

Example: When the baby is born the 

hospital staff must get information for the 

baby’s birth certificate. They will have the 

Affidavit Acknowledging Paternity form 

for the mother and father to sign saying 

that he is the biological father. The 

parents must show a picture ID, such as a 

driver’s license. Both parents must give 

the hospital staff their social security 

numbers. 

_ A-2 
Does there have to be a trial? 

What if the father thinks the pregnancy was 

an accident? 

The mother of the child said she was using 

girth control. I do not think I am 

responsible for the pregnancy, so why do I 

iave to pay? 

What about child support? 

)oes the father have to pay child support? 

f I am afraid of the father, do I have to 

lame him? 

Example: No, not when you and the 

mother both agree that you are the father. 

Even for those cases which go through the 

court, there is usually no trial. It is easiest 

to establish paternity when the mother and 

father have a good relationship. If you 

have any doubts, you may ask for paternity 

blood tests to be sure you are the father 

(Colorado). 

Example: Texas law says that a father is 

responsible for supporting his children. 

This means that once the court decides he 

is the biological father, the man must pay 

to help support his child, even if the 

pregnancy was an accident. 

Example: Legally, you are responsible for 

supporting the child if you are his or her 

biological father. It does not matter 

whether you agreed to the pregnancy. 

Example: The law requires that both 

parents provide for the financial needs of 

their child. By receiving assistance from 

both parents a child’s chances for success 

are greatly improved. 

Example: Yes. Once paternity is 

established, the father has a legal 

obligation to support his child through 

minority and /or as otherwise allowed 

under law. 

If you are asking for public assistance or 

help with paternity establishment, you must 

name the father. However, you may not 

be required to establish paternity if you can 

show risk to yourself or the child. This is 

called “GOOD CAUSE.” Include contact 

telephone numbers for more information. 

A-3 
Appendix B: Sheet for Parents’ Initials 

WHATD-OESIThfEANlFYOC'SlGNTHLS FORM? 

6~ stgning this acknowledgment of parentage. you are establishing your child’s legal patcrtuty. Paterruty means fatherhood 

For parents who are not married to one another, paternity may be established legally only by signing this form or by gomg 

10 court Otherwae. your child ~111 have no legal father. 

Slgrung dus form IS volun~ Smcc thus form has legal consequences. you may warn (0 consult an anomey before sigrunf 

. If your child IS under SK months of age when you s1g1-1tlus form. patemny IS established on the dare both ~DG 

h+vt signed this form unless either parent quests blood or genetic marker MU within OIK year of signing. Such 

blood or genetic marker tests must be rquested through the proper court or the State Child Support Enforcemem 

Division. Once signed by both parents and notaruai. thus form has the same btnding effect 1s a court Judgrnenl of 

pat~tity ad the birth record will not be changed withour a court order. 

. If YOU child is six months of age or older when you sign this form, pstensity is u&bii~bcd 00 the date both 

pU’al& &WC S@d this form. You cannot request blood or genetic marker tests later. If you want t0 have a blood 

or gmtic marker teat to verify paternity, do oot sign this form until you have received the results of the teSl Once 

signal by both parents and notarized, this form will have rbe same binding effect as a coun judgment of paterrury 

Thts acknowledgment allows a parent to seek a child support order wlrhout funher court proceedings to establish patenut? 

T?USaChWkigment my be fikd in court and serve 1s the basts for orders of custody or vtsitatton. 

If this form is not signai in the hospital, the father’s name will not appear on the birth cemficare unless the blah c~filfi~e 

IS amc&d at a later due. If you want to add the father’s name later. you musf complete rlus Volwuary Achnowledgmeru qf 

PUWIUU~C - F’osM~~I form. YOU must then file the completed form WI&I the cny or town clerk’s offxe where the ch.tld NX 

born or go to court to vnend the child’s birth certificate. 

TIus acknowMgma?t is not a public record. It wtll be available only 10 the parents and child namal on this form. the 

child’s legal guardian or legal rcprcsentarlve. or grvemmenr officials tn the conducr of their official duties. 

If another W’S name is alrudy on the birth ccnificate ud you want to amend the birth cenifiute to include the father 

named on rhIs form. you must file this form with the court. 

WHAT ARE YOUR RIGHTS AND RESI’ONSIBILITIES AS PARENTS? 

Both parents are required by law to support their child from birth. If your child does not live with you. you m?y be ordered 

by the court to pay child suppon until the child’s eightccnrb btrthday. or beyond III some circumstances. 

A parent who does not live with the child may have the rtght to visit and establish a relationship with the child as you both 

agree or as ordered by the court. 

For children born of wmarricd parents. the mother has custody of the child unlas otherwise ordered by the court. 

HOW WILL YOUR CHILD BENEFIT IF YOU SIGN THIS FORM? 

Every child has the right 10 hw his or her mother and father and benefit from a relationship with both pventJ 

1.our child ha.5 a right to fuunclal support from both of you until age cightan. or beyond in some circumstances 

Ir will be easer for your child to learn the maIlcal hlsror1c.s of both parents and 10 benefit from health care coverage 

available co you 

II WIII be tlSler for your child to receive benefits such as dependent or survivor’s benefits from the \ etefan’s AdnuNstratlon 

or from the Social Security Admmistratlon 

Ir will be easier for your child to mhertt through you. Mother's Initials Father's hilids 

QWSUOIU Egudmg the buth ~;~ISUXUOD procu~ should be auutcd to the Reglsrry of vital R&ords and 9atistx.s it 617-727JNJ6 

@ZS~IO~E R@rdmg ctuld supCran should be duesred I@ rhc MA Dcpr of Revenue. Cfuld Suppon Enforuwnt DW 11 1-8@-33?-273! 

B-l 
What Is Patemlty? How Da WI Eatiblish Paternity? 

Paternity means fatherhood. EatabW&bgpaWmity Then arc several ways that paternity may be 

meanrapersoftMmcd~thththcrd~drlldhr m. A kM tip&r&ion of each of them is 

been legally dctemrlnrd to k thr bthW d @Chit& Usted below. If you kve questions about any one 

the mother is not ma&d to thr bthrr of tht child. meet your needs, you may contaci the Child Support 

Liforcernrnt office, legal counsel or your local Clerk 

dcouri. 

Why Is Estabw Paternity Importlnt? 

Establishment of ~8terrdty is tKQIuIJ e when method or md help to determine which may best 

B-North Carolina provides 

Both parents have a right and a need to know that theopportunity fora father toacknowledge paternity 

they have contributed to the future development of at the time of a child’s birth. This is a simple 

their child. procedure whereby parents sign the Affidavit of 

Parentage form in the hospital. This allows the 

ldfntifv - b%kall have a basic need to know who we father’s name to be placed on the birth certificate, and 

JW and who our family members are. By knowing also serves as a legal acknowledgment of paternity. 

both parents we have a better undccstondingof our 

own identity and pasL Establishing paternity will Paternity may be established by signtng thir 

help to strengthen a child’s emotional growth by affidavit if: 

providing an added sensed security as well as aiding 

in the child’s social and pychd~gid development. the mother was unmarried when 

she became pregnant and when 

&&,tj -Yourchild needs tobe �w~ofhisparents the child was born, & 

rnrdicd history This is important as your child may 

have inherited diseases or diisordcn which may not the father is willing to sign an 

be detected at birth or in chiidhood. affidavit stating that he is the 

father of the child. 

w - Your child has the right to benefits from 

both parents. These may in&de Sod81 sccU?it~, This Affidavit of parentage is filed with thr State 

insurance benrfits, inheritan- rights, Hteran’s and Registrar (Vital Records) and legally declares the 

other types of benefits. Your child may not receive paternity of your child. 

these fnlm his father unless paternity hasbeen legally 

Jcknowlrdged or established. p * I ‘_ Ifyoudid 

not rstablirh paternity at the time of birth, you may 

w The Irw requires that both parents provide choose todoso at a later datr. The mothrr and father 

for the financial needs of their child. By receiving sign documentsacknowledging they are the parents 

.Issistance from both parent5 achild’s cham for of a child. These signed statements are presented to 

success are greatly improved. ; the court and an Order of Paternity is entered ‘l’hls 

lrgally establishes patqmity for a child. 

FJther?;as well as mother; have the right to know : 

their child and a responsibdity t0 SUppOrt them. CpnrhE - If there a~ any doubts regarding 

the paternity of a child, you should not sign any 

II 1111 

Parentsdonot agnx tovolunt.~rily t*2rtdbh-h patcvnlty. 

legal action my be filed with thLeWU~I IO c>tabiA 

paternity for a child. After ,111t*vidrnkr I> ~ve’v’nt~~d, 

a iudge will decide If patcrnlty ~I~OUIJ hc cmI~*nxt 

Do We Need To Establish f’Jtrrnity Now? 

What Abe-It Visitation And Custody? 

How Do I Find Out More Information On 

Paternity And Other 

Child Support Services? 

If you have morv qurstlons rvgardtng p,ltvrnlty .ln<l 

other child support issues ‘+ou m.ly contact tht* Loc.ll 

Child Support Enforcement ofttce whtch FCWO yc,ur 

county The staff can answer any furthcar quc+~c~~ 

that you may have on patrrmly .I\ well ,I> cxpl.~~n ~11 

other child support svrv\cvb that rlrv .~v.~ll~hlt 
Appendix D: Parent Information Sheet 

What is a Dcclamtion 

of Paternity? 

How Can a Dtclamtion of 

Paternity help me? 

Why should I sign 

the declaration? 

wh8tdoesitmeanwilen 

I sign the declaration? 

Howdol.flIIoutthe 

: t!eclu8donr 

: 

How a Decltmtion of Puternity 

Can HelpYou andYour New Baby 

The Declaration qffafemr!y is a legal document that, when signed by 

both parents, says the man ts the natural father of the child. 

When the parents of a child are not married at the beginning of the 

pregnancy or at the birth of the child, the father may NOT be considered 

a legal parent with rights or responsibilities for the child. Even signing 

the child’s birth certificate will not make him the legal father. 

To help you gain legal tights asyour child’s father, you can sign the 

Dechztion of Paternity In most cases,signing the form will make it 

easier to establish paternity in court later. 

To show your child that you are proud to be his or her father! 

To help you have a bond with yourchild. 

To get a legal paper that saysyou are presumed 

to be the child’s father under California law. 

To giveyourchild your legalname ifyou choose, 

To helpyou be able to add yourchid to yourhealth insuranceplan. 

To help make surethat your socialsecurityor veteran’sbenefitsare 

paid to your child in caseyoudie or aredisabled. 

To help protect your child’s right to inherit from you. 

After both parentshave signedthe Lkhation of Pattmiq, the form 

and other appropriatepaperworkmaybe filed with the courtto establish 

paternity.Oncepaternityis established,youwill havethe legalrightsand 

Bnancialresponsibilitiesof a parent underCalifbmia law. Siig this 

declarationwill help yourchild havethe samerightsthat he or shewould 

haveif youweremarried to the other parent. 

sectionsA,BuldDshouldbefiucdoutbythepvrntsof~echildThe 

witnesswill fill out sectionE. Seethe inshucGonson the declarationfor 

mom detailx 

cs9lO (It%.) 
Appendix E: Parent Statements 

PATEKNITY ACKNOWLEDGEME?, 

RJGHTS AND RESPONSIBILITIES STATI3IEN-I 

RlGHTS AND RESPONSIBILITIES OF FATHER 

I have read or was told.of the follo\%ing matters before signmg the acknouledgement of patemit?, on the reverse side of thus 

form 

I I understand that my signature on this form establishes that I am the natural parent of the named child for all 

legal purposes 

2 1sign the Acknowledgement of Patemit! voluntarily and understand that l am under no obligation to do so No 

pressure is being or has been placed upon me to sign I understand I may take the followmg actions instead of 

signing this form 

:: 

C 

seek the advice or representation of legal ccunsel 

request that blood tests be taken and 

have the matter of patemi& determined by the court 

3 I understand that I will have the responsibility 10 provide support for rn>’child 

4 1 understand l will be responsible to pay such support until the child turns I 8 years of age or beyond if required 

by law. 

5 I understand that after palernie is established 1ha1.e the right to request visitation with and custody of the child 

Custody and visitation are decided in legal actions separate from the issues of paternie and child support 

6 I understand that the Acknowledgement of Patemit?. may be used rn any legal proceeding regarding my child 

7 I understand that I have the right to talk to a staff person to clat-if? information on this form and answer an> 

questions I have. 

RIGHTS AND RESPONSlBlLlTlES OF MOTHER 

I have read or was told of the following matters before signing tile acknowledgement of paternity on the reverse side of this 

form. 

I. I understand that my sibwahlre on this form means that I swear that f am the mother of named child and the 

Person signing as the father is the biological father of the child. 

2. I sign the Acknowledgement of Paternity voluntarily and understand that 1 am under no obligation to do ~0. No 

Pm is being or has been placed upon me to sign I understand I mav take the following actions *ad of 

signing this form. 

a. seek the advice or representation of IegaI counsel 

b request that bled tests be taken and 

C have the matter o I’patemiv determined by the court 

3 1 understand that a&r patemitv is established the father has the right to request visitation with and cudY of the 

child. Custody and vi srtation he decided in legal actions separate loom the issues of paternity and child SuPpOfl 

4. 1understand that I h.?ve the right to talk to a staff person to clarify information on this form and answer any 

questions I have. 

E- 1 
1 

Jon 

Young. confused and 

WImtiq to mrkc the 

rlghi choict. 

‘-7 

‘. VI 

b-! 

4 

i 

Ernie 

! .wkpJ tar love in all He liva a lift of *me 

;!:r wrung places. He hks his b~ka name 

Jon and Mary just had a baby. It’s a joyous occasion. 

Thafre still young, and this is going td be a major test 

ol their maturity... 

Baby 

Jon 81 Mary’;newborn 

bay. wa they adish 

paternity? Maybe! 

Dinah 

&privcd daughter 

of Ann and .--? 

“TIP 

T6mns 

The product al looking ~SI 

love in ah the wrong piacq 
-- 

--- 

--- 

Appendix G: Certificate Worksheet 

BIRTH CERTIFICATE WORKSHEET 

Sonora Community Hospital 

Delivered By: Medical Record Number: -

I have named my baby: (rti) (middle) O-t) 

SexofChild:~M F Single -Twin -Triplet Length inches 

Date ofBirth: / / Time of Birth: : a.mJp.m. Weight Ibs.-oz. 

Information on Father: (nm) (middle) 0-0 

State of Birth: Date ofBirtb: / / Last grade of education complete& 

Information on Mother: (n,,t) (middle) @uiIkn) 

State of Birth: DateofBirth: / / Last grade of education completed: 

’ Race of H&w 6Ui-j: White / Black / Asian / American Indian / Other 

Spanish or Hispanic in background? No / Yes WHY) Social Security Number: 

Occupation of Father: Type of Industry: 

Race of Mother wdu): White I BIack I Asian I American Indian i Other 

Spanish of Hispanic in Background? No / Yes WICCWY~ Social Security Number: 

Occupation of Mother: Type of Industry: 

Home Address of Mother: I 

mlrrr* w.=-.zlpMaiIing Address of Mother: I 

-

sbrup.0.Box CltY.sbt*upCounty of Fksidence: Telephone Number: ( ) 

Dateoflastnormal Inenhldpeliod: / / Month prenatal care began w llsti*): 

Number of psxsata.i visii !hurce of payment for care: Private Pay / Muli-Cal I Blue Cross/ E=Tvate

I have -otherchildnnwhoycnowliving(<-tbb~r~~~~ 

Ibave- otherchildren~omrrborn~ebut~enowdead(~lc-~Um~rld~~ 

I have had miscarriages before the Wth month of pregnancy. I have had - miscarriages after the Gfth month of 

Pregntney.--

Date of birth ofyoungest cbild~~rtcrttuaudr..,~~~ / / . 

Dateoflastmiscarriage: - I -d I 

p0 you want a soti security number for (your new baby? Yes _ No. May the Social Security Administration share 

ti~theDeparbnentofHe.&hServices. -Yes-No. 

Signature of Mother or Father: Dated: I I 

G-l 
Appendix H: Evaluation 

Name: 

First Middle 

Name: 

First Middle 

County of Residence: 

Marital Status: 

1 - Married to FOB 

2 - Married but not FOB 

3 - Common law with FOB 

4-Notmarried 

Language Barrier: 

l-No 

2 - Yes... I- Spanish only 

2-other 

Mother’s social security number: 

Name: 

First Middle 

RXXX 

Was father present at delivery: 

l-Yes 

~-NO 

0 - No information 

Was the paternity affidavit signed: 

1 - Both parents signed 

2 - Mother signed 

3 - Neither signed 

8-Other 

RR Present? CSE-6 Gives? 

l-No l-No 

2-Yes 2-Yes 

# Video # In-person # Class 

BABY INFORMATION 

Baby’s DOB: 1 ! 

Last 

MOTHER INFORMATION 

Mother’s DOB: 1 ! 

La.St Maiden 

Race: Years of Education: 

Occupation: 

Worked during pregnancy: l-Yes ~-NO O-Don’t know 

Number of other children: 

Pre-natal care: 

I- No pre-natal care 

2 - Pre-natal care, not at this facility 

3 - Pre-natal care at this facility 

FATHER’S INFORMATION 

Father’s DOB: / ! 

Last 

Years of Education: 

PROJECT INFORMATION 

Reasons Paternity Affidavit Not Completed (CWC 011thatapply) 

1 - Mother doesn’t want him on (abusive/fears/dislikes father) 

2 - Father uninterested, not involved 

3 - Father incarcerated 

4 - Father out of state 

5 - Father not at hospital 

6 - Both interested, but want to wait 

7 - Mother wants father to marry her Brst 

8 - Mother wants boyf?iend to adopt the baby 

9 - Adoption by third party 

10 - Father doesn’t believe the baby is his 

11 - Neither parent interested 

12 -Wants iuf&mal payments, can do better financially alone 

13 - Doesn’t kttow who father is 

14 - Mother doesn’t want him on, no reason given 

15 - Married, but not to FOB 

16 - Cannot determine 

17-Other 

H-l 
Appendix I: Follow-up Letter 

Dear 

Our records indicate that your baby was born on 

to date we have been unable to register the baby’s birth for the following 

reason(s): 

Parents of the child have not signed the birth certificate and/or the 

acknowledgment of parentage. 

Mother of the child has not signed the birth certificate and/or the 

acknowledgment of parentage. 

Father of the child has not signed the birth certificate and/or the 

acknowledgment of parentage. 

Parent(s) have not completed a birth certificate worksheet. Please 

find worksheet enclosed. Fill out immediately and return to the 

medical records department at the hospital. 

Other: 

Your immediate attention is required on this matter. Please contact me 

with any questions you might have. 

The baby’s incomplete birth certificate will be sent to the town hall on 

if we do not hear from you. At the town hall the birth 

certificate will be pi into a pending file until this matter is taken by you. 

Thank you. 

Birth Registrar 

I-l