New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter A - Forms Authorized by Section 205.7 › Uniform Interstate Family Support Act Forms › Form UIFSA-4 - Uniform support petition

Current through Register Vol. 46, No. 28, July
					 10, 2024
F.C.A. Art. 5-B UIFSA-4
UNIFORM SUPPORT PETITION
____________
Petitioner [ ] IV-D Non-Public
						Assistance
[ ] IV-D Non PA Medicaid
[ ] Full Services
[ ] Medical Services Only
Respondent [ ] IV-D Public
						Assistance
[ ] IV-E Foster Care (IV-D Case)
[ ] Non-IV-D
File Stamp
Responding IV-D Case No. ________
						Initiating IV-D Case No. ____________
Responding Docket No. ________ Initiating
						Docket No. ____________
____________
I. Action
The Respondent and/or the Respondent's
						property is subject to the jurisdiction of the responding tribunal.
The Respondent owes a duty of support to
						the following children:
Full Name (First, Middle, Last) Date of
						Birth Social Security No.
The Petitioner files this Petition to
						request:
[ ] Establishment of a Paternity
[ ] Establishment of Order for:
[ ] Child Support [ ] Medical
						Coverage
[ ] Spousal Support [ ] Reasonable
						Attorney Fees, Other Fees and Costs
[ ] Support for a Prior Period;
						From:________ To: ________
[ ] Paternity Testing Costs in the Amount
						of $ ________
[ ] Modification of a Support Order
[ ] Other Remedy Sought:
						____________
II. Grounds Supporting the Remedy Sought
						in Section I (when applicable)
[ ] Respondent is the noncustodial parent
						of the children named in this Petition.
[ ] A modification is appropriate due to a
						change in circumstances.
[ ] Grounds for other remedy
						sought:
____________
Uniform Support Petition OMB 0970-0085
						Page 1 of 2
UNIFORM SUPPORT PETITION, PAGE 2
						Initiating IV-D Case No.
____________
III. Additional Supporting
						Information
The following documents are attached to,
						and incorporated in, this Petition. These documents contain the required
						additional information.
[ ] Petitioner's General Testimony [ ]
						Affidavit in Support of Establishing Paternity
[ ] Acknowledgment of Paternity [ ] Birth
						Certificate of the Child
[ ] Other: ____________
____________
IV. Verification
[ ] Under penalties of perjury, all
						information and facts stated in this Petition are true to the best of my
						knowledge and belief.
_________
Date
__________________
[ ] Signature of Petitioner [ ] IV-D
						Representative/Title
__________
Sworn to and Signed Before
Me This Date, County/State
______________
Notary Public, Court/Agency Official and
						Title
____________
Commission Expires
_________
Date
__________________
[ ] Signature of Petitioner's Attorney /
						Bar Number (if applicable)
____________
Uniform Support Petition Page 2 of
						2
OMB 0970 - 0085
INSTRUCTIONS FOR UNIFORM SUPPORT
						PETITION
PURPOSE OF THE FORM: The Uniform Support
						Petition is a legal pleading needed for the responding State to initiate
						action. Its purposes are to show how the tribunal has jurisdiction, to show
						enough facts to notify the respondent of the claim being made, and to provide
						the petitioner with a means to request specific action or relief. Additional
						information can be provided in the accompanying affidavits and other
						attachments.
HEADING/CAPTION:
Identify the Petitioner and Respondent in
						the appropriate spaces.
Check the appropriate space to identify
						the type of case: IV-D Non Public Assistance; IV-D Non Public Assistance
						Medicaid (indicate whether receiving Full Services or Medical Services Only);
						IV-D Public Assistance; IV-E Foster Care; or Non IV-D. IV-D means the case is
						being worked by the State or local child support enforcement agency (i.e., IV-D
						agency). Public Assistance means the obligee's family receives IV-A cash
						payments [IV-A was formerly called Aid to Families with Dependent Children
						(AFDC) and is now called Temporary Family Assistance]. A IV-D Non Public
						Assistance Medicaid case is a case where the obligee's family receives Medicaid
						but does not receive Public Assistance (IV-A cash payments).
Under "Responding IV-D Case No." and
						"Responding Docket No.", enter appropriate case and docket numbers that the
						responding State uses to identify the case, if applicable and if known. Under
						"docket number", you may enter the docket number, cause number, or any other
						appropriate reference number.
Under "Initiating IV-D Case No." and
						"Initiating Docket No.", enter appropriate case and docket numbers which your
						IV-D agency or local tribunal has assigned to the case. Under "docket number",
						you may enter the docket number, cause number, or any other appropriate
						reference number.
SECTION I, ACTION: List the children on
						whose behalf the action in the petition is requested. Include each child's full
						name (First, Middle, Last), date of birth, and Social Security Number.
Check the appropriate boxes to indicate
						which actions are requested. Multiple actions may be requested, as
						appropriate.
Check "Establishment of Paternity" to
						request that paternity be established. In a IV-D case, ask another State to
						establish paternity only if use of long-arm jurisdiction is not appropriate. Be
						sure to attach an "Affidavit in Support of Establishing Paternity" for each
						child whose paternity is at issue.
Check "Establishment of Order" to request
						that an order be established. Indicate the type of order by checking the
						appropriate box.
Check "Child Support" to request the
						initial establishment of a new child support order. If the responding State
						uses UIFSA and an order governing the same obligor, obligee, and child(ren)
						already exists, you should generally only request the establishment of a new
						order if: (1) there is more than one existing order, (2) the obligor, obligee,
						and child have all moved out of the issuing States, and (3) the parties have
						not filed written consent allowing an issuing State to assert
						jurisdiction.
____________
Instructions to Uniform Support
						Petition--Page 1
Check "Spousal Support" to request
						establishment of a spousal support order. Do not check this item in a IV-D
						case; establishment of spousal support is not IV-D function. When requesting
						establishment of spousal support, contact the support enforcement agency for
						the appropriate procedure.
Check "Support for a Prior Period" to
						request establishment of support for a prior period. On the "From" and "To"
						lines, enter the beginning and ending dates of the prior period. If support for
						multiple prior time periods is being requested, enter the beginning date of the
						first period in the "From" line, and enter the closing date of the last time
						period in the "To" line. States may establish child support awards covering a
						prior period, but such awards must be based on guidelines and take into
						consideration either the current earnings and income at the time the order is
						set, or the obligor's earnings and income during the prior period. The award of
						back support is not required under Federal rules but may be appropriate in
						accordance with State law. Not all States have authority to establish support
						orders for prior periods.
Check "Paternity Testing Costs" to request
						an order for reimbursement of costs incurred as a result of genetic testing for
						paternity establishment purposes. If the initiating State has already incurred
						costs for genetic testing, enter the amount of the costs on the blank line. If
						reimbursement of previously paid genetic tests is not sought, but genetic tests
						may be ordered, enter "actual" on the blank line.
Check "Medical Coverage" to request
						establishment of an order that provides for the provision of medical insurance
						or other health care coverage. Medical support must be requested in all IV-D
						Public Assistance cases, all IV-D Non Public Assistance Medicaid cases, and in
						other IV-D Non Public Assistance cases where health coverage is sought.
Check "Reasonable Attorney Fees, Other
						Fees and Costs" to request an order for attorney fees or other costs such as
						costs of the delivery of the child and other medical costs not covered by
						insurance. Provide testimony regarding the type and amount of these
						costs.
Check "Modification of a Support Order" to
						request modification of an existing order.
If you are requesting modification of an
						order that was issued by the responding State, in most instances you do not
						need to complete a Uniform Support Petition. On the other hand, if you are
						requesting modification of an order that was issued by a State other than the
						responding State, a Uniform Support Petition is usually necessary.
If multiple orders exist, do not ask a
						responding UIFSA State to modify an order unless that order is the
						"controlling" that has priority under UIFSA. UIFSA contains rules for
						determining which order is recognized when multiple orders exist.
Check "Other Remedy Sought" if you are
						requesting an action not listed in section I. Specify in the space provided
						what remedy you are requesting.
The Uniform Support Petition is generally
						not needed to request enforcement action from a UIFSA State.
SECTION II, GROUNDS FOR REMEDY
						SOUGHT:
In those cases where the respondent is the
						noncustodial parent of the children named in the petition, check the first box
						in section II of the petition.
____________
Instructions for Uniform Support
						Petition--Page 2
Grounds (reasons) for remedy sought are
						required in actions to register an out-of-state child support order for
						modification. If you are using the petition to request a modification, check
						the second box under section II of the petition.
Grounds for remedy sought are also
						required when seeking a remedy that must be affirmatively sought under the
						responding State's law.
SECTION III, ADDITIONAL SUPPORTING
						INFORMATION:
Check the appropriate boxes to indicate
						which documents are being sent with the petition. If you are sending forms with
						the petition that are not specifically identified in this section, mark the
						"Other" box and list the additional forms in the space provided.
SECTION IV, VERIFICATION:
The petition must be verified by the
						petitioner. Check the box under this part and have the petitioner (obligee,
						guardian, putative father, or authorized IV-D representative) sign and date the
						form.
Only the verification (petitioner's)
						signature requires a notary. (If petitioner retains an independent (non IV-D)
						attorney who also signs the petition, the attorney's signature is not
						notarized.)
UIFSA allows a party to retain independent
						counsel. If the petitioner is represented by a private attorney, obtain the
						attorney's signature and Bar Number (if applicable) in the space provided in
						this part.
**************************************************
The Paperwork Reduction Act of 1995
This information collection is conducted
						in accordance with
						45 CFR
						303.7 of the child support enforcement
						program. Standard forms are designed to provide uniformity and standardization
						for interstate case processing. Public reporting burden for this collection of
						information is estimated to average one hour per response. The responses to
						this collection are mandatory in accordance with
						45 CFR
						303.7. This information is subject to State
						and Federal confidentiality requirements; however, the information will be
						filed with the tribunal and/or agency in the responding State and may,
						depending on State law, be disclosed to other parties. An agency may not
						conduct or sponsor, and a person is not required to respond to, a collection of
						information unless it displays a currently valid OMB control number.
____________
Instructions for Uniform Support
						Petition--Page 3