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-9 - Registration statement

Current through Register Vol. 46, No. 28, July
					 10, 2024
F.C.A. Art. 5-B UIFSA-9
REGISTRATION STATEMENT
____________
Responding IV-D Case No. ____________
						Initiating IV-D Case No. ________
Responding Docket No. ____________
						Initiating Docket No. ________
____________
I. Case Summary (Background of this
						Matter: Court / Administrative Actions)
Date of Support Order State and County
						Issuing Order Tribunal Case No.
Support Amount/Frequency Date of Last
						Payment Amount of Arrears Period of Computation
$ $
___
Date thru
___
Date
____________
II. Mother Information [ ] Obligor [
						]Obligee
Full Name and Aliases Address (Street,
						City, State, Zip) Employer (Name, Street, City, State, Zip)
(First, Middle, Last)
SSN:
____________
III. Father Information [ ] Obligor [
						]Obligee
Full Name and Aliases Address (Street,
						City, State, Zip) Employer (Name, Street, City, State, Zip)
(First, Middle, Last)
SSN:
____________
IV. Caretaker (If Not a Parent)
						Relationship to Child(ren) ____________
Full Name and Aliases Address (Street,
						City, State, Zip)
(First, Middle, Last)
SSN:
____________
V. Additional Case Information
This order is registered in the following
						states:
Description and location of any property
						not exempt from execution:
Other:
____________
VI. Verification / Certification
Under penalties of perjury, all
						information and facts concerning the arrearage accrued under this order are
						true to the best of my knowledge and belief:
_______
Date
[ ] Party seeking Registration [ ] Records
						Custodian
_______
Sworn to and Signed
______________
Notary Public, Court/Agency Official and
						Title
______
Commission Expires
Before Me This
Date, County/State
____________
Registration Statement OMB No. 0970 - 0085
						Page 1 of 1
OMB-No. 0970 - 0085
INSTRUCTIONS FOR REGISTRATION
						STATEMENT
PURPOSE OF THE FORM: The Registration
						Statement is completed by the initiating jurisdiction to request registration
						of an existing order for enforcement and/or modification. The purpose of the
						form is to refer specific order information to the responding State. This form
						can be used in IV-D and non-IV-D interstate cases. It should be included with
						the other appropriate forms and directed to the responding State's central
						registry. It is important to remember that a separate Registration Statement is
						needed for each order that the initiating State is requesting be registered by
						the responding State.
HEADING/CAPTION:
The initiating jurisdiction add its IV-D
						case and docket numbers to the heading, at the space available. The responding
						jurisdiction will add its IV-D case and docket numbers to the heading after
						receiving the form from the initiating jurisdiction.
SECTION I, CASE SUMMARY:
Provide complete information for all
						court/administrative actions regarding support for dependents. Use a separate
						Registration Statement form for each court/administrative order you are
						requesting be registered. For "Period of Computation", enter the month, day,
						and year for both the beginning and ending dates. The information in this
						section will be used to aid in verifying calculated arrearages and to assist in
						determining/verifying which order is controlling and which State has continuing
						exclusive jurisdiction.
Attach the required number of copies of
						all pertinent order that relate to support. If you are sending this case to a
						State that uses UIFSA, you will generally need to attach two copies, one of
						which is certified, of any support order. If your are sending this case to a
						State that uses a version of URESA, you will generally need to attach three
						certified copies of any support order. Note, however, that some responding
						States may be able to take certain administrative enforcement actions (e.g.,
						interstate wage withholding) without having a certified copy of the order,
						although a regular copy is necessary.
SECTION II, MOTHER INFORMATION:
This section provides basic information
						about the child(ren)'s mother. Check the appropriate box to indicate if the
						mother is the obligor or obligee. Provide the mother's full name (first,
						middle, last) as well as aliases or maiden name, and all other
						information.
SECTION III, FATHER INFORMATION:
This section provides basic information
						about the child(ren)'s father. Check the appropriate box to indicate if the
						father is the obligor or obligee. Provide the father's full name (first,
						middle, last) as well as aliases, and all other information. Provide the name
						and full address for the father's employer.
____________
Instructions for Registration
						Statement--Page 1
SECTION IV, CARETAKER (IF NOT A
						PARENT):
Complete this section only if the
						child(ren)'s caretaker is not the child(ren)' s parent. In the space labelled
						"Relationship to Child(ren)", indicate the relationship of the caretaker to the
						child(ren). Provide the caretaker's full name (first, middle, last) as well as
						aliases or maiden name, and all other information.
SECTION V, ADDITIONAL CASE
						INFORMATION:
In this section, provide additional
						information which may be useful to the responding jurisdiction in working the
						case, such as a complete listing of all States where the child support order
						has previously been registered and a description, including the location, of
						all known property or assets not exempt from execution. In addition to the
						requested information, use this portion of the form to provide other
						information which may assist the responding jurisdiction in its efforts to
						register the order.
SECTION VI, VERIFICATION /
						CERTIFICATION:
The Registration Statement may be signed
						by either the party seeking registration or an authorized IV-D
						representative/records custodian. Check the appropriate box to indicate who has
						signed this form.
The verification signature requires a
						notary.
**************************************************
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 Registration
						Statement--Page 2