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-1 - Child support enforcement transmittal #1-initial request

Current through Register Vol. 46, No. 28, July
					 10, 2024
F.C.A. Art. 5-B UIFSA-1
CHILD SUPPORT ENFORCEMENT TRANSMITTAL #1 -
						INITIAL REQUEST
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
To: (Agency Name and Address)
Responding FIPS Code ________ State
						____________
Responding IV-D Case No.
						____________
Responding Docket No. ____________
____________
From: (Contact Person, Agency, Address,
						Phone, Fax, Internet)
Initiating FIPS Code ________ State
						____________
Initiating IV-D Case No.
						____________
Initiating Docket No. ____________
Send Payments To: (if different from
						above)
Payment FIPS Code ________ State
						____________
Bank Account ____________ Routing Code
						________
Initiating Jurisdiction [ ] URESA [ ]
						UIFSA State with Continuing Exclusive Jurisdiction (CEJ) ________
____________
I. Action. The Responding Jurisdiction
						Should Provide All Appropriate Services Including:
1. [ ] Establishment of Paternity
2. [ ] Establishment of Order for:
A. [ ] Child Support D. [ ] Medical
						Coverage
B. [ ] Spousal Support E. [ ] Other Costs
						(Use Sec. VII)
C. [ ] Support for a Prior Period
3. [ ] Enforcement of Responding Tribunal
						Order
4. [ ] Modification of Responding Tribunal
						Order
5. [ ] Change of Payee/Redirection of
						Payment
6. [ ] Registration of Foreign Support
						Order:
A. [ ] For Enforcement Only C. [ ] For
						Modification
B. [ ] For Modification and
						Enforcement
Requested by: [ ]Obligor [ ]Obligee [
						]State Agency
(Requires Sworn Statement of
						Arrears)
7. [ ] Collection of Arrears
8. [ ] Income Withholding
9. [ ] Administrative Review for Federal
						Tax Offset
............
____________
II. Case Summary (Background of this
						Matter: Court/Administrative Actions)
Date of Support Order State & County
						Issuing Order Tribunal Case No.
Support Amount/Frequency Date of Last
						Payment Amount of Arrears Period of Computation
$ $ ________ thru ________
............
[ ] Presumed Controlling Order [ ]
						Determined Controlling Order
____________
Date of Support Order State & County
						Issuing Order Tribunal Case No.
Support Amount/Frequency Date of Last
						Payment Amount of Arrears Period of Computation
$ $ ________ thru ________
............
[ ] Presumed Controlling Order [ ]
						Determined Controlling Order
____________
Date of Support Order State & County
						Issuing Order Tribunal Case No.
Support Amount/Frequency Date of Last
						Payment Amount of Arrears Period of Computation
$ $ ________ thru ________
............
[ ] Presumed Controlling Order [ ]
						Determined Controlling Order
____________
Child Support Enforcement Transmittal #1 -
						Initial Request OMB No. 0970- 0085 Page 1 of 3
CHILD SUPPORT ENFORCEMENT TRANSMITTAL #1 -
						INITIAL REQUEST Initiating IV-D Case No.
____________
III. Mother Information [ ] Obligor [ ]
						Obligee
Full Name and Aliases Address (Street,
						City, State, Zip) Employer/Address (Name, Street, City, State, Zip)
(First, Middle, Last)
Home Phone () [ ] Address Confirmed
						________ [ ] Employer Confirmed ________
Work Phone () Date Date
Date/Place of Birth ________ ________
						Social Security No.____________
Date Place
____________
IV. Father Information [ ] Obligor [ ]
						Obligee
Full Name and Aliases Address (Street,
						City, State, Zip) Employer/Address (Name, Street, City, State, Zip)
(First, Middle, Last)
Home Phone () [ ] Address Confirmed
						________ [ ] Employer Confirmed ________
Work Phone () Date Date
Date/Place of Birth ________ ________
						Social Security No.____________
Date Place
____________
V. Caretaker (If Not a Parent)
						Relationship to Child(ren)____________
Full Name and Aliases Address (Street,
						City, State, Zip)
Employer/Address (Name, Street, City,
						State, Zip)
(First, Middle, Last)
Home Phone () [ ] Address Confirmed
						________ [ ] Employer Confirmed ________
Work Phone () Date Date
Date/Place of Birth ________ ________ Sex
						________ Social Security No.____________
Date Place M/F
____________
VI. Dependent Children Information State
						of Residence
Full Name (First, Middle, Last) Date of
						Birth Sex Social Security No. for last 6 months
____________
VII. Additional Case Information
[ ] Nondisclosure Finding Attached
____________
VIII. Attachments (Supporting
						Documentation)
[ ] Arrears Statement/Payment
						History
[ ] Uniform Support Petition (3
						Copies)
[ ] General Testimony/Affidavit
[ ] Affidavit in Support of Establishing
						Paternity
[ ] Acknowledgment of Parentage
[ ] Other Documents Relating to
						Paternity
[ ] Support Order(s)
[ ] Divorce Decree
[ ] Assignment of Rights
[ ] Description of Real/Personal
						Property
[ ] Photograph of Respondent
[ ] Other Attachments
_____
Date
____________
Initiating Contact Person (Print or
						Type)
__________
Telephone Number & Extension
__________
Fax Number
____________
Child Support Enforcement Transmittal #1 -
						Initial Request Page 2 of 3
CHILD SUPPORT ENFORCEMENT TRANSMITTAL #1 -
						INITIAL REQUEST
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
To: (Agency Name and Address)
Responding FIPS Code ________ State
						____________
Responding IV-D Case No.
						____________
Responding Docket No. ____________
____________
From: (Contact Person, Agency, Address,
						Phone, Fax, Internet)
Initiating FIPS Code ________ State
						____________
Initiating IV-D Case No.
						____________
Initiating Docket No. ____________
Send Payments To: (if different from
						above)
Payment FIPS Code ________ State
						____________
Bank Account ____________ Routing Code
						________
Initiating Jurisdiction [ ] URESA [ ]
						UIFSA State with Continuing Exclusive Jurisdiction (CEJ) ________
____________
ACKNOWLEDGMENTS Return This Form to
						Initiating State
[ ] Request Received and No Additional
						Information is Necessary
[ ] Additional Information Needed
[ ] Arrears Statement/Payment
						History
[ ] Uniform Support Petition
[ ] General Testimony/Affidavit
[ ] Affidavit in Support of Establishing
						Paternity
[ ] Acknowledgment of Parentage
[ ] Other Documents Relating to
						Paternity
[ ] Support Order(s)
[ ] Divorce Decree
[ ] Assignment of Rights
[ ] Description of Real/Personal
						Property
[ ] Photograph of Respondent
[ ] Other (See Remarks)
[ ] Remarks/Response
[ ] Your Case has been Forwarded for
						Action to:
___________________________
Name of Worker
___________________________
Agency Name
___________________________
Address, FIPS Code
___________________________
Phone & Extension
___________________________
Fax
()
_____
Date
____________
Person Completing Form (Print or
						Type)
__________
Telephone Number & Extension
()
__________
Fax Number
____________
Child Support Enforcement Transmittal #1 -
						Initial Request Return this Page to the Initiating Jurisdiction Page 3 of
						3
OMB No. 0970 - 0085
INSTRUCTIONS FOR
CHILD SUPPORT ENFORCEMENT TRANSMITTAL # 1
						- INITIAL REQUEST
PURPOSE OF THE FORM: The CSE Transmittal
						#1-Initial Request form is a "cover letter" required to refer IV-D interstate
						cases to any responding State's central registry. The form can also be used in
						non-IV-D cases. It contains basic case information and space for indicating
						which services are requested. The form can be used to request administrative or
						legal action, including establishment of paternity and/or support obligation,
						modification, or enforcement. It does not take the place of, and therefore must
						be accompanied by, the appropriate standard interstate forms (e.g. Uniform
						Support Petition, General Testimony, etc.) and supporting documentation.
HEADING/CAPTION (Pages 1 & 3): The
						initiating jurisdiction determines the heading. Note that the heading appears
						on both page 1 of the Child Support Enforcement Transmittal #1 and on page 3,
						the Acknowledgment page.
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).
In the space marked "To:", list the name
						and address (street, city, State, and zip code) of the central registry, court,
						or agency where you are sending the CSE Transmittal #1. In IV-D cases, initial
						referrals must be sent to the responding State's central registry. In non-IV-D
						cases, contact the responding State central registry to determine appropriate
						procedures.
In the appropriate spaces, if applicable
						and if known, enter the Responding jurisdiction's FIPS code, State, IV-D case
						number, and docket number. The responding FIPS code is not essential for an
						initial IV-D referral since you will be sending the case to the responding
						central registry. Under "docket number", you may enter the docket number, cause
						number, or any other appropriate reference number that the responding State may
						use to identify the case, if known.
In the space marked "From:", list a
						contact person, agency name, address (street, city, State, zip code), phone
						number (including extension), fax number, and Internet address.
In the appropriate spaces, enter the
						Initiating jurisdiction's FIPS code, State, IV-D case number, and docket
						number. Under "docket number", you may enter the docket number, cause number,
						or any other appropriate reference number which the initiating tribunal or
						agency has assigned to the case.
In the space marked "Send Payments To:"
						enter the address to which payments should be sent, if the address is different
						from the agency address provided in the space labelled "From". Specify the case
						identifier if you want the responding jurisdiction to use an identifier other
						than the initiating IV-D case number when remitting payments.
In the appropriate spaces, enter the FIPS
						code and State where payments should be sent.
____________
Instructions for Child Support Enforcement
						Transmittal #1-Initial Request--Page 1
If funds can be transmitted electronically
						via Electronic Funds Transfer (EFT), enter the bank account number under "Bank
						Account" and the bank routing code under "Routing Code".
Check the appropriate box to indicate
						whether the initiating jurisdiction uses the Uniform Reciprocal Enforcement of
						Support Act (URESA) or the Uniform Interstate Family Support Act
						(UIFSA).
In the appropriate space, note the State
						which you believe has continuing exclusive jurisdiction (CEJ), if known. Under
						UIFSA, a State that issues a child support order maintains CEJ as long as the
						obligor, obligee, or child(ren) reside in that State, or until each party files
						written consent allowing another State to assume CEJ. If there are multiple
						orders governing the same obligor, obligee, and child(ren), UIFSA contains
						rules for determining which order is controlling. The tribunal that issued the
						controlling order has CEJ as long as the conditions for CEJ are met. CEJ means
						the authority to modify the order.
SECTION I (page 1), ACTION: Check the
						appropriate box(es) to indicate which actions are requested. Multiple actions
						may be requested, as appropriate.
In IV-D cases, the responding jurisdiction
						should provide the full range of appropriate services. for example, even if the
						initiating IV-D agency only checks box 1 "Establishment of Paternity", the
						responding jurisdiction should establish paternity, establish a support order,
						and enforce the support order.
Check item 1 "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 item 2 "Establishment of Order" to
						request that an order be established. Indicate the type of order by checking
						the appropriate box.
Check item 2A "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 establishment of a new order
						if: (1) there is more than one existing order, and (2) the obligor, obligee,
						and child have all moved out of the issuing States.
Check item 2B "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 a IV-D function. When requesting
						establishment of spousal support, contact the support enforcement agency for
						the appropriate procedure.
Check item 2C "Support for a Prior Period"
						to request establishment of support for prior period. 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 item 2D "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.
____________
Instructions for Child Support Enforcement
						Transmittal #1-Initial Request--Page 2
Check item 2E "Other Costs" to request an
						order for other costs such as: costs of the delivery of the child, other
						medical costs not covered by insurance, genetic testing, and attorney's fees.
						Describe the costs in section VII "Additional Case Information".
Check item 3 "Enforcement of Responding
						Tribunal Order" to request enforcement of an existing order that was issued by
						the responding tribunal.
If multiple orders governing the same
						obligor, obligee, and child(ren) exist, do not ask a responding UIFSA State to
						prospectively enforce (or modify) an order unless that order is the
						"controlling order" that has priority under UIFSA. UIFSA contains rules for
						determining which order is recognized when multiple orders exist. Under these
						rules:
1. The order issued by a tribunal with
						continuing, exclusive jurisdiction (CEJ) has priority. An issuing tribunal
						retains CEJ as long as the issuing State remains the residence of the obligor,
						obligee, or child, or until all parties file written consent with the tribunal
						allowing another State to assume CEJ.
2. If more than one issuing tribunal would
						have CEJ, the order issued by the child's current home State has
						priority.
3. If more than one tribunal would have
						CEJ but there is no order in the child's current home State, the most recently
						issued order has priority.
4. If no tribunal would have CEJ, the
						responding State may issue a new support order and it becomes the CEJ
						State.
Check item 4 "Modification of Responding
						Tribunal Order" to request modification (or review and adjustment) of an
						existing order that was issued by the responding tribunal.
Do not request a responding UIFSA State to
						modify its own order if the obligor, obligee, and child(ren) have all moved out
						of that State, or if the parties have filed written consent with the issuing
						tribunal in that State allowing another State to modify the order.
If multiple orders exist, do not ask a
						responding UIFSA State to modify an order unless that order is the "controlling
						order" that has priority under UIFSA. UIFSA contains rules for determining
						which order is recognized when multiple orders exist.
Generally, you need to attach a completed
						General Testimony.
Check item 5 "Change of Payee/Redirection
						of Payment" to request a change of payee or redirection of payment. Describe
						your request in Section VII "Additional Case Information". "Change of Payee" is
						an administrative action used when the person or agency entitled to receive
						funds has changed. It may occur with a change in Public Assistance or Foster
						Care status or a change in custody. "Redirection of Payment" is an
						administrative action used when the custodian has moved. In some States a court
						action may be required if the custodian's move compels transfer of documents or
						funds to another jurisdiction.
Check item 6 "Registration of Foreign
						Support Order" to request registration of a support order. Orders from one
						State may be registered in another State, under UIFSA, URESA, or the Uniform
						Enforcement of Foreign Judgments Act (UEFJA). Also check item 6A "For
____________
Instructions for Child Support Enforcement
						Transmittal #1-Initial Request--Page 3
Enforcement Only", item 6B "For
						Modification and Enforcement" or item 6C "For Modification" to indicated
						whether the registration is for enforcement and/or modification. Check either
						item 6B or 6C if you are requesting review and adjustment of a foreign order.
						Check the appropriate box to indicate whether registration is requested by the
						obligor, obligee, or state enforcement agency.
To modify another State's order, a
						responding State must first register the order. To enforce another State's
						order, a responding State may have to register the order; UIFSA allows for
						administrative enforcement without registration (but requires registration for
						other enforcement actions).
When requesting registration, certain
						information or documents are required. The requirements for requesting
						registration depend on whether you are registering the order under UIFSA, URESA
						or UEFJA or other law. To request registration of an order under UIFSA, you
						must include:
o A letter of transmittal to the tribunal
						requesting registration for enforcement and/or modification. The CSE
						Transmittal #1 serves this function. Check the appropriate boxes in item 6 of
						section I to indicate the action requested.
o Two copies, including one certified copy
						of all orders to be registered, including any modification of an order.
o A sworn statement by the party seeking
						registration or a certified statement by the custodian of records showing the
						amount of any arrearage. At State option, page 6a of the General Testimony may
						be used for this purpose. In section VIII "Attachments", check the first box
						("Arrears Statement/Payment History") to indicate that a sworn statement of
						arrears is attached.
o The name of the obligor and, if known:
						the obligor's address and Social Security Number; the name and address of the
						obligor's employer and any other source of income of the obligor; and a
						description and the location of property of the obligor in the responding State
						not exempt from execution. Space for most of this information is provided on
						the CSE Transmittal #1. If you have information about the obligor's other
						sources of income or property, include the information in section VII or an
						attachment. In section VIII, check the box labelled "Description of
						Real/Personal Property" if a description is attached.
o The name and address of the obligee.
						Space for this information is provided on the CSE Transmittal #1.
o If applicable, the agency or person to
						whom support payments are to be remitted. Space for this information is
						included in the heading of the CSE Transmittal #1.
In addition, to allow the responding State
						to establish a IV-D case, you will probably need to complete all other
						information on the CSE Transmittal #1, particularly information regarding the
						children.
Furthermore, when requesting registration
						for modification, you generally need to attach a completed Uniform Support
						Petition and General Testimony.
____________
Instructions for Child Support Enforcement
						Transmittal #1-Initial Request--Page 4
Do not ask a responding UIFSA State to
						modify another State's order unless:
o (1) the child(ren), obligee, and obligor
						do not live in the State that issued the order; (2) the party seeking
						modification does not live in the responding State; and (3) the responding
						State has personal jurisdiction over the other party (the party not requesting
						modification).
OR
o The responding State has personal
						jurisdiction over the obligor, obligee, or child(ren), and the obligor and
						obligee have filed written consent in the tribunal that issued the order
						providing that the responding State may modify the support order and assume
						continuing, exclusive jurisdiction over the order.
If multiple orders governing the same
						obligor, obligee, and child(ren) exist, do not ask a responding UIFSA State to
						prospectively enforce or modify an order unless that order is the "controlling
						order" that has priority under UIFSA. UIFSA contains rules for determining
						which order is recognized when multiple orders exist.
Generally, the CSE Transmittal #1 is used
						to send initial case referrals and the CSE Transmittal #2 is used to
						send/request additional information or action after the initial referral.
						However, since the CSE Transmittal #2 does not contain the necessary
						information needed to request registration of a foreign order, you may use the
						CSE Transmittal #1 to request registration even in a case that has previously
						been referred to the responding jurisdiction. If you are requesting
						registration in a case that has previously been referred to the responding
						jurisdiction, you may send the request directly to the responding entity
						working the case rather than to the responding central registry.
Check item 7 "Collection of Arrears" to
						request collection of arrears. You should request enforcement of arrears under
						all known orders.
Check item 8 "Income Withholding" to
						request interstate income withholding. If the employer's State uses UIFSA, you
						may send a withholding order/notice directly to the out-of-State employer. If
						you prefer, you may still send the CSE Transmittal #1 to send a request for
						withholding in a IV-D case to the IV-D central registry in a responding State.
						In fact, in a IV-D case, if the employer's State does not use UIFSA and your
						State does not have jurisdiction over the employer under State law, you must
						send a request, using the CSE Transmittal #1, to the IV-D central registry in
						the employer's State. Be sure to specify the amount to be withheld. Attach a
						copy of the support order and, if appropriate, a statement of arrears. Attach
						any other documentation required by the responding State (see the Interstate
						Roster and Referral Guide). In some instances, registration of a foreign income
						withholding order or underlying support order may be necessary. To request
						other enforcement techniques, rather than just income withholding, check item 3
						or item 6, as appropriate.
Check item 9 "Administrative Review for
						Federal Tax Offset" to request an administrative review in the responding State
						if a Federal income tax refund offset has been challenged.
Check item 10 "Other" if you are
						requesting a service other than those listed. Describe the service on the blank
						line.
SECTION II (page 1), CASE SUMMARY: Provide
						complete information for all court/administrative actions regarding support for
						dependents. If there are more than three orders, use additional page(s) or
						Section VII. For "Period of Computation", enter the month, day, and year
____________
Instructions for Child Support Enforcement
						Transmittal #1-Initial Request--Page 5
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.
If you believe a particular order is
						controlling under UIFSA, check the box beside "Presumed Controlling Order";
						otherwise leave the box blank. If there are multiple orders governing the same
						obligor, obligee, and child(ren), UIFSA contains rules for determining which
						order is controlling. The responding tribunal will make the final determination
						regarding which order is controlling.
Attach the required number of copies of
						all pertinent orders 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 you 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 III (page 2), 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. List additional information (i.e.,
						phone number changes, relatives' phone numbers, multiple employers or assets)
						in section VII. In cases where the mother is the respondent, the information
						can be used for location purposes if necessary. If the mother's address has
						been confirmed or verified, check the "Address Confirmed" box and indicate the
						date the address was confirmed. If the employer/employer's address has been
						confirmed or verified, check the "Employer Confirmed" box and indicate the date
						the information was confirmed. Verified, current information expedites
						processing of any child support case. However, if information cannot be
						verified, provide last known information.
SECTION IV (page 2), FATHER INFORMATION:
						This section provides basic information about the child(ren)'s father. In a
						case where paternity has not been established, use this section to provide
						information about the alleged 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. List additional
						information (i.e., phone number changes, relatives' phone numbers, multiple
						employers or assets) in section VII. In cases where the father is the
						respondent, the information can be used for location purposes if necessary. If
						the father's address has been confirmed or verified, check the "Address
						Confirmed" box and indicate the date the address was confirmed. If the
						employer/employer's address has been confirmed or verified, check the "Employer
						Confirmed" box and indicate the date the information was confirmed. Verified,
						current information expedites processing of any child support case. However, if
						information cannot be verified, provide last known information.
SECTION V (page 2), 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. Note: if the caretaker does not have a legal
						obligation to contribute to a child's support, information regarding the
						caretaker's employment may be privileged.
SECTION VI (page 2), DEPENDENT CHILDREN
						INFORMATION: List all children for whom support is owed or being sought. For
						each child, provide full name (first, middle, last) date of birth, sex, Social
						Security Number, and State of residence for last 6 months. If additional space
						is needed, use section VII.
____________
Instructions for Child Support Enforcement
						Transmittal #1-Initial Request--Page 6
SECTION VII (page 2), ADDITIONAL CASE
						INFORMATION: In this section, provide additional information which may be
						useful to the responding jurisdiction in working the case, such as pending
						action, amounts reported to credit bureaus, or prior attempts of long-arm
						action. If additional space is needed, attach page(s).
If there is an order preventing disclosure
						of a party's or child's address/identifying information, check the box for
						"Nondisclosure Finding Attached" and attach a copy of the finding. In
						accordance with the finding, do not provide the address/identifying
						information; you may provide a substitute address. A nondisclosure finding
						means a finding that the health, safety, or liberty or a party or child would
						be unreasonably put at risk by disclosure of identifying information (e.g.,
						residential address). UIFSA provides that interstate petitions must include
						certain identifying information regarding the parties and child(ren) unless a
						tribunal (court or agency) makes a nondisclosure finding by ordering that the
						address or identifying information not be disclosed. The procedures for
						obtaining a nondisclosure finding vary from State to State.
SECTION VIII (page 2), ATTACHMENTS: Check
						the appropriate box(es) to indicate all documents attached. For attachments
						other than those listed, check "Other Attachments" and explain in section
						VII.
Attach the required number of copies of
						all pertinent orders 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 you 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.
At the bottom of page 2, provide a
						specific worker's name, a direct telephone number (with extension if necessary)
						and fax number to expedite communications between jurisdictions.
PAGE 3, ACKNOWLEDGMENT: The responding
						jurisdiction completes the Acknowledgments section of page 3 and returns it to
						the initiating jurisdiction. The initiating jurisdiction should not include
						this form in the initial referral packet. This form is intended to be generated
						by the responding jurisdiction in response to its receipt of the transmittal
						packet from the initiating State. In addition to acknowledging receipt of the
						case, the responding jurisdiction may request additional information (a request
						for state-specific forms which substantially duplicate or duplicate in part the
						content or purpose of the standard interstate forms is not allowed) and/or
						report back to the initiating jurisdiction what action/results have occurred
						(e.g., income withholding begun, arrearage reported to credit bureau, case
						closed and reason). The responding jurisdiction must indicate where the case
						has been referred for action, and the name, telephone and fax number of a
						contact person.
**************************************************
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 Child Support Enforcement
						Transmittal #1-Initial Request--Page 7