Fill and Sign the Fidm Guidance Document Administration for Children Hhs Form

Child Support Enf orcement Transmit t al # 1 - Init ial RequestOM B No. 0 9 7 0 - 0 0 8 5 Page 1 of 3 CHILD SUPPORT ENFORCEM ENT TRANSM ITTAL # 1 - INITIAL REQUEST Pet it ioner [ ] IV -D Non Public A ssist ance [ ] IV -D Non PA M edicaid [ ] Full Serv ices Respondent [ ] M edical Serv ices Only [ ] IV -D Public A ssist ance [ ] IV -E Fost er Care (IV -D Case) [ ] Non-IV -D File St amp To : (A gency Name and A ddress) Responding FIPS Code ________________ St at e _________________________ Responding IV -D Case No. _____________________ ________________________ Responding Docket No. ________________________ ________________________ From : (Cont act Person, A gency , A ddress, Phone, Fax , Int e rnet ) Init iat ing FIPS Code __________________ St ate __________________________ Init iat ing IV -D Case No. _____________________ ___________________________ Init iat ing Docket No. ________________________ ___________________________ Send Pay ment s To: (if dif f erent f rom abov e) Pay ment FIPS Code ___________________ St at e _________________________ Bank A ccount ________________________ Rout i ng Code _________________ Init iat ing J urisdict ion [ ] URESA [ ] UIFSA St at e w it h Cont inuing Ex clusiv e J urisdict ion ( CEJ ) _______________________ I. Action. The Responding J urisdict ion Should Prov ide A ll A ppr opriat e Serv ices Including: 1 . [ ] Est ablishment of Pat ernit y 6 . [ ] Regist rat ion of Foreign Support Order: 2 . [ ] Est ablishment of Order f or: A . [ ] For Enf orcement Only C. [ ] For M odif icat ion A . [ ] Child Support D. [ ] M edical Cov erage B. [ ] For M odif icat ion and Enf orcement B. [ ] Spousal Support E. [ ] Ot her Cost s (Use Sec. V II) Request ed by : [ ] Obligor [ ] Obligee [ ] St at e A gency C. [ ] Support f or a Prior Period (Requires Sw orn St at ement of A rrears) 3 . [ ] Enf orcement of Responding Tribunal Order 7 . [ ] Collect ion of A rrears 4 . [ ] M odif icat ion of Responding Tribunal Order 8 . [ ] Income W it hholding 5 . [ ] Change of Pay ee/ Redirect ion of Pay ment 9 . [ ] A dminist rat iv e Rev iew f or Federal Tax Of f set Please Ret urn t he A cknow ledgment A t t ached (3 of 3 ) 1 0 . [ ] Ot her __________________________________ II. Case Summary (Background of t his M at t er: Court / A dminist rat iv e A ct ions) Dat e of Support Order St at e & Count y Issuing Order Tribunal Case No. Support A mount / Frequency Dat e of Last Pay ment A mount of A rrears Period of Comput at ion $ $ __________t hru__________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. [ ] Presumed Cont rolling Order [ ] Det ermined Cont rolling Order Dat e of Support Order St at e & Count y Issuing Order Tribunal Case No. Support A mount / Frequency Dat e of Last Pay ment A mount of A rrears Period of Comput at ion $ $ __________t hru__________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Dat e [ ] Presumed Cont rolling Order [ ] Det ermined Cont rolling Order Dat e of Support Order St at e & Count y Issuing Order Tribunal Case No. Support A mount / Frequency Dat e of Last Pay ment A mount of A rrears Period of Comput at ion $ $ __________t hru__________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. [ ] Presumed Cont rolling Order [ ] Det ermined Cont rolling Order Child Support Enf orcement Transmit t al # 1 - Init ial Request Page 2 of 3 CHILD SUPPORT ENFORCEM ENT TRANSM ITTAL # 1 - INITIAL R EQUEST Init iat ing IV -D Case No. III. M other Information [ ] Obligor [ ] Obligee Full Name and A liases A ddress (St reet , Cit y , St at e, Zip) Employ er/ A ddress (Name, St reet , Cit y , St at e, Zip) (First , M iddle, Last ) Home Phone ( ) [ ] A ddress Conf irmed ___________ [ ] Employ er Conf irmed ____________ Dat e Dat e W ork Phone ( ) Dat e/ Place of Birt h______________ ________________ _______ Social Securit y No. _______________________ __ Dat e Place IV . Father Information [ ] Obligor [ ] Obligee Full Name and A liases A ddress (St reet , Cit y , St at e, Zip) Employ er/ A ddress (Name, St reet , Cit y , St at e, Zip) (First , M iddle, Last ) Home Phone ( ) [ ] A ddress Conf irmed ___________ [ ] Employ er Conf irmed ____________ Dat e Dat e W ork Phone ( ) Dat e/ Place of Birt h______________ ________________ _______ Social Securit y No. _______________________ __ Dat e Place V . Caretaker (If Not a Parent) Relat ionship t o Child(ren)_________________________ ________________________ Full Name and A liases A ddress (St reet , Cit y , St at e, Zip) Employ er/ A ddress (Name, St reet , Cit y , St at e, Zip) (First , M iddle, Last ) Home Phone ( ) [ ] A ddress Conf irmed ___________ [ ] Employ er Conf irmed ____________ Dat e Dat e W ork Phone ( ) Dat e/ Place of Birt h_____________ _________________ _____ Sex ____ Social Securit y No. ________________ _______ Dat e Place M / F V I. Dependent Children Information St at e of Residence Full Name (First , M iddle, Last ) Dat e of Birt h Sex Soc ial Securit y No. f or last 6 mont hs V II. Additional Case Information [ ] Nondisclosure Finding A t t ached V III. Attachments (Support ing Document at ion) [ ] A rrears St at ement / Pay ment Hist ory [ ] Support Order(s) [ ] Unif orm Support Pet it ion (3 Copies) [ ] Div orce Decree [ ] General Test imony / A f f idav it [ ] A ssignment of Right s [ ] A f f idav it in Support of Est ablishing Pat ernit y [ ] Descript ion of Real/ Personal Propert y [ ] A cknow ledgment of Parent age [ ] Phot ograph of Respondent [ ] Ot her Document s Relat ing t o Pat ernit y [ ] Ot her A t t achment s _____________________ _________________________ __________________ (________)_________________________ Dat e Init iat ing Cont act Person (Print or Ty pe) Telephone Number & Ex t ension (________)_________________________ Fax Number Child Support Enf orcement Transmit t al # 1 - Init ial Request Ret urn This Page t o t he Init iat ing J urisdict ion Page 3 of 3 CHILD SUPPORT ENFORCEM ENT TRANSM ITTAL # 1 - INITIAL REQUEST Pet it ioner [ ] IV -D Non Public A ssist ance [ ] IV -D Non PA M edicaid [ ] Full Serv ices Respondent [ ] M edical Serv ices Only [ ] IV -D Public A ssist ance [ ] IV -E Fost er Care (IV -D Case) [ ] Non-IV -D File St amp To : (A gency Name and A ddress) Responding FIPS Code ________________ St at e _________________________ Responding IV -D Case No. _____________________ ________________________ Responding Docket No. ________________________ ________________________ From : (Cont act Person, A gency , A ddress, Phone, Fax , Int er net ) Init iat ing FIPS Code __________________ St at e __________________________ Init iat ing IV -D Case No. _____________________ ___________________________ Init iat ing Docket No. ________________________ ___________________________ Send Pay ment s To: (if dif f erent f rom abov e) Pay ment FIPS Code ___________________ St at e _________________________ Bank A ccount ________________________ Rout in g Code __________________ Init iat ing J urisdict ion [ ] URESA [ ] UIFSA St at e w it h Cont inuing Ex clusiv e J urisdict ion ( CEJ ) _______________________ ACKNOW LEDGM ENTS Ret urn This Form t o Init iat ing St at e [ ] Request Receiv ed and No A ddit ional Inf ormat ion is Necessary [ ] A ddit ional Inf ormat ion Needed [ ] A rrears St at ement / Pay ment Hist ory [ ] Support Order(s) [ ] Unif orm Support Pet it ion [ ] Div orce Decree [ ] General Test imony / A f f idav it [ ] A ssignment of Right s [ ] A f f idav it in Support of Est ablishing Pat ernit y [ ] Descript ion of Real/ Personal Propert y [ ] A cknow ledgment of Parent age [ ] Phot ograph of Respondent [ ] Ot her Document s Relat ing t o Pat ernit y [ ] Ot her (See Remarks) [ ] Remarks/ Response [ ] Your Case has been Forw arded f or A ct ion t o: Name of W orker A gency Name A ddress, FIPS Code Phone & Ex t ension Fax ___________________ ____________________________ ____________ (_________)____________________________ Dat e Person Complet ing Form (Print or Ty pe) Telephone Number & Ex t ension (______ ___)____________________________ Fax Number Inst ruct ions f or Child Support Enf orcement Transmitt al # 1 -Init ial Request --Page 1 OM B No. 0 9 7 0 - 0 0 8 5 INSTRUCTIONS FOR CHILD SUPPORT ENFORCEM ENT TRANSM ITTAL # 1 - INITIAL REQUEST PURPOSE OF THE FORM : The CSE Transmit t al # 1 -Init ial Request f orm is a " cov er let t er" required t o ref er IV -D int erst at e cases t o any responding St at e ' s cent ral regist ry . The f orm can also be used in non-IV -D cases. It cont ains basic case inf ormat ion and space f or indicat ing w hich serv ices are request ed. The f orm can be used t o request adminis t rat iv e or legal act ion, including est ablishment of pat ernit y and/ or support obligat ion, modif icat ion, or enf orcement . It does not t ake t he place of , and t heref ore must be accompanied by , t he appropriat e s t andard int erst at e f orms (e. g. Unif orm Support Pet it ion, General Test imony , et c. ) and support ing d ocument at ion. HEA DING/ CA PTION (Pages 1 & 3 ) : The init iat ing jurisdict ion det ermines t he headi ng. Not e t hat t he heading appears on bot h page 1 of t he Child Support Enforcement Transmittal # 1 and on page 3 , t he Acknow ledgment page. # Ident if y t he pet it ioner and respondent in t he appro priat e spaces. # Check t he appropriat e space t o ident if y t he t y pe of case: IV -D Non Public A ssist ance; IV -D Non Public A ssist ance M edicaid (indicat e w het her receiv ing Full Serv ices or M edical Serv ices Only ); IV -D Public A ssist ance; IV -E Fost er Care; or Non IV -D. IV -D means t he case is being w orked by t he St at e or local child support enf orcement agency (i. e. , IV -D agency ). Public A ssist ance means t he obligee' s f amily receiv es IV -A cash pay me nt s [ IV -A w as f ormerly called A id t o Families w it h Dependent Children (A FDC) and is now called Temporary Family A ssist ance] . A IV -D Non Public A ssist ance M edicaid case is a case w here t he obligee' s f amily receiv es M edicaid but does not receiv e Public A ssist ance (IV -A cash pay ment s). # In t he space marked " To: " , list t he name and addres s (st reet , cit y , St at e, and zip code) of t he cent ral regist ry , court , or agency w here y ou are se nding t he CSE Transmit t al # 1 . In IV -D cases, init ial ref errals must be sent t o t he responding St at e' s cent ral regist ry . In non-IV -D cases, cont act t he responding St at e cent ral regist ry t o de t ermine appropriat e procedures. # In t he appropriat e spaces, if applicable and if kno w n, ent er t he Responding jurisdict ion' s FIPS code, St at e, IV -D case number, and docket number. The responding FIPS code is not essent ial f or an init ial IV -D ref erral since y ou w ill be send ing t he case t o t he responding cent ral regist ry . Under " docket number" , y ou may ent er t he docket num ber, cause number, or any ot her appropriat e ref erence number t hat t he responding St at e may use t o ident if y t he case, if know n. # In t he space marked " From: " , list a cont act person, agency name, address (st reet , cit y , St at e, zip code), phone number (including ex t ension), f ax number, and Int ernet address. # In t he appropriat e spaces, ent er t he Init iat ing jur isdict ion' s FIPS code, St at e, IV -D case number, and docket number. Under " docket number" , y ou may ent er t he docket number, cause number, or any ot her appropriat e ref erence number w hich t he init iat ing t ribunal or agency has assigned t o t he case. # In t he space marked " Send Pay ment s To: " ent er t he a ddress t o w hich pay ment s should be sent , if t he address is dif f erent f rom t he agency a ddress prov ided in t he space labelled " From" . Specif y t he case ident if ier if y ou w ant t he respond ing jurisdict ion t o use an ident if ier ot her t han t he init iat ing IV -D case number w hen remit t ing pay m ent s. # In t he appropriat e spaces, ent er t he FIPS code and St at e w here pay ment s should be sent . Inst ruct ions f or Child Support Enf orcement Transmitt al # 1 -Init ial Request --Page 2 # If f unds can be t ransmit t ed elect ronically v ia Elec t ronic Funds Transf er (EFT), ent er t he bank account number under " Bank A ccount " and t he bank ro ut ing code under " Rout ing Code" . # Check t he appropriat e box t o indicat e w het her t he i nit iat ing jurisdict ion uses t he Unif orm Reciprocal Enf orcement of Support A ct (URESA ) or t h e Unif orm Int erst at e Family Support A ct (UIFSA ). # In t he appropriat e space, not e t he St at e w hich y ou believ e has cont inuing ex clusiv e jurisdict ion (CEJ ), if know n. Under UIFSA , a St at e t hat issues a child support order maint ains CEJ as long as t he obligor, obligee, or child(ren) reside in t hat St at e, or unt il each par t y f iles w rit t en consent allow ing anot her St at e t o assume CEJ . If t here are mult iple orders gov erning t he same obligor, obligee, and child(ren), UIFSA cont ains rules f or d et ermining w hich order is cont rolling. The t ribunal t hat issued t he cont rolling order has CEJ as long as t he condit ions f or CEJ are met . CEJ means t he aut horit y t o modif y t he order. SECTION I (page 1 ), A CTION : Check t he appropriat e box (es) t o indicat e w hich act ions are request ed. M ult iple act ions may be request ed, as appropriat e. In IV -D cases , t he responding jurisdict ion should prov ide t he f u ll range of appropriat e serv ices. For ex ample, ev en if t he init iat ing IV -D agency only ch ecks box 1 " Est ablishment of Pat ernit y " , t he responding jurisdict ion should est ablish pat ernit y , est ablish a support order, and enf orce t he support order. # Check item 1 " Est ablishment of Pat ernit y " t o request t hat pat er nit y be est ablished. In a IV -D case, ask anot her St at e t o est ablish pat ernit y only if use of long-arm jurisdict ion is not appropriat e. Be sure t o at t ach an " A f f idav it in Su pport of Est ablishing Pat ernit y " f or each child w hose pat ernit y is at issue. # Check item 2 " Est ablishment of Order" t o request t hat an order be est ablished. Indicat e t he t y pe of order by checking t he appropriat e box . Check item 2 A " Child Support " t o request t he init ial est ablishme nt of a new child support order. If t he responding St at e uses UIFSA and an order gov erning t he same obligor, obligee, and child(ren) already ex ist s, y o u should generally only request est ablishment of a new order if : (1 ) t here is more t han one ex ist ing order, and (2 ) t he obligor, obligee, and child hav e all mov ed out of t he issuing St at es. Check item 2 B " Spousal Support " t o request est ablishment of a sp ousal support order. Do not check t his it em in a IV -D case; est ablishmen t of spousal support is not a IV -D f unct ion. W hen request ing est ablishment of spousal support , cont act t he support enf orcement agency f or t he appropriat e procedure. Check item 2 C " Support f or a Prior Period" t o request est ablishm ent of support f or a prior period. St at es may est ablish child support a w ards cov ering a prior period, but such aw ards must be based on guidelines and t ake in t o considerat ion eit her t he current earnings and income at t he t ime t he order is set , o r t he obligor' s earnings and income during t he prior period. The aw ard of back support is not required under Federal rules but may be appropriat e in accordance w it h St at e law . Not all St at es hav e aut horit y t o est ablish support orders f or prior periods. Check item 2 D " M edical Cov erage" t o request est ablishment of an order t hat prov ides f or t he prov ision of medical insurance or ot her hea lt h care cov erage. M edical support must be request ed in all IV -D Public A ssist ance cas es, all IV -D Non Public A ssist ance Inst ruct ions f or Child Support Enf orcement Transmitt al # 1 -Init ial Request --Page 3 M edicaid cases, and in ot her IV -D Non Public A ssist ance cases w here healt h cov erage is sought . Check item 2 E " Ot her Cost s" t o request an order f or ot her cost s such as: cost s of t he deliv ery of t he child, ot her medical cost s not cov e red by insurance, genet ic t est ing, and at t orney ' s f ees. Describe t he cost s in sect ion V II " A ddit ional Case Inf ormat ion" . # Check item 3 " Enf orcement of Responding Tribunal Order" t o requ est enf orcement of an ex ist ing order t hat w as issued by t he responding t r ibunal. If mult iple orders gov erning t he same obligor, obli gee, and child(ren) ex ist , do not ask a responding UIFSA St at e t o prospect iv ely enf orce (or modif y ) an order unless t hat order is t he " cont rolling order" t hat has priorit y under UIFSA . UIFSA cont ains rules f or det ermining w hich order is recognized w hen mult iple orders ex ist . Under t hese rules: 1 . The order issued by a t ribunal w it h cont inuing, ex c lusiv e jurisdict ion (CEJ ) has priorit y . A n issuing t ribunal ret ains CEJ as long as t he issuing St at e remains t he residence of t he obligor, obligee, or child, or unt il all part ies f ile w rit t en consent w it h t he t ribunal allow ing anot her St at e t o assume CEJ . 2 . If more t han one issuing t ribunal w ould hav e CEJ , t he order issued by t he child' s current home St at e has priorit y . 3 . If more t han one t ribunal w ould hav e CEJ but t here is no order in t he child' s current home St at e, t he most recent ly issued order has prio rit y . 4 . If no t ribunal w ould hav e CEJ , t he responding St at e may issue a new support order and it becomes t he CEJ St at e. # Check item 4 " M odif icat ion of Responding Tribunal Order" t o req uest modif icat ion (or rev iew and adjust ment ) of an ex ist ing order t hat w as issue d by t he responding t ribunal. Do not request a responding UIFSA St at e t o modif y i t s ow n order if t he obligor, obligee, and child(ren) hav e all mov ed out of t hat St at e, or if t he part ies hav e f iled w rit t en consent w it h t he issuing t ribunal in t hat St at e all ow ing anot her St at e t o modif y t he order. If mult iple orders ex ist , do not ask a responding U IFSA St at e t o modif y an order unless t hat order is t he " cont rolling order" t hat has prio rit y under UIFSA . UIFSA cont ains rules f or det ermining w hich order is recognized w hen mult iple orders ex ist . Generally , y ou need t o at t ach a complet ed General T est imony . # Check item 5 " Change of Pay ee/ Redirect ion of Pay ment " t o reques t a change of pay ee or redirect ion of pay ment . Describe y our request in S ect ion V II " A ddit ional Case Inf ormat ion" . " Change of Pay ee" is an administ rat iv e act ion used w hen t he person or agency ent it led t o receiv e f unds has changed. It may occur w it h a cha nge in Public A ssist ance or Fost er Care st at us or a change in cust ody . " Redirect ion of Pay ment " is an administ rat iv e act ion used w hen t he cust odian has mov ed. In some St at es a court ac t ion may be required if t he cust odian' s mov e compels t ransf er of document s or f unds t o anot her jurisdict ion. # Check item 6 " Regist rat ion of Foreign Support Order" t o request regist rat ion of a support order. Orders f rom one St at e may be regist ered in anot her St at e, under UIFSA , URESA , or t he Unif orm Enf orcement of Foreign J udgment s A ct (UEFJ A ). A lso check item 6 A " For Enf orcement Only " , Inst ruct ions f or Child Support Enf orcement Transmitt al # 1 -Init ial Request --Page 4 item 6 B " For M odif icat ion and Enf orcement " or item 6 C " For M odif icat ion" t o indicat e w het her t he regist rat ion is f or enf orcement and/ or modif ica t ion. Check eit her it em 6 B or 6 C if y ou are request ing rev iew and adjust ment of a f oreign order . Check t he appropriat e box t o indicat e w het her regist rat ion is request ed by t he obligor, o bligee, or st at e enf orcement agency . To modif y anot her St at e' s order, a responding St at e must f irst regist er t he order. To enf orce anot her St at e' s order, a responding St at e may hav e t o regist er t he order; UIFSA allow s f or administ rat iv e enf orcement w it hout regis t rat ion (but requires regist rat ion f or ot her enf orcement act ions). W hen request ing regist rat ion, cert ain inf ormat ion o r document s are required. The requirement s f or request ing regist rat ion depend on w het her y ou are regist ering t he order under UIFSA , URESA or UEFJ A or ot her law . To reque st regist rat ion of an order under UIFSA , y ou must include: o A let t er of t ransmit t al t o t he t ribunal request ing regist rat ion f or enf orcement and/ or modif icat ion. The CSE Transmit t al # 1 serv es t his f unct ion. Check t he appropriat e box es in it em 6 of sect ion I t o indicat e t he act ion request ed. o Tw o copies, including one cert if ied copy , of all or ders t o be regist ered, including any modif icat ion of an order. o A sw orn st at ement by t he part y seeking regist rat ion or a cert if ied st at ement by t he cust odian of records show ing t he amount of any arrearage. A t St at e opt ion, page 6 a of t he General Test imony may be used f or t h is purpose. In sect ion V III " A t t achment s" , check t he f irst box (" A rrears St at em ent / Pay ment Hist ory " ) t o indicat e t hat a sw orn st at ement of arrears is at t ac hed. o The name of t he obligor and, if know n: t he obligor' s address and Social Securit y Number; t he name and address of t he obligor' s emplo y er and any ot her source of income of t he obligor; and a descript ion and t he locat ion of propert y of t he obligor in t he responding St at e not ex empt f rom ex e cut ion. Space f or most of t his inf ormat ion is prov ided on t he CSE Transmit t al # 1 . If y ou hav e inf ormat ion about t he obligor' s ot her sources of income or prop ert y , include t he inf ormat ion in sect ion V II or an at t achment . In sect ion V III, check t he box labelled " Descript ion of Real/ Personal Propert y " if a descri pt ion is at t ached. o The name and address of t he obligee. Space f or t hi s inf ormat ion is prov ided on t he CSE Transmit t al # 1 . o If applicable, t he agency or person t o w hom support pay ment s are t o be remit t ed. Space f or t his inf ormat ion is included i n t he heading of t he CSE Transmit t al # 1 . In addit ion, t o allow t he responding St at e t o est ab lish a IV -D case, y ou w ill probably need t o complet e all ot her inf ormat ion on t he CSE T ransmit t al # 1 , part icularly inf ormat ion regarding t he children. Furt hermore, w hen request ing regist rat ion f or modif icat ion, y ou generally need t o at t ach a complet ed Unif orm Support Pet it ion and General Te st imony . Inst ruct ions f or Child Support Enf orcement Transmitt al # 1 -Init ial Request --Page 5 Do not ask a responding UIFSA St at e t o modif y anot h er St at e' s order unless: o (1 ) t he child(ren), obligee, and obligor do not liv e in t he St at e t hat issued t he order; (2 ) t he part y seeking modif icat ion does not liv e in t he responding St at e; and (3 ) t he responding St at e has personal jurisdict ion ov er t he ot her part y (t he part y not request ing modif icat ion). OR o The responding St at e has personal jurisdict ion ov er t he obligor, obligee, or child(ren), and t he obligor and obligee hav e f iled w rit t en consent in t he t ribunal t hat issued t he order prov iding t hat t he responding St at e may modif y t he support order and assume cont inuing, ex clusiv e juri sdict ion ov er t he order. If mult iple orders gov erning t he same obligor, obli gee, and child(ren) ex ist , do not ask a responding UIFSA St at e t o prospect iv ely enf orce or modif y an order unless t hat order is t he " cont rolling order" t hat has priorit y under UIF SA . UIFSA cont ains rules f or det ermining w hich order is recognized w hen mult iple orders ex ist . Generally , t he CSE Transmit t al # 1 is used t o send i nit ial case ref errals and t he CSE Transmit t al # 2 is used t o send/ request addit ional i nf ormat ion or act ion af t er t he init ial ref erral. How ev er, since t he CSE Transmit t al # 2 do es not cont ain t he necessary inf ormat ion needed t o request regist rat ion of a f or eign order, y ou may use t he CSE Transmit t al # 1 t o request regist rat ion ev en in a ca se t hat has prev iously been ref erred t o t he responding jurisdict ion. If y ou are request ing regist rat ion in a case t hat has prev iously been ref erred t o t he responding jurisdic t ion, y ou may send t he request direct ly t o t he responding ent it y w orking t he case rat her t han t o t he responding cent ral regist ry . # Check item 7 " Collect ion of A rrears" t o request collect ion of a rrears. You should request enf orcement of arrears under all know n orders. # Check item 8 " Income W it hholding" t o request int erst at e income w it hholding. If t he employ er' s St at e uses UIFSA , y ou may send a w it hholding order/ not ice direct ly t o t he out -of -St at e employ er. If y ou pref er, y ou may st ill send t he CS E Transmit t al # 1 t o send a request f or w it hholding in a IV -D case t o t he IV -D cent ral regi st ry in a responding St at e. In f act , in a IV -D case, if t he employ er' s St at e does not use UIFSA an d y our St at e does not hav e jurisdict ion ov er t he employ er under St at e law , y ou must send a request , using t he CSE Transmit t al # 1 , t o t he IV -D cent ral regist ry in t he employ er' s St at e. Be sure t o specif y t he amount t o be w it hheld. A t t ach a copy of t he support order and, if appropri at e, a st at ement of arrears. A t t ach any ot her document at ion required by t he responding St at e (see t he Int erst at e Rost er and Ref erral Guide ). In some inst ances, regist rat ion of a f oreign in come w it hholding order or underly ing support order may be necessary . To request ot her e nf orcement t echniques, rat her t han just income w it hholding, check it em 3 or it em 6 , as appr opriat e. # Check item 9 " A dminist rat iv e Rev iew f or Federal Tax Of f set " t o request an administ rat iv e rev iew in t he responding St at e if a Federal income t ax ref und of f set has been challenged. # Check item 1 0 " Ot her" if y ou are request ing a serv ice ot her t han t hose list ed. Describe t he serv ice on t he blank line. SECTION II (page 1 ), CA SE SUM M A RY : Prov ide complet e inf ormat ion f or all court / admin ist rat iv e act ions regarding support f or dependent s. If t here are more t han t hree orders, use addit ional page(s) or Sect ion V II. For " Period of Comput at ion" , ent er t he mont h, day , and y ear f or bot h t he beginning Inst ruct ions f or Child Support Enf orcement Transmitt al # 1 -Init ial Request --Page 6 and ending dat es. The inf ormat ion in t his sect ion w ill be used t o aid in v erif y ing calculat ed arrearages and t o assist in det ermining/ v erif y ing w hich order is cont rolling and w hich St at e has cont inuing ex clusiv e jurisdict ion. If y ou believ e a part icular order is cont rolling un der UIFSA , check t he box beside " Presumed Cont rolli ng Order" ; ot herw ise leav e t he box blank. If t here ar e mult iple orders gov erning t he same obligor, oblig ee, and child(ren), UIFSA cont ains rules f or det erminin g w hich order is cont rolling. The responding t ribunal w ill make t he f inal det erminat ion regarding w hich o rder is cont rolling. A t t ach t he required number of copies of all pert ine nt orders t hat relat e t o support . If y ou are sending t his case t o a St at e t hat uses UIFSA , y ou w ill gene rally need t o at t ach t w o copies, one of w hich is cert if ied, of any support order. If y ou are sendin g t his case t o a St at e t hat uses a v ersion of URESA , y ou w ill generally need t o at t ach t hree cert if ied c opies of any support order. Not e, how ev er, t hat some responding St at es may be able t o t ake cert ain administ rat iv e enf orcement act ions (e. g. , int erst at e w age w it hholding) w it hout hav ing a cert if ied copy of t he order, alt hough a regular copy is necessary . SECTION III (page 2 ), M OTHER INFORM A TION : This sect ion prov ides basic inf ormat ion about t h e child(ren)' s mot her. Check t he appropriat e box t o indicat e if t he mot her is t he obligor or obligee. Prov ide t he mot her' s f ull name (f irst , middle, last ) as w ell as aliases or maiden name, and all ot her inf ormat ion. List addit ional inf ormat ion (i. e. , ph one number changes, relat iv es' phone numbers, mult iple employ ers or asset s) in sect ion V II. In c ases w here t he mot her is t he respondent , t he inf ormat ion can be used f or locat ion purposes if ne cessary . If t he mot her' s address has been conf irmed or v erif ied, check t he " A ddress Conf irmed " box and indicat e t he dat e t he address w as conf irmed. If t he employ er/ employ er' s address has been conf irmed or v erif ied, check t he " Employ er Conf irmed" box and indicat e t he dat e t he inf ormat io n w as conf irmed. V erif ied, current inf ormat ion ex pedit es processing of any child support case. Ho w ev er, if inf ormat ion cannot be v erif ied, prov ide last know n inf ormat ion. SECTION IV (page 2 ), FA THER INFORM A TION : This sect ion prov ides basic inf ormat ion about t h e child(ren)' s f at her. In a case w here pat ernit y has not been est ablished, use t his sect ion t o prov ide inf ormat ion about t he alleged f at her. Check t he appropriat e box t o indicat e if t he f at her is t he obligor or obligee. Prov ide t he f at her' s f ull name (f irst , middle, last ) as w ell as aliases, and all ot her inf ormat ion. List addit ional inf ormat ion (i. e. , ph one number changes, relat iv es' phone numbers, mult iple employ ers or asset s) in sect ion V II. In c ases w here t he f at her is t he respondent , t he inf ormat ion can be used f or locat ion purposes if ne cessary . If t he f at her' s address has been conf irmed or v erif ied, check t he " A ddress Conf irmed" box and indicat e t he dat e t he address w as conf irmed. If t he employ er/ employ er' s address has been conf irmed or v erif ied, check t he " Employ er Conf irmed" box and indicat e t he dat e t he inf ormat ion w as conf irmed . V erif ied, current inf ormat ion ex pedit es processing of any child support case. How ev er, if inf ormat ion cannot be v erif ied, prov ide last know n inf ormat ion. SECTION V (page 2 ), CA RETA KER (IF NOT A PA RENT) : Complet e t his sect ion only if t he child(ren)' s caret aker is not t he child(ren)' s parent . In t he s pace labelled " Relat ionship t o Child(ren)" , indicat e t he relat ionship of t he caret aker t o t he child(ren). P rov ide t he caret aker' s f ull name (f irst , middle, la st ) as w ell as aliases or maiden name, and all ot her inf or mat ion. Not e: if t he caret aker does not hav e a leg al obligat ion t o cont ribut e t o a child' s support , inf o rmat ion regarding t he caret aker' s employ ment may be priv ileged. SECTION V I (page 2 ), DEPENDENT CHILDREN INFORM A TION : List all children f or w hom support is ow ed or being sought . For each child, prov ide f ull name (f irst , middle, last ), dat e of birt h, sex , Social Securit y Number, and St at e of residence f or last 6 mont hs. If addit ional space is needed, use sect ion V II. Inst ruct ions f or Child Support Enf orcement Transmitt al # 1 -Init ial Request --Page 7 SECTION V II (page 2 ), A DDITIONA L CA SE INFORM A TION : In t his sect ion, prov ide addit ional inf ormat ion w hich may be usef ul t o t he responding j urisdict ion in w orking t he case, such as pending act ion, amount s report ed t o credit bureaus, or prio r at t empt s of long-arm act ion. If addit ional space is needed, at t ach page(s). If t here is an order prev ent ing disclosure of a par t y ' s or child' s address/ ident if y ing inf ormat ion, ch eck t he box f or " Nondisclosure Finding A t t ached" and at t ach a copy of t he f inding. In accordance w it h t he f inding, do not prov ide t he address/ ident if y ing inf ormat ion; y ou may prov ide a subst it ut e address. A nondisclosure f inding means a f inding t hat t he he alt h, saf et y , or libert y of a part y or child w ould be unreasonably put at risk by disclosure of ident if y i ng inf ormat ion (e. g. , resident ial address). UIFSA prov ides t hat int erst at e pet it ions must include cer t ain ident if y ing inf ormat ion regarding t he part ies and child(ren) unless a t ribunal (court or agency ) make s a nondisclosure f inding by ordering t hat t he address or ident if y ing inf ormat ion not be disclosed . The procedures f or obt aining a nondisclosure f inding v ary f rom St at e t o St at e. SECTION V III (page 2 ), A TTA CHM ENTS : Check t he appropriat e box (es) t o indicat e all do cument s at t ached. For at t achment s ot her t han t hose list ed, check " Ot her A t t achment s" and ex plain in sect ion V II. A t t ach t he required number of copies of all pert ine nt orders t hat relat e t o support . If y ou are sending t his case t o a St at e t hat uses UIFSA , y ou w ill gene rally need t o at t ach t w o copies, one of w hich is cert if ied, of any support order. If y ou are sendin g t his case t o a St at e t hat uses a v ersion of URESA y ou w ill generally need t o at t ach t hree cert if ied c opies of any support order. Not e, how ev er, t hat some responding St at es may be able t o t ake cert ain administ rat iv e enf orcement act ions (e. g. , int erst at e w age w it hholding) w it hout hav ing a cert if ied copy of t he order, alt hough a regular copy is necessary . A t t he bot t om of page 2 , prov ide a specif ic w orker' s name, a direct t elephone number (w it h ex t ension if necessary ) and f ax number t o ex pedit e communicat ions bet w een jurisdict ions. PA GE 3 , A CKNOW LEDGM ENT : The responding jurisdict ion complet es t he A cknow ledgment s sect ion of page 3 and ret urns it t o t he init iat ing jurisdic t ion. The init iat ing jurisdict ion should not include t his f orm in t he init ial ref erral packet . This f orm is int ended t o be generat ed by t he responding jurisdic t ion in response t o it s receipt of t he t ransmit t al packe t f rom t he init iat ing St at e. In addit ion t o acknow ledging receipt of t he case, t he responding j urisdict ion may request addit ional inf ormat ion (a request f or st at e-specif ic f orms w hich subst ant iall y duplicat e or duplicat e in part t he cont ent or purpose of t he st andard int erst at e f orms is not all ow ed) and/ or report back t o t he init iat ing jurisdict ion w hat act ion/ result s hav e occurred (e. g. , income w it hholding begun, arrearage report ed t o credit bureau, case closed and reason). The responding ju risdict ion must indicat e w here t he case has been ref erred f or act ion, and t he name, t elephone and f a x number of a cont act person. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * The Paperw ork Reduct ion A ct of 1 9 9 5 This inf ormat ion collect ion is conduct ed in accorda nce w it h 4 5 CFR 3 0 3 . 7 of t he child support enf orcement program. St andard f orms are designed t o prov ide unif ormit y and st andardizat ion f or int erst at e case processing. Public report ing burde n f or t his collect ion of inf ormat ion is est imat ed to av erage one hour per response. The responses t o t h is collect ion are mandat ory in accordance w it h 4 5 CFR 3 0 3 . 7 . This inf ormat ion is subject t o St at e an d Federal conf ident ialit y requirement s; how ev er, t he inf ormat ion w ill be f iled w it h t he t ribunal and/ or agency in t he responding St at e and may , depending on St at e law , be disclosed t o ot her part ies. A n ag ency may not conduct or sponsor, and a person is not required t o respond t o, a collect ion of inf orma t ion unless it display s a current ly v alid OM B cont rol number.