Form 1 Transmittal 1 - Initial Request

CHILD SUPPORT ENFORCEMENT TRANSMITTAL #1 - INITIAL REQUEST

The information on this form may be disclosed as authorized by law.

If you are not the intended recipient, you are hereby notified that any use, disclosure, distribution,

or copying of this form or its contents is strictly prohibited.

Child Support Agency Confidential Information Form must be attached.

Petitioner: Legal Name (first, middle, last, suffix)

IV-D Case:

[ ] TANF

[ ] IV-E Foster Care

Tribal Affiliation (if applicable)

[ ] Medicaid Only

[ ] Former Assistance

Respondent: Legal Name (first, middle, last, suffix)

[ ] Never Assistance

File Stamp

Tribal Affiliation (if applicable)

Responding Locator Code:

State

To: (Agency Name and Address)

Responding IV-D Case Identifier:

Responding Tribunal Number:

From: (Agency Name and Address)

Initiating Locator Code:

State

Initiating IV-D Case Identifier:

Initiating Tribunal Number:

Send Payments To: (If different from above)

Payment Locator Code:

State

NOTE:

[ ] Nondisclosure Finding/Affidavit attached

[ ] This form sent through EDE

[ ] This request or information sent through CSENet

Section I. Action: The responding jurisdiction should open an intergovernmental case with the initiating jurisdiction and provide

all appropriate services, including: (Please acknowledge receipt of the Transmittal #1.)

1.

[ ] Establish parentage

4.

[ ] Take the following action on a support order of another

2.

[ ] Establish and enforce order, and forward payment to the

jurisdiction and forward payment to the initiating

initiating jurisdiction’s SDU for:

jurisdiction’s SDU:

A.

[ ] Current child support, including medical support

A.

[ ] Register and enforce

B.

[ ] Retroactive child support

B.

[ ] Register, modify, and enforce

C.

[ ] Medical support only

C.

[ ] Register, modify, then close this

3.

[ ] Take the following action(s) on the responding tribunal’s

intergovernmental IV-D case

order and forward payment to the initiating jurisdiction’s SDU:

D.

[ ] Register and enforce arrears only

A.

[ ] Enforce

5.

[ ] Other _________________________________________

B.

[ ] Modify and enforce

C.

[ ] Modify then close this intergovernmental IV-D case

D.

[ ] Enforce arrears only

E.

[ ] Change person/entity entitled to receive funds and enforce

Section II. Case Summary: (Background of this matter: court/administrative actions)

Date of support order

State and county, tribe, or foreign country issuing order

Tribunal number

Support amount/frequency

Date of last payment

Total amount of arrears

Period of computation

$

$

through

[ ] Current Support [ ] Arrears Only

CHILD SUPPORT ENFORCEMENT TRANSMITTAL #1 - INITIAL REQUEST, PAGE 2
Section II. Case Summary (Continued):
Date of support order	State and county, tribe, or foreign country issuing order			Tribunal number
Support amount/frequency	Date of last payment	Total amount of arrears	Period of computation
$		$			thru
[ ] Current Support [ ] Arrears Only
[ ] Additional orders or information attached.

Section III. Obligee Information: [ ] Parent [ ] Caretaker

Obligee legal name (first, middle, last, suffix) _________________________________________________________________________________

If caretaker: relationship to child(ren) ___________________________ [ ] Has legal custody/guardianship of the child(ren)

Section IV. Obligor Information: Obligor legal name (first, middle, last, suffix)___________________________________

Section V. Dependent Child(ren) Information:

Legal Name (first, middle, last, suffix)

VI. Other Pertinent Information:

[ ] Continued on attached sheet(s), incorporated by reference.

VII. Attachments:

(Supporting Documentation)

[ ] Child Support Agency Confidential Information Form for IV-D Use Only

[ ] Uniform Support Petition

[ ] Declaration in Support of Establishing Parentage

[ ] General Testimony

[ ] Personal Information Form for UIFSA § 311

[ ] Support order(s)

[ ] Letter of Transmittal Requesting Registration

[ ] Acknowledgment of parentage

[ ] Payment history

[ ] Birth certificate/birth record

[ ] Arrears balance and/or accrued interest (affidavit of arrears)

[ ] Nondisclosure finding/affidavit

[ ] Arrears calculation (month by month)

[ ] Other attachments

VIII. Contact Information:

( )

Date

Initiating contact person (first, middle, last, suffix)

Direct telephone number and extension

Fax:

( )

E-mail:

Encryption Requirements:

When communicating this form through electronic transmission, precautions must be taken to ensure the security of the data. Child support agencies are encouraged to use the electronic applications provided by the federal Office of Child Support Enforcement. Other electronic means, such as encrypted attachments to e-mails may be used if the encryption method is compliant with Federal Information Processing Standard (FIPS) Publication 140-2 (FIPS PUB 140-2).

INSTRUCTIONS FOR CHILD SUPPORT ENFORCEMENT TRANSMITTAL #1 - INITIAL REQUEST

PURPOSE OF THE FORM:

The CSE Transmittal #1-Initial Request form is required for initiating an intergovernmental case to any responding state’s central registry. It contains basic case information and space for indicating which services are requested. The form can be used to request a number of different actions, including establishment of parentage and/or a support obligation, modification, and/or enforcement. It does not take the place of, and therefore must be accompanied by, the appropriate standard intergovernmental forms (e.g., Uniform Support Petition, Personal Information Form for UIFSA §311, General Testimony, Declaration in Support of Establishing Parentage, Letter of Transmittal Requesting Registration) and supporting documentation. Whenever possible, a Transmittal #1 request should be sent electronically using the appropriate CSENet transaction. However, some states also require a paper Transmittal #1.

The information on this form may be disclosed as authorized by law.

If you are not the intended recipient, you are hereby notified that any use, disclosure, distribution, or copying of this form or its contents is strictly prohibited.

Italicized text that appears within a “box” refers to policy or provides additional information.

For an address outside the United States, be sure to include the foreign country and postal code.

Tribal IV-D programs may choose to use the federal Intergovernmental forms.  However, they are not required to use or accept such forms.  If you have any questions, contact the tribal IV-D agency directly using the contact information on the OCSE website.

If this is a tribal IV-D case, note that tribal locator codes uniquely identify tribal cases with “9” in the first position, 0 (zero) in the second position, and then a 3-character tribal code defined by the Bureau of Indian Affairs (BIA).

The Child Support Agency Confidential Information Form must be attached.

HEADING/CAPTION:

• The initiating jurisdiction determines the heading.

• Identify the petitioner and respondent by full legal name (first, middle, last, suffix) and, if applicable, include the name of the tribe with which the petitioner or respondent is affiliated.

• Check the appropriate box to identify the type of IV-D case: TANF, IV-E foster care, Medicaid only, former assistance, or never assistance.

TANF means the obligee’s family is currently receiving IV-A cash payments. A Medicaid only case is a case in which the obligee’s family receives Medicaid but does not receive TANF. A former assistance case might be a case for state arrears only or for a family that previously received TANF, but is not doing so at this time.

• In the space marked “To:”, list the name and address (street, PO Box, city, state, and zip code) of the agency to which you are sending the CSE Transmittal #1.

Once an initial referral in a IV-D case has been made to the responding state’s central registry (using a CSE Transmittal #1), subsequent communication should occur with the agency/court/jurisdiction that is actually working the case (using a CSE Transmittal #2).

• In the appropriate spaces, enter the responding jurisdiction’s locator code, state, and, if applicable and known, IV-D case identifier and tribunal number.

The responding jurisdiction is the jurisdiction that is working the case at the request of the initiating jurisdiction. Under “IV-D case identifier”, enter the number/identifier identical to the one submitted on the Federal Case

Registry, which is a left-justified up to 15-character alphanumeric field, allowing all characters except asterisk and

backslash, and with all characters in uppercase. Under “tribunal number”, you may enter the docket number, cause number, or any other appropriate reference number that the responding tribunal may use to identify the case, if known.

• In the space marked “From:” list the initiating agency’s name and address (street, PO Box, city, state, and zip code).

The initiating jurisdiction is the jurisdiction that referred the case to the responding jurisdiction for services.

Under “IV-D case identifier”, enter the number/identifier identical to the one submitted on the Federal Case Registry, which is a left-justified up to 15-character alphanumeric field, allowing all characters except asterisk and backslash, and with all characters in uppercase. Under “tribunal number”, you may enter the docket number, cause number, or any other appropriate reference number that the initiating tribunal has assigned to the case.

• In the appropriate spaces, enter the initiating jurisdiction’s locator code, state, IV-D case identifier, and, if applicable, tribunal number.

• In the space marked “Send Payments To:”, list the name and address (street, PO Box, city, state, and zip code) of your agency’s support disbursement unit (SDU) if it is not the same information as listed in “To:” above.

• In the appropriate spaces, enter the locator code and state where payments should be sent.

In the “NOTE:” section, check any of the following that apply:

• Nondisclosure Finding/Affidavit attached – If there is a finding prohibiting disclosure of a party’s or child(ren)’s address/identifying information or an affidavit alleging that disclosure of such information would result in risk of harm, check the box for “Nondisclosure Finding/Affidavit” and attach a copy of the finding/affidavit in accordance with section 312 of UIFSA. If there is a finding/affidavit prohibiting disclosure, the information must be sealed and may not be disclosed to the other party or the public. You may provide the address of the IV-D agency as a substitute address for the protected party.

UIFSA requires that the petition or accompanying documents include certain identifying information regarding the parties and child(ren) (e.g., residential address, social security number) unless a party alleges in an affidavit or a pleading under oath that the health, safety, or liberty of a party or child would be jeopardized by disclosure of such information. In that event, the information must be sealed.

If a jurisdiction has reason to believe that information should not be released because of safety concerns, it should ensure that there is a nondisclosure finding or an allegation in an affidavit or the pleading that disclosure of identifying information would result in a risk or harm, as provided under section 312 of UIFSA. In addition to identifying information included on this form, it may be appropriate to submit certain financial information under seal.

• This form sent through EDE – Check if this form was sent through the Electronic Document Exchange (EDE).

• This request or information sent through CSENet – Check if this request or information was sent through CSENet.

CSENet and EDE transactions are the recommended methods for making requests or sending information to another state. If CSENet is not listed as an option on the form, then it cannot be used to convey any of the requests or information provided on the form.

Supporting documentation should be sent through EDE, whenever possible.

Section I. Action:

Check the appropriate box(es) to indicate which actions are requested. Multiple actions may be requested, as appropriate. You may acknowledge receipt of the Transmittal #1 via CSENet or by returning the separate Transmittal #1 Acknowledgment form.

• Check item 1 “Establish parentage” when parentage has not been legally determined. Be sure to attach a separate “Declaration in Support of Establishing Parentage” for each child whose parentage is at issue.

• Check item 2 “Establish and enforce order, and forward payment to the initiating jurisdiction’s SDU for” to request the establishment of an order. Indicate the type of order by checking the appropriate box(es).

• Check item 2A “Current child support, including medical support” to request the initial establishment of a new child support order.

  

  States may establish child support awards covering a prior period, but such awards must be based on the responding state’s child support guidelines. The award of retroactive 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. The law of the responding state governs the extent to which retroactive support is available. A medical support provision must be included in any new or modified order in a IV-D case.

  
  

  
  

• Check item 2B “Retroactive child support” to request support for a prior period.

• Check item 2C “Medical support only” in a Medicaid case in which a child support order does not exist and is not sought. If seeking to add medical support to an existing child support order, check either item 3.B or 4.B (modify and enforce) depending on whether the order being modified was issued by the responding tribunal or is being registered for modification in the responding jurisdiction.

• Check item 3 “Take the following action(s) on the responding tribunal’s order and forward payment to the initiating jurisdiction’s SDU:” when the responding tribunal has already issued a support order. More than one action can be chosen.

  • Check item 3A “Enforce” to enforce the support order.

  • Check item 3B “Modify and enforce” to modify and enforce the support order.

You may ask a responding state to modify its order if either the obligor, the individual obligee or the child(ren) reside in the responding state and the individual parties have not filed a consent in a record in the responding tribunal for another state to assume jurisdiction to modify. You may ask a responding state to modify its order, even if it is not the residence of the obligor, individual obligee, or the child so long as the parties have consented in a record or in open court that the tribunal may continue to exercise jurisdiction to modify its order. You may also ask a responding state to modify its order if one party resides in another state and the other party resides outside the United States.

• Check item 3C “Modify then close this intergovernmental IV-D case” to modify the support order and then close the IV-D case because additional services are not needed in this intergovernmental case. If you select this action, you are not requesting enforcement or the forwarding of payments. Do not check this box if you want the responding jurisdiction to also enforce the modified order.

• Check item 3D “Enforce arrears only” to enforce the collection of arrears only. Do not check this if you are also requesting enforcement of current support.

• Check item 3E “Change person/entity entitled to receive funds and enforce” to change the person or agency entitled to receive child support payments.

This action is used when the initiating agency asserts that the person/entity entitled to receive child support payments has changed from the person/entity designated in the existing support order due to a change in custody or foster care status. Some IV-D agencies have administrative authority to make the change; in other jurisdictions, a court action is required. The initiating agency should confer with the responding IV-D agency to determine what documentation or pleading is required for the responding jurisdiction to consider the requested action.

• Check item 4 “Take the following action on a support order of another jurisdiction and forward payment to the initiating jurisdiction’s SDU:” when the responding jurisdiction has not issued the support order that you are seeking to modify and/or enforce.

  • Check item 4A “Register and enforce” to register and enforce the support order.

Under section 507(b) of UIFSA, the support enforcement agency, without initially seeking to register the order under Article 6, shall consider and, if appropriate, use any administrative procedure authorized by the law in the responding state to enforce a support order or an income withholding order, or both.

• Check item 4B “Register, modify, and enforce” to register, modify, and enforce the support order. Once the responding jurisdiction modifies the registered order, the responding jurisdiction’s order controls and must be enforced.

Do not ask a responding state to modify the order of another state unless the following facts exist:

• Neither the obligor, the individual obligee, nor the child(ren) resides in the state that issued the order; AND

• The individual seeking to register the order for modification does not reside in the responding state; AND

• The responding state has or may obtain personal jurisdiction over the non-registering party;

OR

• The responding state is the residence of the child, or the responding state has or may obtain personal jurisdiction over an individual party; AND

All of the individual parties have filed consents in a record in the tribunal that issued the order for the tribunal in the responding state to modify the support order and assume continuing, exclusive jurisdiction.

OR

• All of the individual parties reside in the responding state and the child does not reside in the state that issued the order.

• Check item 4C to “Register, modify, then close this intergovernmental IV-D case” to register, modify, then close the IV-D case because additional services are not needed in this intergovernmental case. If you select this action, you are not requesting enforcement or the forwarding of payments. Do not check this box if you want the responding jurisdiction to also enforce the modified order.

• Check item 4D to “Register and enforce arrears only” to enforce the collection of arrears only. Do not check this if you are also requesting enforcement of current support.

Federal regulations allow case closure when the initiating agency has notified the responding agency that its intergovernmental services are no longer needed. An initiating agency must instruct the responding agency to close its interstate case and to stop any withholding order or notice before the initiating state transmits a withholding order or notice, with respect to the same case, to the same or another employer unless the two states reach an alternative agreement on how to proceed.

• Check item 5 “Other” for an action that is not listed and describe the action requested.

Section II. Case Summary:

• NOTE: This is a summary document. Refer to the order for additional information.

• Enter:

• Date of support order

• State and county, tribe, or foreign country issuing order

• Tribunal number

• Support amount/frequency

• Date of last payment

• Total amount of arrears

• Period of computation - enter the month, day, and year for both the beginning and ending dates.

• NOTE: For a breakdown of “Total amount of arrears,” refer to the order and, if applicable, the Letter of Transmittal Requesting Registration.

• Check whether the order is for current support or arrears only.

• Check “Additional orders or information attached” if you are sending more than two orders or additional information to the responding jurisdiction.

This section allows a IV-D agency to include information about more than one order for current support. For example, there may be separate orders for different children involving the same obligor and obligee. The rarer situation will be multiple current support orders that may have been improperly entered. The initiating jurisdiction may use this section to provide information about the multiple orders. It should then check item 5 “Other” under Section I Action and request that the responding jurisdiction determine the validity of the orders.

This section allows a IV-D agency to include information about an arrears only order. For example, in some states, administrative orders for current child support are later superseded by a judicial order in the same state, such as a divorce decree, that does not recognize, incorporate, or modify the administrative order. While under state law the judicial order controls current support, arrears accrued under the superseded administrative order and not included in the judicial order remain collectible under the administrative order. This section also allows the IV-D agency to provide information about the enforceable arrears under the administrative order. It also allows a IV-D agency to provide information about a money judgment for arrears or an order that only addresses support for a prior period.

If sending by mail, attach two copies of the order(s), including one certified copy, which you are asking the responding jurisdiction to enforce. Send only one certified copy, if sending by EDE. Refer to the order for additional information such as effective dates, arrears payment amount, and frequency of payments.

Section III. Obligee Information:

This section provides basic information about the obligee. Check the appropriate box to indicate if the obligee is the parent or caretaker. Provide the obligee’s full legal name (first, middle, last, suffix). If the obligee is the caretaker, indicate the caretaker’s relationship to the child(ren) (e.g., grandmother, cousin). Check “Has legal custody/guardianship of child(ren)” if the caretaker has legal custody/guardianship of the child(ren). Provide all other identifying information about the obligee on the Child Support Agency Confidential Information Form.

Section IV. Obligor Information:

This section provides basic information about the obligor. Provide the obligor’s full legal name (first, middle, last, suffix). Provide all other identifying information about the obligor on the Child Support Agency Confidential Information Form.

Section V. Dependent Child(ren) Information:

List all child(ren) for whom support is owed or being sought. For each child, provide the child’s full legal name (first, middle, last, suffix). Provide all other identifying information about the child(ren) on the Child Support Agency Confidential Information Form.

Section VI. Other Pertinent Information:

In this section, provide additional information that may be useful to the responding jurisdiction. If the information is related to a previous section, identify the section and item number. If additional space is needed, check “Continued on attached sheet(s), incorporated by reference.”

Section VII. Attachments:

Check the appropriate box(es) to indicate all documents attached. For attachments other than those listed, check “Other attachments”.

Section VIII. Contact Information:

At the bottom of page 2, provide a specific contact person’s name, a direct telephone number (with extension if necessary), a fax number, and an e-mail address to expedite communication between jurisdictions.

Encryption Requirements:

When communicating this form through electronic transmission, precautions must be taken to ensure the security of the data. Child support agencies are encouraged to use the electronic applications provided by the federal Office of Child Support Enforcement. Other electronic means, such as encrypted attachments to e-mails may be used if the encryption method is compliant with Federal Information Processing Standard (FIPS) Publication 140-2 (FIPS PUB 140-2).

The Paperwork Reduction Act of 1995 (Pub. L. 104-13)

Public reporting burden for this collection of information is estimated to average 0.21 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.

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.

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Child Support Enforcement Transmittal #1 – Initial Request OMB 0970 – 0085 Expiration Date: XX/XX/XXXX Page 1 of 2