CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3 - REQUEST FOR ASSISTANCE/DISCOVERY Petitioner Name, SSN IV-D Case: Respondent Name, SSN, Verified Address [ [ [ [ [ ] TANF ] IV-E Foster Care ] Medicaid Only ] Former Assistance ] Never Assistance Non-IV-D Case: [ ] File Stamp Children's Legal Names To: (Agency/Tribunal Name and Address) Responding FIPS Code State Responding IV-D Case No. Responding Tribunal No. From: (Contact Person, Agency, Address, Phone, Fax, E-mail) Initiating FIPS Code State Initiating IV-D Case No. Initiating Tribunal No. Response Needed by _____________________(Date) I. Action 1. [ ] Provide/Obtain Copies of Documentation [ ] Certified Copies of Orders [ ] Financial Statement [ ] Payment Records [ ] Other 2. [ ] Provide Assistance with Service of Process (See Attached) (See Section II and/or Attached) 3. [ ] Provide Assistance with Genetic Testing 4. [ ] Obtain Answers for Interrogatories (See Attached) 5. [ ] Provide Assistance with Teleconference for Hearing or Deposition (See Attached) (See Section II and/or Attached) 6. [ ] Obtain Financial Data/Proof of Respondent's Income 7. [ ] Obtain Party Signature on Attached Form (See Attached) 8. [ ] Provide Assistance with a Lien (See Attached) 9. [ ] File a Notice of Determination of Controlling Order with An Order-Issuing Tribunal 10. [ ] Other: ___________________________________________________________________________ Please Return the Acknowledgment Attached II. Additional Information [ ] Nondisclosure Finding Attached ___________________ Date Fax: [ ] Verified Address of Employer: _______________________________________ Initiating Contact Person (Print or Type) (_________)_______________________________ Child Support Enforcement Transmittal #3 - Request for Assistance/Discovery (_________)______________________ Telephone Number & Extension E-mail:______________________ OMB No. 0970 - 0085 Expiration Date: 01/31/2008 Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3 - REQUEST FOR ASSISTANCE/DISCOVERY IV-D Case: [ ] TANF Petitioner Name, SSN [ ] IV-E Foster Care [ ] Medicaid Only Respondent Name, SSN, Verified Address [ ] Former Assistance [ ] Never Assistance Non-IV-D Case: [ ] File Stamp To: (Agency Name and Address) Responding FIPS Code State Responding IV-D Case No. Responding Tribunal No. From: (Contact Person, Agency, Address, Phone, Fax, E-mail) Initiating FIPS Code State Initiating IV-D Case No. Initiating Tribunal No. ACKNOWLEDGMENTS [ ] To be Completed by Responding Agency and Returned to Initiating Agency Request Received and No Additional Information is Necessary [ ] Additional Information Needed (See Remarks) [ ] Remarks/Response [ ] Your Case has been Forwarded for Action to: Name of Worker Agency Name Address, FIPS Code Phone & Extension Fax ( Date Fax: ( Person Completing Form (Print or Type) ) ) Telephone Number & Extension E-mail: Child Support Enforcement Transmittal #3 - Request for Assistance Discovery Return This Page to the Initiating Jurisdiction Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com INSTRUCTIONS FOR CHILD SUPPORT TRANSMITTAL #3 - REQUEST FOR ASSISTANCE/DISCOVERY PURPOSE OF THE FORM: The CSE Transmittal #3-Request for Assistance/Discovery is designed for use when the requesting jurisdiction is working its case locally (e.g., by long-arm jurisdiction) and needs limited assistance from another jurisdiction, but does not want the other jurisdiction to open a IV-D case. Sections 316 and 318 of the model version of UIFSA contain specific provisions that allow a tribunal to receive evidence from another State and to obtain discovery through a tribunal of another State. The form may be sent electronically using the appropriate CSENet transaction. When a jurisdiction receives a CSE Transmittal #3-Request for Assistance/Discovery from another jurisdiction, it should not open a IV-D case; it should only provide the limited assistance requested. By contrast, the CSE Transmittal #1-Initial Request is designed for use when the initiating State is requesting the responding State to open a IV-D case. HEADING/CAPTION (Pages 1 & 2): The jurisdiction requesting assistance/discovery determines the heading. Note that the heading appears on both page 1 of the Child Support Enforcement Transmittal #3 and on page 2, the Acknowledgment page. Identify the petitioner and respondent name and Social Security number in the appropriate spaces. The jurisdiction requesting assistance/discovery should include a verified address for the respondent, if necessary for responding to the request, or if known. Enter the children’s legal names to assist the responding State in discussing the request with the noncustodial parent. Check the appropriate space to identify the type of case: TANF; IV-E Foster Care, Medicaid only; former assistance, never assistance, or Non-IV-D. TANF means the obligee's family receives IV-A cash payments. A Medicaid only case is a case where the obligee's family receives Medicaid but does not receive TANF (IV-A cash payments). In the space marked "To:", list the name and address (street, city, State, and zip code) of the agency or court where you are sending the CSE Transmittal #3. In the appropriate spaces, if applicable and if known, enter the Responding jurisdiction's FIPS code, State, IV-D case number, and tribunal number. Under “IV-D case number”, enter the number/identifier identical to the one submitted on the Federal Case Registry, which is a left-justified 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 State may use to identify the case, if known. The "responding" jurisdiction is the jurisdiction that receives the request for assistance. In the space marked "From:", list a contact person, agency name, address (street, city, State, zip code), phone number (including extension), fax number, and e-mail address. In the appropriate spaces, enter the Initiating jurisdiction's FIPS code, State, IV-D case number, and tribunal number. Under “IV-D case number”, enter the number/identifier identical to the one submitted on the Federal Case Registry, which is a left-justified 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 which the initiating tribunal or agency has assigned to the case. The "initiating" jurisdiction is the jurisdiction that is requesting assistance. In the space marked "Response Needed by" enter the date by which a response is needed. Child Support Enforcement Transmittal #3 - Request for Assistance/Discovery Page 1 of 3 American LegalNet, Inc. www.USCourtForms.com SECTION I, ACTION: Check the appropriate box(es) to indicate which actions are requested. Multiple actions may be requested, as appropriate. Check item 1 "Provide/Obtain Copies of Documentation" to request copies of documentation. Check appropriate box(es) to indicate the type of documentation: certified copies of orders, payment records, financial statement, or other (describe on blank line). In Section II "Additional Information", describe your request and provide background information necessary to identify the requested documents. Check item 2 "Provide Assistance with Service of Process" if you are requesting assistance with service of process. You may directly contact (via phone, fax, or other means) the sheriff, or other appropriate official, in another jurisdiction to request personal service of process. Send the Request for Assistance/Discovery only if such attempts have been unsuccessful. Attach such documentation as necessary for service of process. Check item 3 "Provide Assistance with Genetic Testing" if you are requesting assistance with genetic testing. Include in section II or attach any necessary information or materials, including names of genetic testing laboratories, protocols to be followed, testing kits, etc. Check item 4 "Obtain Answers for Interrogatories" if you are requesting completion of interrogatories. Attach the interrogatories. Check item 5 "Provide Assistance with Teleconference for Hearing or Deposition" if you are requesting assistance in scheduling a teleconference for a hearing or deposition. Attach copy of hearing notice or deposition. Check item 6 "Obtain Financial Data/Proof of Respondent's Income" if you are requesting financial data or proof of the respondent's income. Explain your request in Section II or an attachment. Check item 7 "Obtain Party Signature on Attached Form" if you are requesting assistance in obtaining a signature. Attach forms which require signatures. Request assistance with obtaining a signature only after you have attempted and failed to obtain the signature yourself. Check item 8 "Provide Assistance with a Lien" if you are requesting help with a lien/levy action. Prior to using Transmittal #3 for this purpose, contact the assisting State and provide all additional information and documents needed. If the assisting State requires "full" case information or documentation, use Transmittal #1 instead. Check item 9 "File a Notice of Determination of Controlling Order with An Order-Issuing Tribunal" if the requesting State issued an order that contributed to a determination process. Attach a copy of the Notice of Determination of Controlling Order and a certified copy of the determination itself and any arrears reconciliation order. Check item 10 "Other" if the reason you are requesting assistance or discovery is not listed above. On the blank line, indicate the assistance needed; be as specific as possible. If you are requesting only "quick locate", do not use this form. Instead, use the Locate Data Sheet, or CSENet if you are using an electronic format. If you are requesting that the tribunal in the other State compel a person over whom it has jurisdiction to respond to a discovery order issued by a tribunal of another State (in accordance with section 318 of the model version of UIFSA), attach certified copies of the discovery order. Child Support Enforcement Transmittal #3 - Request for Assistance/Discovery Page 2 of 3 American LegalNet, Inc. www.USCourtForms.com SECTION II, ADDITIONAL INFORMATION: In a narrative format, indicate any other information that will be useful in processing your request. Provide any necessary identifying information and background information about why the request is being made, including: (1) information on the nature of the pending action (e.g., paternity, support, modification, enforcement, etc.) and (2) the reason assistance from the other jurisdiction is needed. If you have a verified employer address, include it in Section II. 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 of 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. At the bottom of page 1, provide a specific worker's name, a direct telephone number (with extension if necessary) fax number and e-mail address to expedite communications between jurisdictions. PAGE 2, ACKNOWLEDGMENT: The jurisdiction requesting assistance/discovery completes the Heading/Caption on this page. Upon receiving a request for assistance on a Transmittal #3, the receiving State completes the rest of the acknowledgment. The acknowledgment can be used to provide information in response to a request received via the Transmittal #3, or to indicate when (how many days or on what date) the requested information/action will be provided. The jurisdiction sending the acknowledgment should indicate where the case has been referred for action, and the name, telephone, fax number and email address of a contact person. ******************************************* The Paperwork Reduction Act of 1995 This information collection is conducted in accordance with 42 U.S.C. 651 et seq. and 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 under half an hour per response. The responses to this collection are mandatory in accordance with the above statute and regulation. 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. Child Support Enforcement Transmittal #3 - Request for Assistance/Discovery Page 3 of 3 American LegalNet, Inc. www.USCourtForms.com