CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3 226 REQUEST FOR ASSISTANCE/DISCOVERY File Stamp The information o n this form . 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 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 Tribal Affiliation (if applicable) To: (Agency Name and Address) Assisting Locator Code : State Assisting Case Identifier : Assisting Tribunal Number : From: (Agency Name and Address) Requesting Locator Code : State Requesting IV - D Case Identifier : Requesting Tribunal Number : NOTE: [ ] Nondisclosure Finding/Affidavit attached [ ] This form sent t hrough EDE [ ] This request or information sent t hrough CSENet Dependent Child(ren) Information: Legal n ame (s) (first, middle, last, suffix): Section I. Action : The requesting agency asks for the following required limited service(s): 1.003 [ ] Copy of:002 [ ] Support o rder ( s )002 [ ] Must be certified002 [ 003] Payment r ecord ( s )002 [ ] Must be certified002 2. [ ] 003 Assistance with service of p rocess 3. [ ] 003 Assistance with genetic t esting 4. [ ] 003 Assistance with t eleconferen ce for hearing or d eposition 5. [ ]003 Assistance with administrative r eview 6. [ ] 003 Assistance with d iscovery 7. [ ] Assistance with AEI The requesting agency asks for the following limited ser vice ( s ) , which may be provided at s tate option: 8. [ ] 003Assistance with a l ien 9. [ ] 003 Financial data/proof of respondent222s i ncome 10. [ ] 003Other: The requesting agency asks for the following payment processing action: 11.003 [ ] Forward payments received by your agency222s SDU to the requesting agency222s SDU for disbursement. Send payments to: (SDU Name and Address): Payment Locator Code: State Response n eeded by003 (Date) . Child Support Enforcement Transmittal #3 226 Request for Assistance/Discovery OMB 0970 226 0085 Expiration Date: 12/31/2019 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3 226 REQUEST FOR ASSISTANCE/DISCOVERY, PAGE 2002 Section II. Other Pertinent Information : Please Return the Acknowledgment Section III. Contact Information: Date Requesting c ontact p erson (first, middle, last , suffix ) ( ) Direct t elephone n umber and e xtension 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). Child Support Enforcement Transmittal #3 226 Request for Assistance/Discovery OMB 0970 226 0085 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3 226 RE QUEST FOR ASSISTANCE/DISCOVERY ACKNOWLEDGMENT File Stamp The information o n 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. 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 Tribal Affiliation (if applicable) To: (Agency Name and Address) Assisting Locator Code : Assisting Case Identifier : Assisting Tribunal Number : State From: ( Agency Name and Address ) Requesting Locator Code : Requesting IV - D Case Identifier : Requesting Tribunal Number : State NOTE: [ ] Nondisclosure Finding/ Affidavit attached [ ] This form sent t hrough EDE [ ] This request or information sent t hrough CSENet ACKNOWLEDG MENT : To be Completed by Assisting Agency and Returned to Requesting Agency [ ] Request received and no additional information is n ecessary [ ] Additional i nformation n eeded (See r emarks . ) [ ] Remarks/Response [ ] Your request has been forwarded for a ction to: Name of p erson (first, middle, last , suffix ) : Agency n ame : Address : Locator code: Direct t elep hone n umber and e xtension : Fax: ( ) E - mail: Date Person completing f orm (first, middle, last , suffix ) Direct telephone n umber and e xtension 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 emails may be used if the encryption method is compliant with Federal Information Processing Standard (FIPS) Publication 140-2 (FIPS PUB 140-2). Child Support Enforcement Transmittal #3 226 Request for Assistance/Discovery OMB 0970 226 0085 Expiration Date: 12/31/2019 Page 1 of 1 Acknowledgment -Return This Page to the Requesting Agency American LegalNet, Inc. www.FormsWorkFlow.com If this is a tribal IV-D case, note that tribal locator codes uniquely identify tribal cases with 2239224 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). INSTRUCTIONS FOR THE CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3 REQUEST FOR ASSISTANCE/DISCOVERY AND ACKNOWLEDGMENT PURPOSE OF THE FORM: The CSE Transmittal #3 - Request for Assistance/Discovery is designed for use when a IV-D agency needs limited assistance from another IV-D agency, but does not want the other agency to open a IV-D case. Federal law and regulations require all IV-D agencies to cooperate with requests from another state agency for limited services and payment forwarding. Sections 316 and 318 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. Whenever possible, a CSE Transmittal #3 request should be s ent electronically using the appropriate CSENet transaction. When a IV-D agency receives a CSE Transmittal #3 - Request for Assistance/Discovery from another IV-D agency, it should not open an intergovernmental IV-D case. It should only provide the limited assistance requested. By contrast, an initiating jurisdiction should use CSE Transmittal #1 - Initial Request when asking t he responding jurisdiction to open an interstate IV-D case. HEADING/CAPTION: The agency requesting assistance/discovery determines the heading. Note that the heading appears on both the Child Support Enforcement Transmittal #3 and on the Acknowledgment page. 225 Check if a Child Support Agency Confidential Information Form is attached. The Child Support Agency Confidential Information Form will be needed for most actions being requested since most of the identifying information has been removed from the CSE Transmittal #3. 225 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. 225 Check the appropriate box to identify the type of IV-D case: TANF, IV-E foster care, Medicaid only, former assistance, or never assistance. 225 In the space marked 223To:224, list the name and address (street, PO Box, city, state, and zip code) of the agency to which you are sending the CSE Transmittal #3. 225 In the appropriate spaces, if applicable and if known, enter the assisting agency222s locator code, state, case identifier, and tribunal number. The assisting agency is the IV-D agency that is providing services at the request of the requesting agency.