NOTICE OF DETERMINATION OF CONTROLLING ORDER File Stamp 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. Date of Notice: IV-D Case: [ ] TANF [ ] IV-E Foster Care Obligor: Legal n[ ] Medicaid Only [ ] Former Assistance [ ] Never Assistance Obligee: Legal name (first, middle, last, suffix) Non-IV-D Case: [ ] To: (Agency Name and Address) Responding Locator Code: State 002 Responding IV-D Case Identifier: 002 Responding Tribunal Number: 002 From: (Agency Name and Address) Initiating Locator Code: Initiating IV-D Case Identifier: 002 Initiating Tribunal Number: 002 NOTE:002 [ ] This f orm s ent through EDE002 1. On (date), (tribunal name, county, state) determined which order to recognize for prospective enforcement. The following orders were considered: # County State Date of Order IV-D Case Identifier 2. Check which option applies: [ ] The tribunal determined that order number (enter number) listed above is the controlling order forprospective support. [ 003] The tribunal determined that none of the existing orders is the controlling order for prospective support.002 A new controlling order was entered; a certified copy is attached.002 3. Because it issued the controlling order, the law of (state) governs the duration of the support obligation. 4. $ per (frequency) is the current support 5. The tribunal reconciled arrears and calculated them to be $ as of (date). A certified copy of the order reconciling arrears is attached. Notice of Determination of Controlling Order OMB 0970 226 0085 Expiration Date: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com NOTICE OF DETERMINATION OF CONTROLLING ORDER, PAGE 2002 6.A copy of this notice was sent to all tribunals listed in the table above together with a certified copy of the controlling orderdetermination and arrears reconciliation order.Check to confirm that the notice and order were also sent to: [ ] IV -D agencies in all states listed in the table above [ ] Obligee [ ] Obligor [ ] The following entities: (If additional space is needed, attach a separate sheet.) (Entity name, state) (Entity name, state) (Entity name, state) (Entity n ame, s tate) 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). Notice of Determination of Controlling Order003 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR THE NOTICE OF DETERMINATION OF CONTROLLING ORDER PURPOSE OF THE FORM: This notice provides a standard format for alerting entities in other jurisdictions that a controlling order determination has been completed by your tribunal. The actual determination will likely be in a state-specific format (e.g., order or form), which may be attached to the standard Notice of Determination of Controlling Order. Complete this notice when your state222s tribunal makes a determination of controlling order. UIFSA includes provisions to ensure that there is only one valid order between the parties that controls the amount of current support. The need for a determination of controlling order should be rare because there are few cases where there are still multiple valid orders with a current support obligation. You must use the Notice of Determination of Controlling Order to notify: 225003 The initiating IV-D agency if you are acting as a responding jurisdiction in an interstate action; 225003 Any tribunal that issued, registered, or is enforcing a child support order governing the same obligor and child(ren); 225003 Any IV-D agency with an open or a closed IV-D case for the parties; 225003 A party to the order (i.e., the obligor or obligee), as appropriate; HEADING/CAPTION: 225003 Enter the date the notice was issued. 225003 Identify the obligor and obligee by full legal name (first, middle, last, suffix) in the appropriate spaces. 225003 Check the appropriate box to identify the type of IV-D case: TANF, IV-E foster care, Medicaid only, former assistance, never assistance, or non-IV-D. 225003 In the space marked 223To:224, list the name and address (street, PO Box, city, state, and zip code) of the court or agency to which you are sending the Notice of Determination of Controlling Order. 225003 In the appropriate spaces, if applicable and if known, enter the responding jurisdiction222s locator code, state, IV-D case identifier, and tribunal number. The initiating jurisdiction is the jurisdiction that referred the case to the responding jurisdiction for services. Under 223IV-D case identifier224, 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 223tribunal number224, you may enter the docket number, cause number, or any other appropriate reference number that the initiating tribunal has assigned to the case. Italicized text that appears within a 223box224 refers to policy or provides additional information. TANF means the obligee222s family is currently receiving IV-A cash payments. A Medicaid only case is a case in which the obligee222s 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. The responding jurisdiction is the jurisdiction that is working the case at the request of the initiating jurisdiction. Under 223IV-D case identifier224, 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 223tribunal number224, 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. 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. Where forms request a locator code, 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). 225003 In the space marked 223From:224, list the contact person, agency name, address (street, PO Box, city, state, zip code), direct telephone number (including extension), fax number, and e-mail address. 225003 In the appropriate spaces enter the initiating jurisdiction222s locator code, state, IV-D case identifier, and, if applicable, tribunal number. Notice of Determination of Controlling Order003 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com In the 223NOTE:224 section, check any of the following that apply: 003 Check 223This form sent through EDE224 if this form was sent through the Electronic Document Exchange (EDE). The following options are available for making IV-D requests and sending information on IV-D cases: 1.003 CSENet transactions are the recommended method 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 for information or IV-D requests provided on the form. Supporting documentation should be sent through EDE, whenever possible. If certified copies are needed, hard copies should also be sent by mail. Mail or fax may also be used for all docu