1234567890 Child Support Services Interpreter Authorization I, Type or print your name , Family group number (FGN) , Street address hereby appoint and consent to City State Zip code serving as my interpreter to Name of interpreter (Print) the extent authorized by Child Support Services (CSS) and the Office of Administrative Hearings: Child Support. I authorize the above named person to translate confidential information being discussed on my behalf because: I am not able to understand English. My primary language is and/or I am hearing impaired and cannot communicate orally. I understand this authorization does not allow my interpreter to: · receive documents on my behalf; · negotiate, compromise, or settle my child support case; or · act as my authorized representative in an administrative hearing. I agree to hold CSS and the Oklahoma Department of Human Services harmless for any inaccuracies or unauthorized release of confidential information by the above-named interpreter. ; Customer signature Date I agree to make a true and complete translation of all communications made during the interpretive process to the best of my knowledge and belief per section 2604 of the Oklahoma Statutes (12 O.S. § 2604). I understand the information I interpret is confidential and may not be released unless authorized by federal or state law or rules per 56 O.S. § 183 and Oklahoma Administrative Code 340:25-5-67. Interpreter signature Interpreter street address 03MP003E Revised 12-5-2013 Date City State Zip code American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 03MP003E Purpose of Form Interpreter Authorization Form 03MP003E, Interpreter Authorization, may be used by a Child Support Services (CSS) customer to designate an individual to act as an interpreter on his or her behalf. Form 03MP003E may be used for all designated interpreters other than an Oklahoma Department of Human Services (DHS) employee or contracted interpreter. The customer must pay any cost incurred for a non DHS contracted interpreter. Examples of when the interpreter is used include phone calls, unscheduled or scheduled meetings, and administrative hearings. In hearings held by the Office of Administrative Hearings: Child Support, administrative law judges may administer an oath to an interpreter instead of permitting the use of this form. Limitations of authorization. Form 03MP003E does not authorize the interpreter to receive documents on the customer's behalf, to negotiate, compromise, or settle the child support case, or to act as the authorized representative for the customer in an administrative hearing. A designated interpreter must be at least 18 years of age and cannot be a child or other case participant in the case. A separate form must be completed for each interpreter designated by the customer. An individual may not serve as an interpreter when there is a conflict of interest. For example, a noncustodial parent may not designate a custodial parent as an interpreter. Instructions Enter the name of the custodial person, biological parent, or noncustodial parent who is authorizing the interpreter. Enter the CSS case number, also known as the family group number (FGN). Enter the mailing address of the authorizing customer. Enter the name of the customer authorized interpreter. Sign and date the form. Obtain the interpreter's signature and date signed. Enter the interpreter's street address. Routing of Form The customer keeps a copy of the form for his or her records. The original completed and signed form must be returned to the district child support office before CSS discusses confidential information about the case with the designated interpreter. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 03MP003E Revised 12-5-2013