Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Child Support Enforcement Transmittal - Request For Assistance Or Discovery Form. This is a Virginia form and can be use in District Court Statewide.
Loading PDF...
Tags: Child Support Enforcement Transmittal - Request For Assistance Or Discovery, OMB-085C, Virginia Statewide, District Court
CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3 - REQUEST FOR ASSISTANCE/DISCOVERY
Petitioner: Name (first, middle, last)
Social Security Number
Tribal Affiliation (if applicable)
IV-D Case: [
[
[
[
[
Non-IV-D Case: [ ]
Respondent: Name (first, middle, last)
Social Security Number
Tribal Affiliation (if applicable)
To:
] TANF
] IV-E Foster Care
] Medicaid Only
] Former Assistance
] Never Assistance
File Stamp
Responding FIPS Code
(Agency Name and Address)
State
Responding IV-D Case Number
Responding Tribunal Number
From:
(Contact Person, Agency, Address, Phone, FAX, E-mail)
Initiating FIPS Code
Send Payments To:
State
Initiating IV-D Case Number
(if different from above)
Initiating Tribunal Number
Response Needed by _____________________(Date)
Children's Legal Names (first, middle, last)
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)
3. [ ] Provide Assistance with Genetic Testing
(See Section II and/or Attached)
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 (first, middle, last)
(_________)_______________________________
Child Support Enforcement Transmittal #3 - Request for Assistance/Discovery
Telephone Number & Extension
E-mail:______________________
OMB 0970 - 0085
Expiration Date: 01/31/2011
Page 1 of 2
American LegalNet, Inc.
www.FormsWorkflow.com
CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3 - REQUEST FOR ASSISTANCE/DISCOVERY
Petitioner: Name (first, middle, last)
Social Security Number
Tribal Affiliation (if applicable)
IV-D Case: [
[
[
[
[
Non-IV-D Case: [ ]
Respondent: Name (first, middle, last)
Social Security Number
Tribal Affiliation (if applicable)
To:
] TANF
] IV-E Foster Care
] Medicaid Only
] Former Assistance
] Never Assistance
File Stamp
Responding FIPS Code
(Agency Name and Address)
State
Responding IV-D Case Number
Responding Tribunal Number
From:
(Contact Person, Agency, Address, Phone, FAX, E-mail)
Initiating FIPS Code
State
Initiating IV-D Case Number
Send Payments To:
Initiating Tribunal Number
(if different from above)
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 (first, middle, last)
Agency Name
Address, FIPS Code
Phone & Extension
FAX
Date
FAX :
(
)
Person Completing Form (first, middle, last)
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.FormsWorkflow.com
