General Testimony (Page 14 of 30) in pdf

OMB No. 0970 - 0085

INSTRUCTIONS FOR GENERAL TESTIMONY

PURPOSE OF THE FORM: The General Testimony provides a framework for stating the detailed

information and evidence necessary to support the action requested in the petition. Its eleven sections

may or may not apply to all cases. Before completing the form, carefully consider the status of the

individual petitioner completing the testimony and his/her relationship to the respondent, the relief you

plan to request in the petition, and other case characteristics to determine what information should be

provided.

(Note: all section headings contain a checkbox to be used when additional comments/remarks are desired

As a general rule, requests for relief

or required. These comments/remarks should be placed in Section X.)

require completion of the following sections:

Section No.

Description

Case Type Requiring Completion

Personal Information About Child(ren)'s Mother

All

Personal Information About Child(ren)'s Father

All

III

Caretaker's Personal Information

Cases where the caretaker is an individual other

than the child(ren)'s parent

Legal Relationship of Parents

All

Dependent Child(ren) in this Action

All

Medical Insurance

All, except non-Public Assistance, non-Medicaid

cases where applicant requests that medical

support not be sought

VII

Support Order and Payment Information

All cases where an order for support has been

entered

Page 6a

Obligor's Payment History

All cases where an order for support has been

entered; however, a certified copy of the court or

agency payment history may be attached in lieu of

Page 6a

VIII

Obligee's Public Assistance Status

Cases where the obligee received public

assistance

Financial Information

Establishment and modification cases, as required by

States' guidelines

Other Pertinent Information

When needed (Note: all section headings contain a

checkbox to be used when additiona

comments/remarks are desired or required.)

Verification

All

HEADING/CAPTION:

Identify the petitioner and respondent in the appropriate spaces.

Check the appropriate space to identify the type of case: IV-D Non Public Assistance; IV-D Non Public

Assistance Medicaid (indicate whether receiving Full Child Support Services or Medical Services Only);

IV-D Public Assistance; IV-D Foster Care (IV-E); or Non IV-D. IV-D means the case is being worked by

the State or local child support enforcement agency (i.e., IV-D agency). Public Assistance means the

Instructions for General Testimony--Page 1

General Testimony Page 14

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