General Testimony Page 20
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30Item 4: Enter the caretaker's home or residential address (Street, City, State, Zip Code). If this
address has been confirmed/verified by the initiating State agency, check the box indicating that the
information has been confirmed and the date it was confirmed. If the address cannot be confirmed,
provide last known address.
Item 5: Enter the caretaker's Social Security Number.
Item 6: Enter the caretaker's date of birth (Month, Date, Year).
Item 7: Enter the caretaker's sex or gender: male or female.
Item 8: Enter the caretaker's home phone number. Include the area code.
Item 9: Enter the caretaker's work phone number. Include the area code.
Note: If the caretaker does not have a legal obligation to contribute to the child(ren)'s support, items
10 through 14 concerning the caretaker's employment and income may be privileged.
Item 10: Enter the name and address of the caretaker's employer. If this information has been
confirmed/verified by the initiating State agency, check the box indicating that the information has
been confirmed and the date it was confirmed. If the employer name and address cannot be
confirmed, provide last known information.
Item 11(a): Enter the father's occupation, trade, or profession.
Item 11(b): Enter the caretaker's highest attained level of education. If the caretaker is the obligor,
the educational level can be used by some responding States to impute the income of an unemployed
or underemployed obligor.
Item 12: Enter the dollar amount of the caretaker's estimated gross monthly earnings.
Item 13: Enter the dollar amount of the caretaker's monthly income other than earnings. Indicate the
source of the income.
Item 14: Enter the date the child(ren) began residing with the caretaker.
SECTION IV, LEGAL RELATIONSHIP OF PARENTS: Identify the legal relationship between the
child(ren)'s mother and father. Check all appropriate boxes and enter the pertinent corresponding
information.
Item 1: Check this box if the parents were never married to each other.
Item 2: Check this box if the parents were married to each other. Indicate the date (Month, Date,
Year) and County/State of the marriage.
Item 3: Check this box if the parents were married by common law. Indicate the time period (dates)
and the County/State of the common law marriage.
Item 4: Check this box if the parents are separated. Indicate the date (Month, Date, Year) of the
separation.
Item 5: Check this box if the parents are divorced. Indicate the date (Month, Date, Year) and
County/State of the finalized divorce.
Instructions for General Testimony--Page 7
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