General Testimony (Page 22 of 30) in pdf

Item d: Enter the child's sex or gender: male or female.

Item e: Enter the child's date of birth (Month, Date, Year).

Item f: Check the appropriate box to indicate whether the father's paternity of the child has been

established.

Item g: Check the appropriate box to indicate whether a child support order for the child has been

established.

Item h: Check the appropriate box to indicate whether the child is living with the petitioner. In this

instance, "petitioner" means the individual who is the moving party rather than a State child support

agency that is bringing action.

Part B: Indicate the month and year when the child(ren) began residing in the State. If this

information is not the same for all children, provide separate information for each child in Section X:

Other Pertinent Information. If the child(ren) are older than six months of age and have resided in the

State less than six months, provide information about the child(ren)'s previous States of residence

(including length of residence) in Section X: Other Pertinent Information. Information about the

child(ren)'s length of residence in the State is necessary under the Uniform Interstate Family Support

Act (UIFSA) in order to determine which child support order should be prospectively enforced or

modified if multiple orders exist.

SECTION VI, MEDICAL INSURANCE: This information is used to determine if medical coverage is

currently provided for the dependents. If coverage is not provided, additional information in this

section is a basis for adding medical coverage to new and existing orders. You should provide this

information in all IV-D cases except those non-Public Assistance, non-Medicaid cases, where the

applicant requests that medical coverage not be sought.

Item 1: Check the appropriate box to indicate whether the obligor is required by a child support order

to provide medical insurance for the child(ren).

Item 2: Check the appropriate box to indicate whether the obligor is required by a child support order

to provide medical insurance for the obligee.

Item 3: Check the appropriate boxes to indicate who provides medical coverage for the dependent

child(ren) (listed in Section V) and obligee. The choices are: obligee, obligor, State Medicaid, obligee's

employer, obligor's employer, and other. If you check "other", list in the blank the person or entity

that provides coverage (e.g., obligee's current spouse). Check "unknown" if you do not know who

provides coverage. Check "no coverage" if the child(ren)/obligee do not have coverage.

In the appropriate spaces, enter the name and policy number of the obligee's insurance company, the

obligor's insurance company, and any other relevant insurance company. If information about "Other

Insurance Company" is provided, describe this company and its relation to the parties in Section X:

Other Pertinent Information.

Item 4: Enter the monthly medical insurance cost paid by the obligee for the obligor's child(ren) only.

Do not include the portion of the monthly cost of medical insurance for the obligee or children other

than the obligor's. If the obligee is the individual petitioner in this action and is seeking reimbursement

for these medical insurance costs, attach proof of payment.

Item 5: If medical insurance is provided by the obligee or the obligee's employer, do not answer this

item; skip to item 6. Otherwise, enter the monthly cost to the obligee if he/she were to provide

Instructions for General Testimony--Page 9

General Testimony Page 22