General Testimony (Page 23 of 30) in pdf

needed medical insurance. If the cost is unknown, enter "unknown". Some responding States may

require you to enter a prorated amount per child.

Item 6: As a lead for possible third party coverage, check the appropriate box to indicate whether the

obligor's children were ever covered by medical insurance provided through the obligor or obligee or

his/her current employer. If you check "Yes", describe this coverage in Section X: Other Pertinent

Information.

Item 7: Indicate whether any of the obligor's children have special needs or extraordinary medical

expenses not covered by insurance. This includes special medical needs, medical equipment,

counseling, special schooling, etc. If yes, indicate the child involved, the type of need/expenses, and

the related costs. Attach proof, such as a doctor's statement. If special needs are indicated, explain

in detail any agreements made to cover these costs including agreements that are verbal, written, or

part of any court or administrative order.

SECTION VII, SUPPORT ORDER AND PAYMENT INFORMATION: This information is used to justify

the court or administratively ordered current support and arrearage obligation to be claimed in the

petition.

Item 1: Check the appropriate box to indicate whether a support order exists. If a support order does

not exist, skip to Section VIII on page 7.

Item 2: Check the appropriate box to indicate whether the child(ren) resided with the obligor at

anytime during the period for which support is sought, except during periods of visitation specified by

a tribunal's order. If "yes", identify period of residency with the obligor by entering dates (Month,

Date, Year) in the spaces labelled "From" and "Thru". If this information is not the same for all

children, provide separate information for each child in Section X: Other Pertinent Information.

Item 3: Complete item 3 only if modification of a support order is requested; otherwise skip to item 4.

Indicate the basis for requesting a modification by checking all appropriates boxes. If you check

"other", explain in the blank and/or provide an explanation in Section X and check the “See Section X”

checkbox next to the Heading on this page.)

Item 4: Enter information on court or administratively ordered support amounts. Include information

on the relevant original order, modifications, and interstate orders under the Uniform Reciprocal

Enforcement of Support Act (URESA) or the Uniform Interstate Family Support Act (UIFSA). If there

are more than three pertinent orders, describe the remaining orders in Section X: Other Pertinent

Information.

For each order, indicate:

Date of Order: the date the order was issued or entered.

Current Amount: the amount of periodic current support payments owed under the order.

Specify the total amount for all children (listed in section V) even if the order designates a

separate amount for each child.

Per Month/Week/Etc: the frequency with which current support must be paid (per month, per

week, etc).

Toward Arrears: the amount of any periodic payment ordered to go toward arrears. Specify

the total amount for all children (listed in section V) even if the order designates a separate

amount for each child.

Instructions for General Testimony--Page 10

General Testimony Page 23