Notice Of Determination Of Controlling Order (Page 3 of 4) in pdf

# a central registry in another State. It may be particularly important to notify a central entity if it keeps

a registry of all orders in that State. A central registry may also be willing to notify tribunals or

agencies within that State.

HEADING/CAPTION:

# Enter the date of the notice.

# Identify the obligor and obligee 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 Services or Medical Services Only); IV-D Public

Assistance; IV-E Foster Care; 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 obligee's family

receives IV-A cash payments [IV-A was formerly called Aid to Families with Dependent Children (AFDC)

and is now called Temporary Family Assistance]. A IV-D Non Public Assistance Medicaid case is a case

where the obligee's family receives Medicaid but does not receive Public Assistance (IV-A cash

payments).

# In the space marked "To:", list the name and address (street, city, State, and zip code) of the central

registry, court, or agency where you are sending the Notice of Determination of Controlling Order.

# In the appropriate spaces, if applicable and if known, enter the FIPS code, State, IV-D case number,

and docket number of the jurisdiction to which you are sending the Notice. Under "docket number",

you may enter the docket number, cause number, or any other appropriate reference number that the

receiving State may use to identify the case, if known.

# In the space marked "From:", list a contact person, agency name, address (street, city, State, zip code),

phone number (including extension), fax number, and Internet address.

# In the appropriate spaces, enter your jurisdiction's FIPS code, State, IV-D case number, and docket

number. Under "docket number", you may enter the docket number, cause number, or any other

appropriate reference number which the tribunal or agency has assigned to the case.

MAIN BODY OF FORM:

# In the first blank in item 1, enter the date that the determination of controlling order was made. In the

second blank, enter the Name, County, and State of the tribunal which made the determination.

# For each order considered in the controlling order determination, list in the table in item 1 the County,

State, Date of Order, IV-D Case Number, Docket Number (enter docket number, cause number, or other

appropriate reference number), and Order Type (e.g., de novo support, modification, dissolution,

contempt, paternity, etc.). Include any order issued or modified by this tribunal in the present action.

If more than five orders were considered, list and number additional orders on an attached sheet and

check the space below the table which says "Additional orders listed on attached sheet".

# In the blank in item 2, enter the number from the table (first column) of the order that was determined

to be controlling.

# In item 3, check the first box if a modified order was entered and is attached. Check the second box

if a new order was entered and is attached.

Instructions for Notice of Determination of Controlling Order

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Notice Of Determination Of Controlling Order Page 3