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

Notice Of Determination Of Controlling Order Page 4

# In the blanks in item 4, enter the amount and frequency (e.g., week, month) of the current charging

amount.

# In the blanks in item 5, enter the amount of arrears and the date as of which the amount is correct.

Check the box if a copy of any worksheet(s) used to calculate arrears is attached. Page 6a of the

General Testimony may be used.

# Under item 6, list the Name and State of other entities that you will be sending the notice to. If you

will be sending the notice to all the tribunals listed in the table under number 1, you may write "All

tribunals issuing orders listed in table above". List additional entities on an attached sheet if necessary,

and check the box indicating that there is an attachment. If you are sending a copy of the Notice to

the obligor and/or obligee, check the appropriate box(es) labelled "Obligor"/"Obligee".

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The Paperwork Reduction Act of 1995

This information collection is conducted in accordance with 45 CFR 303.7 of the child support

enforcement program.

Standard forms are designed to provide uniformity and standardization for

interstate case processing. Public reporting burden for this collection of information is estimated to

average one hour per response. The responses to this collection are mandatory in accordance with 45 CFR

303.7. This information is subject to State and Federal confidentiality requirements; however, the

information will be filed with the tribunal and/or agency in the responding State and may, depending on

State law, be disclosed to other parties. An agency may not conduct or sponsor, and a person is not

required to respond to, a collection of information unless it displays a currently valid OMB control number.

Instructions for Notice of Determination of Controlling Order

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Notice Of Determination Of Controlling Order Page 4