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PARENT SURVEY ON THE ACKNOWLEDGMENT OF PATERNITY (AOP)

MANDATED BY LAW

This Survey should be completed after the AOP has been signed or a person has declined to

sign the AOP.

Hospital/EntityName & Location:____________________________________Entity Code:_______

Child’s Name: ____________________________________________ Date of Birth: ____________

Please read and INITIAL the following:

STATEMENTS

MOTHER

FATHER

1. I was given the opportunity to sign an Acknowledgment of Paternity.

_______

2. I did not complete an Acknowledgment of Paternity.

_______

3. I was made aware that I could have a DNA test done before I signed

_______

the AOP.

4. I was given written and oral information regarding the benefits, rights

and responsibilities of an AOP, an explanation of those rights and

_______

responsibilities and information about child support.

5. I was given information that the biological father who signed this

AOP will have all legal rights and duties of a parent. This may

_______

include the legal responsibility for financial and medical support of

the child named in this AOP.

6. I was given information that I have 60 days from the date the AOP is

_______

filed to change my mind and file a rescission in court.

7. I was given information that after 60 days I may challenge the AOP

_______

in court and must prove fraud, duress, or material mistake of fact.

8. I was given information that after four years from the date the AOP is

filed, I can no longer challenge the AOP. Minors may challenge until

_______

4 years after they become an adult.

9. I was given a completed copy of the AOP with the benefits, rights,

_______

and responsibilities on the back.

Mother’s Printed Name:______________________________________

ID Type:_____________________________

Mother’s Signature:__________________________________________

Phone Number:________________________

Father’s Printed Name:_______________________________________

ID Type:_____________________________

Father’s Signature:__________________________________________

Phone Number:________________________

Certified Staff Signature:_____________________________________

Date:________________________________

Presumed Father: (After you read the Denial of Paternity and Change of Mind sections of the rights and

responsibilities, please read the statement below and initial.)

After I have signed the Denial of Paternity and it has been filed with the Vital Statistics Unit, my legal rights and

responsibilities to this child will be terminated. I have 60 days from the date the AOP is filed to change my mind and

file a rescission in court. After 60 days, I may challenge the AOP in court and must prove fraud, duress, or material

mistake of fact. After four years from the date the AOP is filed, I can no longer challenge the AOP. _____

Presumed Father’s Printed Name: _________________________________ID Type:________________________

Presumed Father’s Signature: ____________________________________Phone Number: __________________

Revised 03/10/2008

Form 1798

Form 1798 - Parent Survey On The Acknowledgment Of Paternity (Aop) - Texas General Attorney

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