Personal Information Form {UIFSA-15}

PERSONAL INFORMATION FORM FOR UIFSA 247 311 226 TO BE FILED WITH A TRIBUNAL Nondisclosure finding/affidavit attached THIS FORM CONTAINS SENSITIVE INFORMATION 226 DO NOT FILE THIS FORM IN A PUBLIC ACCESS FILE T he information on this form is filed with the petition or pleading and may be disclosed to the parties in the case, unless accompanied by a nondisclosure finding/affidavit. If you are not the intended recipient, you are hereby notified that any use, disclosure, distribution, or copying of this form or its contents is strictly prohibited . NOTE:002 [ ] This f orm sent t hrough EDE002 Section 1 . Case Information: Initiating jurisdiction name: Responding jurisdiction name: Initiating IV-D case identifier: Responding IVSection 2 . Parent/Caretaker Information: Parent [ ] Obligee or [ ] Obligor Parent [ ] Obligee or [ ] Obligor Legal name (first, middle, last): Legal name (first, middle, last): SSN: SSN: Home address (street, city, state, zip): Home address (street, city, state, zip code): Caretaker -Obligee (When obligee is not the child(ren)222s parent) Legal name (first, middle, last): SSN: Home address (street, city, state, zip code): Section 3 . Child(ren) Information : Child #1 legal name (first, middle, last): Child's address (street, city, state, zip code): The child began residing in (state) on (month/year). Child222s SSN: Child222s date of birth: Gender: [ ] Male [ ] Female Ch il d #2 legal n a m e (first, middle, last): Personal Information Form for UIFSA 247 311 OMB 0970 226 0085 Expiration Date: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Child #3 legal name (first, middle, last): Child's address (street, city, state, zip code): The child began residing in (state) on (month/year). Child222s SSN: Child222s date of birth: Gender: [ ] Male [ ] Female [ ] Additional Child(ren) Information Attached Encryption Requirements: When communicating this form through electronic transmission, precautions must be taken to ensure the security of the data. Child support agencies are encouraged to use the electronic applications provided by the federal Office of Child Support Enforcement. Other electronic means, such as encrypted attachments to emails, may be used if the encryption method is compliant with Federal Information Processing Standard (FIPS) Publication 140-2 (FIPS PUB 140-2). Personal Information Form for UIFSA 247 311 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Italicized text that appears within a 223box224 refers to policy or provides additional information. For an address outside the United States, be sure to include the foreign country and postal code. Tribal IV-D programs may choose to use the federal Intergovernmental forms. However, they are not required to use or accept such forms. If you have any questions, contact the tribal IV-D agency directly using the contact information on the OCSE website. Where forms request a locator code, note that tribal locator codes uniquely identify tribal cases with 2239224 in the first position, 0 (zero) in the second position, and then a 3-character tribal code defined by the Bureau of Indian Affairs (BIA). INSTRUCTIONS FOR PERSONAL INFORMATION FORM FOR UIFSA 247 311002TO BE FILED WITH A TRIBUNAL002 PURPOSE OF THE FORM: The Personal Information Form for UIFSA 247 311 is intended to safeguard the privacy of individuals by providing a means to record required UIFSA personal information on a separate document rather than requiring it to appear on all of the forms needed to process their case. This form can be filed with the tribunal, but should not be filed in a public access file. Nondisclosure Finding/Affidavit attached -If there is a finding prohibiting disclosure of a party222s or child(ren)222s address/identifying information or an affidavit alleging that disclosure of such information would result in risk of harm, check the box for 223Nondisclosure Finding/Affidavit attached224 and attach a copy of the finding/affidavit in accordance with section 312 of UIFSA. If there is a finding/affidavit prohibiting disclosure, the information must be sealed and may not be disclosed to the other party or the public. You may provide the address of the IV-D agency as a substitute address for the protected party. THIS FORM CONTAINS SENSITIVE INFORMATION 226 DO NOT FILE THIS FORM IN A PUBLIC ACCESS FILE. This form includes information that may pose a significant risk to an individual if made available in a public forum or inappropriately disclosed. This form can be filed with the tribunal, but should not be filed or included in a record available to the general public. The information on this form may be disclosed to the parties in the case, unless accompanied by a nondisclosure finding/affidavit. If you are not the intended recipient, you are hereby notified that any use, disclosure, distribution, or copying of this form or its contents is strictly prohibited. UIFSA requires that the petition or accompanying documents include certain identifying information regarding the parties and child(ren) (e.g., residential address, social security number) unless a party alleges in an affidavit or a pleading under oath that the health, safety, or liberty of a party or child would be jeopardized by disclosure of such information. In that event, the information must be sealed. In some states a tribunal may have authority to make a nondisclosure finding. If a jurisdiction has reason to believe that information should not be released because of safety concerns, it should ensure that there is a nondisclosure finding or an allegation in an affidavit or the pleading that disclosure of identifying information would result in a risk of harm, as provided under section 312 of UIFSA. In addition to identifying information included on this form, it may be appropriate to submit certain financial information under seal. In the 223NOTE:224 section, check any of the following that apply: 225003 This form sent through EDE 226 Check if this form was sent through the Electronic Document002 Exchange (EDE).002 Personal Information Form for UIFSA 247 311 Instructions003 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com The initiating jurisdiction is the jurisdiction that referred the case to the responding jurisdiction for services. The responding jurisdiction is the jurisdiction that is working the case at the request of the initiating jurisdiction. Under 223IV-D case identifier224, enter the number/identifier identical to the one submitted on the Federal Case Registry, which is a left-justified up to 15-character alphanumeric field, allowing all characters except asterisk and backslash, and with all characters in uppercase. Under 223tribunal number224, you may enter the docket number, cause number, or any other appropriate reference number that the initiating and responding tribunal have assign ed to the case. The following options are available for making IV-D requests and sending information on IV-D cases: 1. CSENet transactions are the recommended method for making requests or sending information to another state. If CSENet is not listed as an option on the form, then it cannot be used to convey any of the requests for information or IV-D requests provided on the form. Supporting documentation should be sent through EDE, whenever possible. If certified copies are needed, hard copies should also be sent by mail. Mail or fax may also be used for all documents when EDE is not available. 2. If CSENet transactions are not available in your state, EDE is the next preferred method for transmitting your request or information. Both your state and the receiving state must be using the EDE application to use this communication method. 3. If the EDE application is not available in your state or the receiving state, then mail or fax must be used to communicate your request. Section 1. Case Information: In the space provided, enter: Initiating jurisdiction name Initiating IV-D case identifier Initiating tribunal number Responding jurisdiction name Responding IV-D case identifier, if known Responding tribunal number, if known Section 2. Parent/Caretaker Information: Identify each parent as an obligee or o