DEPARTMENT OF HEALTH AND HUMAN SERVICES Form Approved
Administration for Children and Families OMB No.
Office of Child Support Enforcement Expires:
CHILD SUPPORT ENFORCEMENT ANNUAL DATA REPORT
STATE: SUBMISSION: |
NEW |
REVISED |
FISCAL YEAR |
|
ITEMS |
(a) |
(b) |
(c) |
(d) |
SECTION A: CASE INVENTORY |
||||
1. Cases Open at the End of the Fiscal Year | ||||
a. Interstate Cases Initiated in This State | ||||
b. Interstate Cases Received From Another State | ||||
c. Medicaid Only Cases | ||||
2. Cases Open at the End of the Fiscal Year With Support | ||||
a. Interstate Cases Initiated in This State | ||||
b. Interstate Cases Received From Another State | ||||
c. Cases With Orders for Zero Cash Support | ||||
d. Medicaid Only Cases With Orders | ||||
3. Cases Open at the End of the Fiscal Year | ||||
SECTION B: PATERNITY ESTABLISHMENT |
||||
4. Number of Children in Cases Open | ||||
5. Children in IV-D Cases Open at the End of the Fiscal Year | ||||
6. Children in IV-D Cases Open During or at the End of the Fiscal Year With Paternity Established |
||||
7. Children in the IV-D Cases at the End of the Fiscal Year With Paternity Resolved |
||||
8. Children in the State Born Out-of-Wedlock During The Fiscal Year |
||||
9. Children in the State With Paternity Established or Acknowledged During The Fiscal Year (Optional) |
||||
10. Children in the State With Paternity Acknowledged During The Fiscal Year |
||||
SECTION C: SERVICES REQUIRED |
||||
11. Cases Open at the End of the Fiscal Year Requiring Location Services |
||||
12. Cases Open at the End of the Fiscal Year Requiring Services to Establish an Order |
||||
13. Children Requiring Paternity Determination Services in Cases Open at the End of the Fiscal Year |
||||
SECTION D: SERVICES PROVIDED |
||||
14. Title IV-A Cases Closed During the Fiscal Year Where a Child Support Payment Was Received |
||||
15. Cases Receiving Successful Location Services During the Fiscal Year |
||||
16. Children in the IV-D Caseload for Whom Paternity Was Established or Acknowledged During the Fiscal Year |
||||
17. Cases With Orders Established During the Fiscal Year | ||||
18. Cases With Collections During the Fiscal Year | ||||
a. Interstate Cases Initiated in Another State With Collections During the Fiscal Year |
||||
19. Cases Sent to Another State During the Fiscal Year | ||||
20. Cases Received From Another State During the Fiscal Year |
||||
SECTION E: MEDICAL SUPPORT |
||||
21. Cases Open at the End of the Fiscal Year Where Medical Support is Ordered |
||||
22. Cases Open at the End of the Fiscal Year Where Health Insurance is Ordered |
||||
23. Cases Open at the End of the Fiscal Year Where Health Insurance is Provided as Ordered |
||||
SECTION F: COLLECTIONS DUE AND DISTRIBUTED |
||||
24. Total Amount of Current Support Due for the Fiscal Year |
$ | $ | $ | |
25. Total Amount of Support Distributed as Current Support During the Fiscal Year |
$ | $ | $ | |
26. Total Amount of Arrearages Due for All Fiscal Years | $ | $ | $ | |
27. Total Amount of Support Distributed as Arrears During the Fiscal Year |
$ | $ | $ | |
28. Cases With Arrears Due During the Fiscal Year | ||||
29. Cases Paying Toward Arrearages During the Fiscal Year |
||||
SECTION G: STAFF |
||||
30. Full-time Equivalent Employees of State and Local IV-D Offices on the Last Working Day in the Fiscal Year |
||||
31. Full-time Equivalent Employees Under Cooperative Agreements on the Last Working Day in the Fiscal Year |
||||
32. Full-time Equivalent Employees of Privatized IV-D Offices on the Last Working Day in the Fiscal Year |
||||
SECTION H: PROGRAM EXPENDITURES |
||||
33. Amount of Expenditures to Establish Paternities During the Fiscal Year |
$ | |||
34. Amount of Expenditures to Locate Non-custodial Parents During the Fiscal Year |
$ | |||
35. Amount of Expenditures to Establish Support Orders During the Fiscal Year |
$ | |||
36. Amount of Expenditures to Enforce Support Orders During the Fiscal Year |
$ | |||
37. Amount of Expenditures to Distribute Collections During the Fiscal Year |
$ | |||
SECTION I: NONCOOPERATION AND GOOD CAUSE |
||||
38. Cases at the End of the Fiscal Year in Which There is a Determination of Noncooperation |
||||
39. Cases Open During the Fiscal Year With Good Cause Determinations |
||||
SECTION J: ADMINISTRATIVE ENFORCEMENT |
||||
40. Administrative Enforcement Requests Received From Another State During the Fiscal Year |
||||
41. Administrative Enforcement Cases With a Collection During the Fiscal Year |
||||
42. Amount of Support Collected on Administrative Enforcement Cases During the Fiscal Year |
$ | |||
Paperwork Act Notice: State agencies are required to provide the information requested to receive a grant award under the provision of Title IV, Part D (Sections 452 and 469) of the Social Security Act (42 USC 652 and 669). This is public information and is published in an Annual Report to Congress. The responses to this collection are mandatory. This information is not considered confidential, therefore, no additional safeguards are considered necessary beyond that customarily applied to routine government information. Reporting Burden Notice: Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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. Send comments regarding either thins burden estimate or other aspect of this request for information to: the Administration for Children and Families, Office of Child Support Enforcement, 360 L146Enfant Promenade, S.W., Washington, DC 20447 and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
|
||||
This is to certify the information provided on this report is accurate to the best of my knowledge and belief. | Signature: Director, Title IV-D | |||
Agency Name | Typed Name, Title, | Date: |
g:\ocseuser\jmp\form3.doc 11/4/97)
FORM OCSE-157 (10/98) (Replaces forms OCSE-156 and OCSE-158)