Form 1 Tranmittal 3

CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3 – REQUEST FOR ASSISTANCE/DISCOVERY
Petitioner: Name (first, middle, last)
Social Security Number
Tribal Affiliation/Country (if applicable)

IV-D Case:

Respondent: Name (first, middle, last)
Social Security Number
Tribal Affiliation/Country (if applicable)

Non-IV-D Case:

To: (Agency Name and Address)

[
[
[
[
[

]
]
]
]
]

TANF
IV-E Foster Care
Medicaid Only
Former Assistance
Never Assistance
File Stamp

[ ]

State

Responding FIPS Code
Responding IV-D Case Identifier
Responding Tribunal Number

From: (Contact Person, Agency, Address, Phone, FAX, E-mail)

Initiating FIPS Code
Send Payments To: (if different from above)

State

Initiating IV-D Case Identifier
Initiating Tribunal Number

Children’s Legal Names (first, middle, last)

Response Needed by

(Date)

I. Action
1. [ ] Provide/Obtain Copies of Documentation
[ ] Certified Copies of Orders
[ ] Financial Statement
[ ] Payment Records
[ ] Other
2. [ ] Provide Assistance with Service of Process (See Attached)
3. [ ] Provide Assistance with Genetic Testing (See Section II and/or Attached)
4. [ ] Obtain Answers for Interrogatories
(See Attached)
5. [ ] Provide Assistance with Teleconference for Hearing or Deposition
(See Attached)
6. [ ] Obtain Financial Data/Proof of Respondent’s Income
(See Section II and/or Attached)
7. [ ] Obtain Party Signature on Attached Form
(See Attached)
8. [ ] Provide Assistance with a Lien
9. [ ] File a Notice of Determination of Controlling Order with An Order-Issuing Tribunal
(See Attached)
10. [ ] Other:

Please Return the Acknowledgment Attached
II. Additional Information
[ ] Nondisclosure Finding Attached

[ ] Verified Address of Employer:

(
Date
FAX:

(

Initiating Contact Person (first, middle, last)

)

Child Support Enforcement Transmittal #3 – Request for Assistance/Discovery

)
Telephone Number & Extension

E-mail
OMB 0970 – 0085 Expiration Date: 01/31/2014

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CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3 – REQUEST FOR ASSISTANCE/DISCOVERY
IV-D Case: [ ] TANF
[ ] IV-E Foster Care
[ ] Medicaid Only
[ ] Former Assistance
[ ] Never Assistance

Petitioner: Name (first, middle, last)
Social Security Number
Tribal Affiliation/Country (if applicable)

Respondent: Name (first, middle, last)
Social Security Number
Tribal Affiliation/Country (if applicable)

Non-IV-D Case: [ ]

To: (Agency Name and Address)

File Stamp

Responding FIPS Code

State

Responding IV-D Case Identifier
Responding Tribunal Number
From: (Contact Person, Agency, Address, Phone, FAX, E-mail)
Initiating FIPS Code

State

Initiating IV-D Case Identifier
Send Payments To: (if different from above)

ACKNOWLEDGEMENTS
[ ]
[ ]
[ ]

[ ]

Initiating Tribunal Number

To be Completed by Responding Agency and Returned to Initiating Agency

Request Received and No Additional Information is Necessary
Additional Information Needed (See Remarks)
Remarks/Response

Your Case has been Forwarded for Action to:

Name of Worker (first, middle, last)
Agency Name
Address, FIPS code
Phone & Extension
FAX

Date
FAX: (

)

Person Completing Form (first, middle, last)

Telephone Number & Extension

E-mail

Child Support Enforcement Transmittal #3 – Request for Assistance/Discovery

Return This Page to the Initiating Jurisdiction

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INSTRUCTIONS FOR CHILD SUPPORT ENFORCEMENT TRANSMITTAL #3
REQUEST FOR ASSISTANCE/DISCOVERY
PURPOSE OF THE FORM:
The CSE Transmittal #3-Request for Assistance/Discovery is designed for use when the requesting jurisdiction is working
its case locally (e.g., by long-arm jurisdiction) and needs limited assistance from another jurisdiction, but does not want
the other jurisdiction to open a IV-D case. Sections 316 and 318 of the model version of UIFSA contain specific provisions
that allow a tribunal to receive evidence from another State and to obtain discovery through a tribunal of another State.
The form may be sent electronically using the appropriate CSENet transaction.
When a jurisdiction receives a CSE Transmittal #3-Request for Assistance/Discovery from another jurisdiction, it should
not open a IV-D case; it should only provide the limited assistance requested. By contrast, the CSE Transmittal # 1-Initial
Request is designed for use when the initiating State is requesting the responding State to open a IV-D case.

Italicized text that appears within a “box” refers to policy or provides additional information.
HEADING/CAPTION (Pages 1 & 2):
The jurisdiction requesting assistance/discovery determines the heading. Note that the heading appears on both page 1 of
the Child Support Enforcement Transmittal #3 and on page 2, the Acknowledgment page.
• Identify the petitioner and respondent by name (first, middle, last), Social Security Number, and, if applicable,

include the name of the tribe or country in which the petitioner or respondent is associated.
• Check the appropriate space to identify the type of case: TANF; IV-E Foster Care, Medicaid only; former assistance,

never assistance, or Non-IV-D.
TANF means the obligee’s family receives IV-A cash payments. A Medicaid only case is a case where the
obligee’s family receives Medicaid but does not receive TANF (IV-A cash payments).
• In the space marked “To:”, list the name and address (street, city, State, and zip code) of the court or agency where
you are sending the CSE Transmittal #3.
• In the appropriate spaces, if applicable and if known, enter the Responding jurisdiction’s FIPS code, State, IV-D case
identifier, and Tribunal number.
Under “IV-D case identifier”, enter the number/identifier identical to the one submitted on the Federal Case
Registry, which is a left-justified 15-character alphanumeric field, allowing all characters except asterisk and
backslash, and with all characters in uppercase. Under “tribunal number”, you may enter the docket number,
cause number, or any other appropriate reference number that the responding State may use to identify the
case, if known. The Responding jurisdiction is the jurisdiction that is working the case at the request of the

initiating jurisdiction.
• In the space marked “From:”, list a contact person, agency name, address (street, city, State, zip code), phone

number (including extension), FAX number, and E-Mail address.
• In the appropriate spaces, enter the Initiating jurisdiction’s FIPS code, State, and IV-D case identifier, and tribunal

number.
Under “IV-D case identifier”, enter the number/identifier identical to the one submitted on the Federal Case
Registry, which is a left-justified 15-character alphanumeric field, allowing all characters except asterisk and
backslash, and with all characters in uppercase. Under “tribunal number”, you may enter the docket number,
cause number, or any other appropriate reference number which the initiating tribunal or agency has assigned
to the case. The initiating jurisdiction is the jurisdiction that referred the case to the responding jurisdiction for
services.
• In the space marked “Send Payments To:” enter the address to which payments should be sent, if the address is

different from the agency address provided on the form in the space above.
• Enter the children’s legal names to assist the responding State in discussing the request with the non-custodial

parent.

Instructions for Child Support Enforcement Transmittal #3 – Request for Assistance/Discovery

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• In the space marked “Response Needed by” enter the date by which a response is needed.

SECTION I, ACTION:
Check the appropriate box(es) to indicate which actions are requested. Multiple actions may be requested, as
appropriate.
• Check item 1 “Provide/Obtain Copies of Documentation” to request copies of documentation. Check appropriate
box(es) to indicate the type of documentation: certified copies of orders, payment records, financial statement, or
other (describe on blank line). In Section II “Additional Information”, describe your request and provide background
information necessary to identify the requested documents.
• Check item 2 “Provide Assistance with Service of Process” if you are requesting assistance with service of process.
You may directly contact (via phone, FAX, or other means) the sheriff, or other appropriate official, in another
jurisdiction to request personal service of process. Send the Request for Assistance/Discovery only if such attempts
have been unsuccessful. Attach such documentation as necessary for service of process.
• Check item 3 “Provide Assistance with Genetic Testing” if you are requesting assistance with genetic testing.
Include in section II or attach any necessary information or materials, including names of genetic testing laboratories,
protocols to be followed, testing kits, etc.
 Check item 4 “Obtain Answers for Interrogatories” if you are requesting completion of interrogatories. Attach the

interrogatories.
 Check item 5 “Provide Assistance with Teleconference for Hearing or Deposition” if you are requesting assistance in

scheduling a teleconference for a hearing or deposition. Attach copy of hearing notice or deposition.
 Check item 6 “Obtain Financial Data/Proof of Respondent’s Income” if you are requesting financial data or proof of

the respondent’s income. Explain your request in Section II or an attachment.
 Check item 7 “Obtain Party Signature on Attached Form” if you are requesting assistance in obtaining a signature.

Attach forms which require signatures. Request assistance with obtaining a signature only after you have attempted
and failed to obtain the signature yourself.
 Check item 8 “Provide Assistance with a Lien” if you are requesting help with a lien/levy action. Prior to using

Transmittal #3 for this purpose, contact the assisting State and provide all additional information and documents
needed. If the assisting State requires “full” case information or documentation, use Transmittal # instead.
 Check item 9 “File a Notice of Determination of Controlling Order with An Order-Issuing Tribunal” if the requesting

State issued an order that contributed to a determination process. Attach a copy of the Notice of Determination of
Controlling Order and a certified copy of the determination itself and any arrears reconciliation order.
 Check item 10 “Other” if the reason you are requesting assistance or discovery is not listed above. On the blank line,

indicate the assistance needed; be as specific as possible.
If you are requesting only “quick locate”, do not use this form. Instead, use the Locate Data Sheet, or CSENet if
you are using an electronic format.
If you are requesting that the tribunal in the other State compel a person over whom it has jurisdiction to respond to a
discovery order issued by a tribunal of another State (in accordance with section 318 of the model version of UIFSA),
attach certified copies of the discovery order.

SECTION II, ADDITIONAL INFORMATION:
In a narrative format, indicate any other information that will be useful in processing your request. Provide any necessary
identifying information and background information about why the request is being made, including: (1) information on the
nature of the pending action (e.g., paternity, support, modification, enforcement, etc.) and (2) the reason assistance from
the other jurisdiction is needed. If you have a verified employer address, include it in Section II.
If there is an order preventing disclosure of a party’s or child’s address/identifying information, check the box for
“Nondisclosure Finding Attached” and attach a copy of the finding. In accordance with the finding, do not provide the
address/identifying information; you may provide a substitute address.
A nondisclosure finding means a finding that the health, safety, or liberty of a party or child would be unreasonably
put at risk by disclosure of identifying information (e.g., residential address). UIFSA provides that interstate
petitions must include certain identifying information regarding the parties and child(ren) unless a tribunal (court or
agency) makes a nondisclosure finding by ordering that the address or identifying information not be disclosed. The
procedures for obtaining a nondisclosure finding vary from State to State.
Instructions for Child Support Enforcement Transmittal #3 – Request for Assistance/Discovery

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At the bottom of page 1, provide a specific worker’s name, a direct telephone number (with extension if necessary) FAX
number and E-Mail address to expedite communications between jurisdictions.

PAGE 2, ACKNOWLEDGMENT:
The jurisdiction requesting assistance/discovery completes the Heading/Caption on this page. Upon receiving a request for
assistance on a Transmittal #3, the receiving State completes the rest of the acknowledgment. The acknowledgment can be
used to provide information in response to a request received via the Transmittal #3, or to indicate when (how many days or
on what date) the requested information/action will be provided. The jurisdiction sending the acknowledgment should indicate
where the case has been referred for action, and the name, telephone, FAX number and E-Mail address of a contact person.

The Paperwork Reduction Act of 1995
This information collection is conducted in accordance with 42 U.S.C. 651 et seq. and 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 under half an
hour per response. The responses to this collection are mandatory in accordance with the above statute and
regulation. 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 Child Support Enforcement Transmittal #3 – Request for Assistance/Discovery

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