Form 1 Statement of Enforceability of a Decision

OMB Control No: 0970-0488

Expiration date: XX/XX/XXXX

Convention on the International Recovery of Child Support and Other Forms of Family Maintenance

Statement of Enforceability of a Decision

(Article 25(1) b))

1. Name of the State of origin of the decision:

(identify territorial unit if applicable)

2. Competent authority issuing the Statement

   1. Name:

   2. Address:

2.3	Telephone number:
2.4	Fax number:
2.5	E-mail:

3. The decision¹

   1. Type of authority:  judicial authority or  administrative authority²

   2. Name and place of authority:

   3. (address if applicable)

3.4	Date of the decision:	(dd/mm/yyyy)
3.5	Date of effect of the decision:	(dd/mm/yyyy)
3.6	Reference number of the decision:
3.7	Names of the parties to the decision:

4. 

   The decision is enforceable in the State of origin.

Name: (in block letters) Date:

Name of the official from the competent authority of the State of origin (dd/mm/yyyy)



This Statement of Enforceability of a Decision was completed by the official from the competent authority of the State of origin whose name appears above and is transmitted by the requesting Central Authority.

Name: (in block letters) Date:

Authorised representative of the Central Authority (dd/mm/yyyy)

Requesting Central Authority reference number:

(For Central Authority use only)

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to provide information about the enforceability of a decision in an application under the 2007 Hague Child Support Convention. Public reporting burden for this collection of information is estimated to average 0.17 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information per 45 CFR 303.7. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information, please contact the ACF Reports Clearance Officer by email at [email protected].

¹ For the definition of decision see Article 19(1).

² The Administrative Authority referred to in this Statement meets the requirements of Article 19(3).