Form Approved
OMB No. 0970-0177
Expires: 06/30/04

SUPPORT ENFORCEMENT ANNUAL DATA REPORT
(This report consists of three pages)

STATE: SUBMISSION
NEW
REVISED FISCAL YEAR:

ITEMS

(a)
TOTAL

(b)
CURRENT ASSISTANCE

(c)
FORMER
ASSISTANCE

(d)
NEVER
ASSISTANCE

SECTION A: CASE INVENTORY        

1. Cases Open at the End of the Fiscal Year

       

a. Interstate Cases Initiated in This State Open at the End of the Fiscal Year

       

b. Interstate Cases Received From Another State
Open at the End of the Fiscal Year

       

c. Medicaid Only Cases
Open at the End of the Fiscal Year

       
2. Cases Open at the End of the Fiscal Year With Support Orders Established        
a. Interstate Cases Initiated in This State With Support Orders at the End of the Fiscal Year        
b. Interstate Cases Received From Another State With Support Orders at the End of the Fiscal Year        
c. Cases With Orders for Zero Cash Support Open at the End of the Fiscal Year        
d. Medicaid Only Cases With Orders Open at the End of the Fiscal Year        
3. Cases Open at the End of the Fiscal Year for Which the State Has No Jurisdiction        
SECTION B: PATERNITY ESTABLISHMENT

Select PEP

Option: [ ] IV-D [ ]Statewide
4. Number of Children in Cases Open at the End of the Fiscal Year        
5. Children in IV-D Cases Open at the End of the Fiscal Year Who Were Born Out-of-Wedlock        
6. Children in IV-D Cases Open During or at the End of the Fiscal Year With Paternity Established or Acknowledged

 

       
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-WedlockDuring The Fiscal Year        
9. Children in the State With Paternity Established or Acknowledged During The Fiscal Year (Optional)   Reporting Period, if other than FFY:
10. Children in the State With Paternity Acknowledged During The Fiscal Year        
SECTION C: SERVICES REQUIRED        
11. Reserved        
12. Cases Open at the End of the Fiscal YearRequiring Services to Establish an Order        
13. Children Requiring Paternity Determination Services in Cases Open at the End of the Fiscal Year        

FORM OCSE-157 (06/30/01)

ITEMS

(a)
TOTAL

(b)
CURRENT ASSISTANCE

(c)
FORMER
ASSISTANCE

(d)
NEVER
ASSISTANCE

SECTION D: SERVICES PROVIDED        
14. Title IV-A Cases Closed During the Fiscal
Year Where a Child Support Payment Was Received
       
15. Reserved        
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. Reserved        
34. Reserved        
35. Reserved        
36. Reserved        
37. Reserved        
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 AdministrativeEnforcement 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 L’Enfant Promenade, S.W., Washington, DC 20447

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

 

FORM OCSE-157 (06/30/01)