MEMORANDUM

DISCUSSION:

The Affidavit Acknowledging Paternity (VS 465) is revised for use beginning January 1, 2010. It is now four separate documents: Written Notice of Alternatives, Rights and Responsibilities (VS 465); Mother's Affidavit Acknowledging Paternity (VS-465M); Father's Affidavit Acknowledging Paternity (VS 465F); and Husband's Denial of Paternity (VS 465D).

Beginning January 1, 2010, the Bureau of Vital Records (BVR) will only accept the 01-10 revision of the VS-465 series for births occurring on/after January 1, 2010. January 1, 2010 through April 15, 2010, the 11-01 version should be used for births occurring December 31, 2009 and earlier. Effective April 15, 2010, the 01-10 revision must be used for all births — prior to and after January 1, 2010.

The Affidavit Acknowledging Paternity (VS 465) must accompany all other parts of the document: the Mother's Affidavit Acknowledging Paternity (VS 465M), the Father's Affidavit Acknowledging Paternity (VS 465F), and/or the Husband's Denial of Paternity (VS 465D).

The four-page format is the main change to the document. The VS 465 series is used to help unmarried parents establish paternity. Because the paternity affidavit is no longer on a single piece of paper, the eligibility specialist must be aware of three significant changes.

• The Written Notice of Alternatives, Rights and Responsibilities (VS 465) must accompany any other part of the affidavit sent to a party for review and possible completion.
• BVR only accepts the completed VS 465M and VS465F (and VS 465D when appropriate) when submitted together. BVR will return any part of the affidavit submitted separately.
• Because the father and mother may not see each other's acknowledgment, it is important that the eligibility specialist review the VS 465 forms for the request to change the child's last name. The affidavit process is the parents' one-time option to change the child's name without a court order.

A PDF numbered version of the new VS 465 series and instructions are available on the Intranet. These forms must be obtained from the warehouse. The BVR will not accept copies of these forms. DO NOT use these PDF documents.

To access the PDF numbered version and instructions:

• go to Family Support Division (FSD) Intranet site,
• select Temporary Assistance,
• under Forms select IM Forms Manual from the drop-down list,
• select Volume 2, and
• select VS 465 Affidavit Acknowledging Paternity PDF form(s) and instructions.

Manual Section Updates

Income Maintenance Manual sections 0105.025.15.05 and 0205.050.25.05 have been updated to include this information.

The IM Forms manual has been updated to include the new VS 465 series of forms.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Order the VS 465 series of forms from the warehouse using normal ordering procedures.
• Beginning January 1, 2010, begin using the new VS 465 series for births occurring on or after January 1, 2010, and the 11-01 revision of the VS 465 for births occurring December 31, 2009 or earlier.
• Beginning April 15, 2010, use the new VS 465 series for all births.
• After April 15, 2010, destroy/recycle all previous versions.

JP