MEMORANDUM

DISCUSSION:

Income Maintenance Memorandum IM-89, dated December 30, 2009 introduced the revised Affidavit Acknowledging Paternity (VS 465) series of forms, informing staff of the new four-part format:

• 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).

This memorandum contains information on the following:

• PURPOSE OF THE VS 465 SERIES;
• FORMS COMPLETION;
• ORDERING INFORMATION;
• UPDATE TO INCOME MAINTENANCE: QUESTIONS & ANSWERS (Q&As);
• TRAINING; and
• POSTER.

PURPOSE OF THE VS 465 SERIES

The VS 465 series forms are required for Temporary Assistance applicants/participants if all of the following apply:

• the child was born in the state of Missouri;
• the father's name is not shown on the birth certificate;
• the mother alleges that there is only one man who could be the father of the child; and
• there is no existing court order of support for the child.

The Written Notice of Alternatives, Rights and Responsibilities (VS 465) must be provided to each parent (and husband if the VS 465D is needed) along with the appropriate form for completion.

The Mother's Affidavit Acknowledging Paternity (VS 465M) is completed by the mother to declare paternity.

The Father's Affidavit Acknowledging Paternity (VS 465F) is completed by the father to acknowledge paternity.

The Husband's Denial of Paternity (VS 465D) is completed by a husband and the mother to declare he is not the biological father.

The VS 465 series forms are legal documents. Therefore, these forms must be completed fully and carefully, and reviewed thoroughly with the parent(s).

FORMS COMPLETION

All VS 465 forms must be original forms. If an office's supply of forms is low, re-order the forms as soon as possible (see below for Ordering Information). DO NOT COPY a blank form as the Bureau of Vital Records (BVR) does not accept photocopied forms.

The PDF versions of the forms contained in the Income Maintenance (IM) Forms Manual are for reference only. DO NOT USE these forms as they will not be accepted by BVR.

Other tips for completing the VS 465 forms:

• Only use BLACK ink.
• All information entered in the form must be typed or printed.
• Prepare one original of each appropriate form to send to BVR. Provide the parent a copy of the completed form(s).
• No mistakes, erasures, white-out or cross outs are permitted. BVR considers these legal documents which should be free of alteration.
• The parent MUST sign before a notary public or two witnesses. The witnesses MAY NOT be relatives of either parent.

  EXAMPLE:  The mother completes the VS 465M using the sister of the child's father as one of the witnesses. This is not allowed and the form will not be accepted.

Forward all completed VS 465 forms to the Bureau of Vital Records, P.O. Box 570, Jefferson City, MO 65102. Rejected VS 465 forms are returned to Child Support. Child Support contacts the parents to complete new forms. Although BVR requires all forms to be submitted together, if IM staff have only one form (e.g., VS 465M), staff will submit the form to BVR. If BVR rejects the form, it will be returned to Child Support for further processing.

ORDERING INFORMATION

The VS 465 series forms with a revision date of 01-10 are the only acceptable forms. Destroy any forms with a revision date other than 01-10.

The VS 465 forms are available for order from the warehouse. Each form comes in a 100-page tablet. When placing an order, order the number of tablets needed, not the number of forms.

EXAMPLE:  An office determines it needs to order 1,000 VS 465 forms. The office places an order for 10 tablets. (1,000 forms/100 forms per tablet = 10 tablets)

NOTE:  Each of the four forms must be ordered separately.

UPDATE TO INCOME MAINTENANCE: QUESTIONS & ANSWERS (Q&As)

An "Affidavit Acknowledging Paternity (VS 465) Forms" section has been added to the TA portion of the Income Maintenance: Question and Answers.

TRAINING

Training is being developed to help staff with the use and completion of the VS 465 form series. A separate memo will be issued when training is available.

POSTER

A new poster, Establishing Paternity, is available for offices to display in the lobby and interview areas for everyone to see.

To access the poster online:

• Go to Family Support Division (FSD) Intranet site,
• Select Temporary Assistance (located under Programs on left side of screen),
• Select Establishing Paternity Poster (under Quick Links on right side of screen).

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Destroy/recycle all VS 465 forms with a revision date prior to 01-10.
• Order original VS 465 forms from the warehouse as needed.
• Post the Establishing Paternity poster in lobby and interview areas.

GA