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The Double Elimination 20 form is an essential document geared towards streamlining the process of reporting child support payments in California. Crafted by the Department of Child Support Services, this form provides a structured format to accurately record the history of support payments, both ordered and paid. Users must detail the amount of support that the court mandated for each month, as well as the actual payments made. This helps create a clear picture of any outstanding obligations. Additionally, the form includes a section for documenting periods of incarceration or institutionalization, which can impact payment responsibilities. It’s crucial to record payments based on when they were actually made, rather than when they were intended to cover, ensuring accurate financial accountability. If there are changes to the support order, each month must reflect those adjusted amounts. Furthermore, the declaration is not confidential, meaning it can be shared with the other party involved, potentially leading to discussions or disputes regarding the payment history. Should questions arise or if assistance is needed in completing this form, resources are available through local Family Law Facilitator Offices, providing guidance to those navigating this often complex area of family law.

Double Elimination 20 Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF CHILD SUPPORT SERVICES

DECLARATION OF SUPPORT PAYMENT HISTORY

DCSS 0569 (06/17/2018)

INSTRUCTIONS FOR COMPLETING THE DECLARATION

OF SUPPORT PAYMENT HISTORY

On the back of this page is the Declaration of the Support Payment History for your case. Please provide the amount of support that was ordered by the court and the amount that was paid for each month. These figures will help determine the amount of the past due support owed, if any.

Within the boxes on the bottom half of the page, please complete the:

"Amount Ordered" column for each year

Fill in the amount of support that was ordered by the court each month since your order began. If there has been a change in your order, make sure each month reflects the correct amount of support due.

"Amount Paid" column for each year

Fill in the dollar amount of support paid in that month. If more than one payment was made in a given month, put the total dollar amount of support paid. Put the dollar amount next to the month in which the payment was actually paid, and not the month the payments were intended to cover. If needed, you may attach more sheets.

Within the boxes on the bottom half on the page, only if it applies to your case, please complete the:

“Incarceration/Institutionalization History"

Fill in the details of any time periods during which the other parent of your child was involuntarily confined in a state prison, county jail, juvenile facility, mental health facility, or other facility. If needed, you may attach additional sheets.

Please complete a separate page(s) for child support, spousal support, family support, medical support, unreimbursed medical expenses, and other types of support not listed. DO NOT combine child support and spousal support unless your court order combines the two support payments into a "family" support order.

Be aware that this Declaration is not confidential and may be given to the other parent or party in your case for review. If there is a disagreement regarding the payment history, the parties may be required to present proof of payments, for example, cancelled checks, or receipts.

If you have questions and/or need assistance with child support forms, you can get free help from your local court's Family Law Facilitator Office. Information for the Family Law Facilitator can be found at the California Courts website at http://www.courts.ca.gov/selfhelp-facilitators.htm.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF CHILD SUPPORT SERVICES

DECLARATION OF SUPPORT PAYMENT HISTORY

DCSS 0569 (06/17/2018)

Person completing this form (name):

 

 

 

I am the:

 

 

 

 

 

Support Payment History for (check one):

Child

Spousal

Family

Unreimbursed medical expenses

Medical

Other (specify):

 

 

Custodial Party Noncustodial Parent

 

YEAR

 

 

YEAR

 

 

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMOUNT

 

AMOUNT

AMOUNT

AMOUNT

AMOUNT

AMOUNT

 

ORDERED

 

PAID

ORDERED

 

PAID

ORDERED

 

PAID

January

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

February

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

March

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

April

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

May

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

June

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

July

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

August

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

September

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

October

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

November

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

December

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Incarceration/Institutionalization History

BEGIN DATE

(MM/DD/YYYY)

RELEASE DATE (MM/DD/YYYY)

FACILITY/INSTITUTION NAME AND LOCATION

OTHER DETAILS, SUCH AS CHARGING

OFFENSE(S), CONVICTION(S),

VICTIM NAME(S), COURT WHERE

SENTENCED, ETC.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I am aware that this may be provided to the other parent for their verification and that either party may be required to provide documentation.

Signature:

 

Date:

 

CSE Case Number:

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Form Characteristics

Fact Name Description
Governing Law This form is governed by California Family Code § 4000-4200, which outlines child support obligations.
Form Purpose The Declaration of Support Payment History is used to track and report payments made towards child, spousal, or family support.
Monthly Breakdown It requires the completion of ordered and paid amounts for each month since the court order began, ensuring detailed records.
Incarceration Reporting There is a section to document any incarceration history of the noncustodial parent that may affect support obligations.
Verification Requirement Parties may need to provide proof of payments, such as canceled checks or receipts, in case of a disagreement.
Confidentiality Notice This declaration is not confidential and may be shared with the other parent for review and verification purposes.

Guidelines on Utilizing Double Elimination 20

The Double Elimination 20 form is a crucial document in child support cases. By accurately completing this form, individuals can ensure the proper accounting of support payments, whether they are custodial or noncustodial parents. The following steps outline how to fill out the form correctly.

  1. Begin by writing your name at the top of the form in the designated area.
  2. Indicate your relationship to the case by checking the appropriate box (Custodial Party or Noncustodial Parent).
  3. Select the type of support payment history you are reporting by checking one of the provided options: Child, Spousal, Family, Unreimbursed medical expenses, Medical, or Other. If you select "Other," specify the type of support in the space provided.
  4. In the "Amount Ordered" column, fill in the total amount of support ordered by the court for each month of the applicable years.
  5. In the "Amount Paid" column, enter the total amount that was actually paid for each corresponding month, ensuring the figures reflect the month of payment.
  6. If applicable, provide details about any periods of incarceration or institutionalization relevant to the case by completing the corresponding section.
  7. For each incarceration, specify the BEGIN DATE and RELEASE DATE, the name and location of the facility, and other pertinent details such as charges or convictions.
  8. Finally, sign and date the form to verify that all information provided is true and correct under penalty of perjury.
  9. Include the CSE Case Number in the designated area at the bottom of the form.

After completing the form, it may be necessary to submit it to the relevant parties involved in the child support case. Be mindful that the information is not confidential and may be shared with the other parent. If discrepancies arise, either party may need to present evidence regarding payment history.

What You Should Know About This Form

What is the purpose of the Double Elimination 20 form?

The Double Elimination 20 form is used to declare the support payment history in child support cases. It helps to document how much support was ordered by the court and how much has been paid, which is essential in determining any past due support that may be owed.

How do I fill out the 'Amount Ordered' column?

In the 'Amount Ordered' column, enter the total amount of support that the court ordered you to pay each month. Make sure to update this if there have been changes to the support amount since your original order.

What should I include in the 'Amount Paid' column?

In the 'Amount Paid' column, record any payments made for each month. If you made multiple payments in a month, total them and write that amount next to the month in which the payment was actually made, not the month for which it was intended.

Can I attach more sheets if needed?

Yes, you may attach additional sheets if you need more space to detail the payment history. Ensure that any attached sheets are clearly labeled and include the relevant information for your case.

What if the other parent was incarcerated?

If the other parent was incarcerated, you should complete the 'Incarceration/Institutionalization History' section. Provide the beginning and release dates, the name and location of the facility, and any relevant details like offenses or convictions.

Is the information in this form confidential?

No, the Declaration of Support Payment History is not confidential. It can be shared with the other parent or parties involved in the case for their review.

What should I do if there is a disagreement regarding payment history?

If there is a disagreement about the payment history, both parties may be required to present proof of payments, which can include canceled checks or receipts.

Where can I get assistance with filling out this form?

You can get free help from your local court's Family Law Facilitator Office. More information is available at the California Courts website.

What types of support payments should I report?

Report child support, spousal support, family support, unreimbursed medical expenses, and any other types of support listed. Do not combine different types of support unless your court order specifies that they are combined.

What is required for the declaration to be valid?

The declaration must be signed and dated. It is important to declare under penalty of perjury that the information provided is true and correct, as this may be subject to verification.

Common mistakes

When filling out the Double Elimination 20 form, mistakes can easily occur, leading to complications in child support cases. One common error is failing to accurately document the amounts ordered by the court. Each month should reflect what the court has mandated. If a parent mistakenly lists a different amount, this could cause disputes about what is owed.

Another frequent mistake is not keeping track of payments correctly. It's important to list the amount paid in the month it was actually paid, rather than the month it was intended to cover. Inaccurate reporting may lead to confusion and could result in claims of unpaid support.

Omitting pertinent details about changes in support orders is also a concern. If the support amount has changed due to modifications made by the court, it is crucial to update each monthly entry accordingly. Neglecting to record these adjustments can create misunderstandings down the line.

Many people overlook the section on Incarceration/Institutionalization History. This part is significant if there have been periods of confinement, as it can impact support obligations. Failing to complete this section may lead to incomplete information being submitted to the court.

People sometimes also make the mistake of combining different types of support payments. For example, child support and spousal support should not be merged unless the court order explicitly states they are grouped into a "family" support order. This careful attention can prevent significant administrative issues.

Additionally, some individuals forget to sign and date the form. This is a crucial step that confirms the information provided is accurate and complete. Without a signature, the form may be considered invalid.

Another typical error is not providing necessary documentation or evidence of payments made. While the form is designed to declare support payment history, it's advisable to have records such as canceled checks or receipts on hand, as these documents may be requested by the other parent or by the court.

Failing to double-check the completed form before submission is a prevalent mistake as well. A quick review can often catch clerical errors that might otherwise complicate matters later on. It's always wise to ensure all entries are logical and consistent.

In some cases, individuals neglect to seek assistance when confused about how to complete the form. Utilizing resources such as the local court's Family Law Facilitator can provide much-needed guidance. Ignoring available help can lead to unnecessary mistakes and delays.

Lastly, ignoring the fact that the declaration is not confidential can also be problematic. Knowing that this information may be shared with the other parent is essential. Ensuring accuracy may help prevent unnecessary disputes and legal challenges in the future.

Documents used along the form

When dealing with child support cases, several forms and documents work in conjunction with the Double Elimination 20 form. Understanding these documents can streamline the process and ensure compliance with state regulations.

  • Income Withholding Order (IWO): This document directs employers to deduct child support payments directly from a parent's paycheck, ensuring timely payments to the custodial parent.
  • Child Support Order: It outlines the specific amount of child support due, the frequency of payments, and any additional obligations, such as medical expenses.
  • Declaration of Assets and Expenses (DAE): This form provides a detailed account of a parent's financial situation, helping the court assess the ability to pay child support.
  • Modification Request: A parent may submit this request to change the original child support amount due to changes in income, employment, or other significant life circumstances.
  • Payment History Summary: A record that tracks all child support payments made and owed, used to verify compliance with the support order.
  • Child Support Review Request: This document initiates a review of the current support order, particularly when there are changes in financial circumstances or child needs.
  • Health Insurance Verification Form: This confirms whether the child is covered under a medical insurance plan, which can affect the support order regarding medical expenses.

Familiarizing yourself with these forms and their purposes can help navigate child support matters more effectively. Ensure you keep accurate records and documentation as required to support your case.

Similar forms

  • Child Support Payment Summary: Like the Double Elimination 20 form, this document records support ordered by the court and payments made over a specified period. It helps to determine any arrears in support payments.
  • Income Withholding Order: This form specifies the amounts to be deducted from an individual's paycheck for child support. Both documents facilitate the tracking of due and paid amounts over time.
  • Modification Request Form: A modification request form allows a party to officially request changes to the support amount. Similar to the Declaration, it documents payment history and intended adjustments based on changing circumstances.
  • Support Order: This document formalizes the court's order regarding the amount of support to be paid. Just as with the Double Elimination 20 form, it reflects the financial obligations of the parties involved.
  • Agreement to Settle Child Support: This agreement outlines the terms under which both parties agree to a modified support structure. Both documents require details about orders and payments to ensure clarity and enforceability.
  • Financial Statement: This detailed document provides a complete picture of an individual's finances, similar to the Declaration, which requires records of support payments and amounts owed.
  • Past Due Support Notification: This notification communicates the status of unpaid support, similar to how the Double Elimination 20 form assists in establishing whether past due payments exist.
  • Proof of Payment Documentation: This set of records verifies payments made for support obligations. Both documents emphasize the importance of maintaining accurate records for verification and accountability.
  • Respondent's Financial Disclosure: In a related context, this document discloses the financial status of the responding party in support cases. Both forms serve to clarify financial responsibilities and obligations.

Dos and Don'ts

When filling out the Double Elimination 20 form, keep the following tips in mind:

  • Do read all instructions carefully. Understanding what's required can save you time.
  • Don’t mix different types of support. Keep child support and spousal support separate unless stated otherwise.
  • Do ensure monthly amounts are accurate. This will help determine any past due amounts.
  • Don’t forget to attach additional sheets if necessary. If you need more space, it’s alright to add pages.
  • Do use the correct month for payments made. List amounts in the month they were actually paid.
  • Don’t submit incomplete forms. Check that every section is filled out before sending it in.
  • Do be aware of confidentiality. This information can be shared with the other parent.

Misconceptions

  • Only Child Support is Relevant: Many believe that the form is only for child support. In fact, it also covers spousal support, medical expenses, and other types of support if necessary.
  • Payments Can Be Reported Anytime: Some think they can submit payment data anytime. The form must reflect the actual payment dates, not the intended coverage dates.
  • One Entry per Month is Enough: It is a common misconception that a single entry suffices. If there are multiple payments in a month, the total amount should be reported next to the correct month.
  • Incarceration History is Optional: Many assume that filling out the incarceration history is optional. If applicable, this section must be completed as it affects payment obligations.
  • This Form is Confidential: Some people think this form is secret. It's not. The other parent may see it as part of the process.
  • Combining Payments is Allowed: It’s often mistakenly believed that child and spousal support can be combined. You should only combine them if your court order specifies a "family" support order.
  • No Documentation Needed: Some believe they do not need to present proof of payments. However, if there is a disagreement, documentation like receipts may be required.
  • The Form is Not Time-Sensitive: People may think they can submit the form whenever. There are deadlines relevant to your case that should be kept in mind.
  • Assistance is Not Available: Many think they have to figure this out alone. Free help is available from local court Family Law Facilitators for guidance on filling out the form.

Key takeaways

Filling out the Double Elimination 20 form may seem daunting at first, but these key takeaways will simplify the process. Understanding the requirements and implications can help ensure accurate submissions and smooth interactions regarding child support.

  • Understand the Purpose: This form is used to document the support payment history for your case, helping to establish any past due amounts.
  • Provide Accurate Information: It's crucial to enter the correct amounts ordered and paid for each month to ensure a clear payment history.
  • Use Specific Columns: Clearly distinguish between the "Amount Ordered" and "Amount Paid" columns for each year, filling in details for every month.
  • Reflect Changes: If your support order has changed, update the monthly amounts accordingly to reflect accurate support due.
  • Document Multiple Payments: If multiple payments occurred in a month, total them before entering the figure in the correct month.
  • Include Incarceration Details: If applicable, provide information about any involuntary confinement of the other parent, including dates and facility names.
  • Separate Support Types: Complete separate pages for different types of support like medical expenses, unless your court order specifies otherwise.
  • Communicate Openly: Be aware that this declaration is not confidential and can be shared with the other parent, so transparency is important.
  • Prepare Documentation: In case of disputes, be ready to present proof of payments such as receipts or cancelled checks.
  • Access Resources: Use local resources such as the Family Law Facilitator Office for free assistance in filling out child support forms.

Taking these steps can not only help in filling out the form correctly but also facilitate better communication between both parties regarding support payments.