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Information for Providers
A Guide for Providers in Washington StateWelcome
Hospitals, midwives, birth clinics, health departments, physicians, and other organizations form the back-bone of Washington State's Paternity Acknowledgment Program. Your efforts have made Washington State's program an outstanding success and a model for the nation. This guide provides you with the information you need to comply with federal and state laws and meet the needs of parents who desire to sign a paternity acknowledgment. We sincerely appreciate your efforts!
- What is the Paternity Acknowledgment Program?
- Who should use this Guide?
- How do I offer parents an opportunity to sign the Paternity Acknowledgment?
- What if the mother is married but the husband is not the father?
- What if one parent wants to sign, but the other parent does not?
- Are there any other options available if one or both parents do not want to sign the acknowledgment?
- What if a minor (under age 18) wants to sign the acknowledgment?
- Can parents change their minds after they sign the acknowledgment?
- Does signing the paternity acknowledgment establish any custody or visitation rights?
- What should I say if parents have questions about child support that I cannot answer?
- How to order materials
- How to contact someone who can answer further questions.
In 2012, over 28,000 children were born to unmarried parents in Washington State. The Paternity Acknowledgment Program provides unmarried parents an opportunity to voluntarily sign a Paternity Acknowledgment. Once both parents sign the acknowledgment and it is notarized, the Washington State Department of Health (DOH) may enter the father's name on the birth certificate. The acknowledgment establishes a legal finding of paternity. A parent may rescind his or her signature by initiating a court action within no more than 60 days after the Paternity Acknowledgment is filed at DOH. After the rescission period, a challenge to the acknowledgment may be filed in court for limited reasons up to 4 years after the acknowledgment is filed with DOH. Legally establishing paternity helps a child become eligible to receive certain benefits if needed. Some of those benefits include child support, social security, health insurance, and inheritance rights. Establishing paternity also makes it possible for the child to enjoy a sense of belonging that comes from knowing both parents. Washington's program began in July 1989. Your efforts helped the parents of nearly 22,000 children sign a Paternity Acknowledgment last year.
Any person or organization who offers unmarried parents an opportunity to sign a Paternity Acknowledgment should read and follow this guide. Federal regulation (45 CFR 303.5) and state law (RCW 70.58.080) require physicians, midwives, hospitals and birth records agencies to provide unmarried parents an opportunity to sign a Paternity Acknowledgment. Other individuals or organizations such as birthing clinics, social service organizations, and educational institution may participate voluntarily.
Follow the six steps.
These instructions assume that a parent gives birth in a hospital, birthing clinic or at home. Sometimes, however, you will have
opportunity to simply give information about the program to parents who are expecting to give birth weeks or months in the future.
You may give out the Paternity Acknowledgment and booklets, and show the video (English) (Spanish).
Encourage the parents to bring the acknowledgment to the place where they will give birth.
Determine whether or not the parents are married to each other.
If parents are not married to each other:
- Give the parents a Paternity Acknowledgment (DOH/CHS 021) and a copy of the DSHS booklet entitled "Establish Parentage for Your Child's Sake" (DSHS 22-586). The Paternity Acknowledgment and booklet are available in English and Spanish.
- Ask parents to read the instruction page on the front of the acknowledgment and the Statement of Rights and Responsibilities on the back of the acknowledgment. Federal and State laws require us to provide parents this written information.
Federal and state laws also require that parents be given oral information. Parents should not sign the Paternity Acknowledgment until they have received this information. Offer the parents the opportunity to do at least one of the following:
- View a short video which explains the benefits and legal requirements of signing the acknowledgment. The video is available in English and Spanish (English) (Spanish). Or,
- Ask the parents to call 1-800-356-0463 for more information.
- You may read the instruction page and the legal information to the parents.
Help parents complete the Paternity Acknowledgment. Verify that it is filled out completely and accurately. Check carefully the following lines on the acknowledgment:
- Line 24: The mother must check either yes or no. If she checks yes, she must provide the person's name. In addition, be certain that her husband or registered domestic partner also completes and has notarized the Presumed Parent's Denial of Paternity on lines 42 - 48. DOH cannot accept an acknowledgment with the YES box on item 24 unless the husband or domestic partner completes the Presumed Parent's Denial of Paternity.
- Line 31: Federal regulations require providers to attempt to gather the father's social security number. Sometimes a foreign national will not have one. You may leave line 31 blank if the father will not provide his social security number or if he does not have one.
- Line 39: The father must check either yes or no to the first question. If the father answers "No" to the first question, he should leave the second question blank. If the father asks for further information or genetic testing, refer him to the "Establish Parentage for Your Child's Sake" booklet and to the Statement of Rights and Responsibilities on the back of the Paternity Acknowledgment.
- Line 40 and 41: Both parents must sign in the presence of a notary. The notary must attest to the authenticity of the signature being made.
Notarize the parent's signatures on lines 40 and 41. Be certain to separately notarize each signature and place a notary stamp or seal to the right of both the mother's and father's signature block. Sometimes notary services are not immediately available at the place of birth. If possible, help the parents find a place where they may receive notary services. The bottom of the instruction page of the acknowledgment lists some potential notary locations. Any Washington State Division of Child Support (DCS) office will notarize the acknowledgment without cost. Some parents will want to take the acknowledgment home with them. The parents must complete and return the notarized acknowledgment to you within 5 days of the birth. Remind them that if they return the completed acknowledgment to you before you send the birth certificate to DOH, you will forward the acknowledgment to DOH for filing. If parents do not return the completed acknowledgment within five days, they can choose one of the following options:
- " Mail the acknowledgment to DOH with the filing fee. The address is P.O. Box 47814, Olympia, WA 98504-7814 Or,
- Take the complete acknowledgment to the local DCS office. DCS will notarize the acknowledgment without charge and forward it to DOH. DCS will pay the fee for the parents.
Distribute copies to the appropriate people and places as follows:
- Mail the original (white) to the DOH, Center for the Health Statistics (CHS), P.O. Box 47814, Olympia, WA 98504-7814 at the same time you submit the birth certificate information. If the mother is married or in a registered domestic partnership and the husband or domestic partner has signed a denial, include the denial with the acknowledgment.
- Send the pink copy to the Division of Child Support (DCS). *See Step 6 for instructions.
- Give the yellow copy to the mother.
- Give the green copy to the father.
The Washington State Division of Child Support (DCS) will pay you $20 for each correctly completed and notarized acknowledgment. Complete the State of Washington Invoice Voucher (Form DSHS A19-1A) PDF, Word Document
- In the Vendor or Claimant section (Top left), type the official name (not the DBA name) and address of the hospital, person, or organization which should receive payment.
- Assign an invoice number or unique identifier and date in the upper right hand corner. This will assist your fiscal/accounting department when they receive payment from DSHS.
- An authorized person must sign the invoice (top right). Include the phone number and the date signed. The invoice is considered incomplete without this information.
- You may batch several acknowledgments with one invoice (preferred method). Each invoice provides space for up to 30 names that correspond to the acknowledgments you attach. If you submit 30 or less acknowledgments, list each name on the invoice. If you submit more than 30 acknowledgments, you may attach a separate list of names.
- In the Date column enter the child's date of birth.
- In the Child's full name column enter the child's full name.
- Multiply the Quantity times $20 and enter the total in the Total due column.
- Leave all other parts of the invoice voucher form blank.
- Attach the pink copies of the acknowledgments to the invoice.
Mail the completed invoice voucher and the pink acknowledgment copies to:DSHS/ESA/OS Fiscal DCS Fiscal Unit PO Box 45445 Olympia, WA 98504-5445
Answer to Your Questions:
Below are some most often asked questions. If you have additional questions that are not answered in this guide, click here.
Are there any other options available if one or both parents do not want to sign the acknowledgment?Yes. Either parent may open a case with the Division of Child Support (DCS). In most cases, DCS will refer the case to a prosecuting attorney for paternity establishment through the court. That process usually includes genetic testing.
Establish Parentage for Your Child's Sake" booklet for more information.
Establish Parentage for Your Child's Sake booklet. The booklet also provides information on attorney referral services through the Washington State Bar Association.
Description of Materials
You will need the following materials to provide parents the opportunity to sign a Paternity Acknowledgment.
- The Paternity Acknowledgment (DOH/CHS 021) is available in English and Spanish. On the lower left hand corner of the instruction page you will find the form number and the latest revision date. You should be using the July 2011 revision.
- The Establish Parentage for Your Child's Sake booklet (DSHS 22-586). The booklet is currently available in English and Spanish.
- The Invoice Voucher (DSHS A19-1A) is necessary for you to bill DCS for the $20 reimbursement for services.
- The short video which explains the benefits, rights, responsibilities, and legal consequences of signing the acknowledgment is available in English and Spanish
- The booklet entitled "Division of Child Support Voluntary Paternity Testing Program" (DSHS 22-1443) is available beginning July 2011 for participating hospitals. This booklet replaces the booklet entitled "Bright Start: How to Get a Genetic Test" (DSHS 22-959).
Easy OrderingYou may order all of above material quickly and easily.
To order materials, click here.
Complete the on-line order form and submit it to DCS. You may also order materials by calling (360)664-5316. You will receive your order within 7-10 working days.
DCS and DOH will provide training for you and your staff. We can provide specific training at your site or we can arrange for you to attend workshops at sites around the state. Training sessions usually require about 1 hour.
- To ask a question about how to complete the acknowledgment call Ray Moffatte at 360-236-4335 and for the birth certificate, call Jeffrey Weldon at 360-236-4366.
- To arrange for training or ask program questions: call the program coordinator in the DCS field office listed below which is closest to you.