Free Dcss 0053 Form in PDF

Free Dcss 0053 Form in PDF

The DCSS 0053 form, issued by the State of California Health and Human Services Agency's Department of Child Support Services, is designed for documenting actual visitation hours a noncustodial parent spends with their child(ren) over a 12-month period. It serves a crucial role in providing a factual basis for decisions regarding child support and visitation schedules. To ensure accurate child support arrangements and uphold the best interests of the child(ren), completing this form meticulously is essential.

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The DCSS 0053 form, issued by the State of California's Health and Human Services Agency's Department of Child Support Services, serves a critical function in documenting visitation schedules and the actual visitation history between a noncustodial parent and their child or children. Designed to capture a detailed account of visitation over the preceding 12 months, this form requires information such as the number of hours spent with the child each month, meticulously recorded by the custodial party or the noncustodial parent. In addition to the monthly record-keeping, the form also delves into shared custody or visitation arrangements, specifying the types of visitation, including regular, vacation, summer, holiday, and overnight stays, and if these are court-ordered. By offering sections for shared custody, the form acknowledges various custody arrangements and emphasizes the importance of accurate reporting to ensure the wellbeing of the child or children involved. The second page of the form further allows the individual completing it to declare the information's accuracy under penalty of perjury, illustrating the legal weight of the document and its significance in the broader context of child support and custody matters.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF CHILD SUPPORT SERVICES

VISITATION VERIFICATION

DCSS 0053 (08/21/2016)

CSE Case Number:

Name of person completing form:

I am the

Custodial Party

Noncustodial Parent

 

 

 

 

PART 1. ACTUAL VISITATION BY THE NONCUSTODIAL PARENT

INSTRUCTIONS:

Complete the visitation history by filling in the last 12 months and number of hours for each month the noncustodial parent visited with the child(ren). If visitation is different for each child(ren), please complete one form for each child.

Example: If the last 12 months are June 2014 through May of 2015, you will complete June through December on the left side of the chart below. You would put 2014 for the year. Then you would complete the right side of the chart with January through May and put 2015 for the year.

 

NUMBER OF HOURS

 

NUMBER OF HOURS

 

THE NONCUSTODIAL

 

THE NONCUSTODIAL

MONTH/YEAR

PARENT VISITED WITH

MONTH/YEAR

PARENT VISITED WITH

 

THE CHILD(REN) EACH

 

THE CHILD(REN) EACH

 

MONTH

 

MONTH

 

 

 

 

January/

 

January/

 

 

 

 

 

February/

 

February/

 

 

 

 

 

March/

 

March/

 

 

 

 

 

April/

 

April/

 

 

 

 

 

May/

 

May/

 

 

 

 

 

June/

 

June/

 

 

 

 

 

July/

 

July/

 

 

 

 

 

August/

 

August/

 

 

 

 

 

September/

 

September/

 

 

 

 

 

October/

 

October/

 

 

 

 

 

November/

 

November/

 

 

 

 

 

December/

 

December/

 

 

 

 

 

 

TOTAL:

 

TOTAL:

 

 

 

 

Page 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF CHILD SUPPORT SERVICES

VISITATION VERIFICATION

DCSS 0053 (08/21/2016)

PART 2. SHARED CUSTODY/VISITATION

CHECK ONE:

Shared Custody

Visitation Only

Neither

VISITATION HOURS:

Regular Visitation:

From (specify day of the week)

at (specify time)

To (specify day of the week)

at (specify time)

Vacation Visitation:

Yes

If Yes, please specify dates/times:

 

Summer Visitation:

Yes

If Yes, please specify dates/times:

 

Holiday Visitation:

Yes

If Yes, please specify dates/times:

 

Overnight Visitation:

Yes

If Yes, please specify dates/times:

 

(Circle one) a.m./p.m.

(Circle one) a.m./p.m.

No

No

No

No

Court-ordered custody/visitation arrangement:

Yes

No

Additional Information:

I declare to the best of my knowledge and belief that the above information is true and correct. I am aware that this information may be provided to the other parent for their verification and that either party may be required to provide documentation.

PRINT NAME

SIGNATURE

DATE

Page 2 of 2

Document Specs

Fact Name Description
Form Identification The document is identified as DCSS 0053, issued by the State of California's Health and Human Services Agency, Department of Child Support Services.
Form Issue Date The form was last updated on August 21, 2016.
Purpose of the Form Designed to verify visitation history of the noncustodial parent with their child(ren) in the past 12 months.
User Audience It is to be completed by either the custodial party or the noncustodial parent.
Visitation Detailing Requires detailing the number of hours spent by the noncustodial parent with the child(ren) each month.
Child-Specific Instructions If visitation varies among children, a separate form must be completed for each child.
Second Part of the Form Focuses on shared custody/visitation, asking for specifics about regular, vacation, summer, holiday, and overnight visitations, including if they are court-ordered.
Declaration Statement The form includes a declaration statement asserting the information provided is true and correct to the best of the respondent's knowledge and belief.
Governing Laws While specific laws or codes are not mentioned in the contents provided, the form falls under the purview of California's family law concerning child custody and visitation arrangements.

Instructions on Writing Dcss 0053

When navigating through the process of documenting visitation history with the Department of Child Support Services, using the DCSS 0053 form is essential. This form plays a crucial role in verifying visitation patterns between a noncustodial parent and their child(ren). Before diving into completion, understanding what needs to be done next is important. This step involves accurately detailing the past 12 months of visitation, specifying hours spent each month, and clarifying custody arrangements. The aim is to ensure all information reflects the actual visitation patterns, which may impact child support decisions. Follow the steps below to fill out the form properly.

  1. Identify the Participant: At the top of the form, specify whether you are the custodial party or the noncustodial parent. This is crucial for the Department of Child Support Services to understand the source of the information.
  2. Complete Part 1 - Actual Visitation: Start by filling in the visitation history. For each month over the last year, list the total number of hours the noncustodial parent spent with the child(ren). If the visitation differs amongst children, remember to complete separate forms for each child.
  3. Document Shared Custody/Visitation in Part 2: In this section, check the appropriate box that represents the custody arrangement: Shared Custody, Visitation Only, or Neither. This clarity is vital for accurately assessing the situation.
  4. Detail Visitation Hours: Provide specifics about regular, vacation, summer, and holiday visitations, including the start and end times, as well as any overnight visitations. If any visitations were court-ordered, indicate this by checking "Yes" or "No."
  5. Verification and Signature: After ensuring all the provided information accurately reflects the visitation history, print your name, sign the form, and date it. This attests to the fact that you believe the details you've provided are correct and complete.

Once the DCSS 0053 form is filled out thoroughly, the next steps involve submitting it to the designated department within the Health and Human Services Agency. It's important to remember that this form may be shared with the other parent for verification purposes. Additionally, either party may be asked to provide further documentation to support the visitation claims made. Handling this form with honesty and attention to detail is paramount in ensuring that the child support services can make the most informed decisions possible.

Understanding Dcss 0053

What is the purpose of the DCSS 0053 form?

The DCSS 0053 form, issued by the State of California's Department of Child Support Services, serves as a means to document and verify visitation schedules and actual visitation hours between noncustodial parents and their children. This form plays a vital role in ensuring that child support arrangements and custody agreements are followed and reflects any changes in visitation that may affect child support calculations.

Who should complete the DCSS 0053 form?

This form should be completed by either the custodial party or the noncustodial parent, depending on who is reporting the visitation information. It is designed to capture detailed information about the actual visitations, including the dates and the total number of hours spent with the child or children for each month within a specified 12-month period.

How should the visitation history be recorded on the DCSS 0053 form?

Visitation history should be meticulously recorded by filling out the chart provided on the form for the last 12 months. The chart is divided to accommodate entries from June to December on the left side (mentioning the year), and entries from January to May on the right side (also with the year specified). For each month, the number of hours the noncustodial parent spent with each child should be entered. If the visitation varies among children, a separate form should be completed for each child.

What information needs to be included in the shared custody/visitation section?

In the shared custody/visitation section of the form, you need to indicate whether there is shared custody, visitation only, or neither. Detailed information regarding the regularity of visits (days of the week and times), as well as special visitations like vacation, summer, holiday, and overnight stays, should be specified, including exact dates and times if applicable. This portion also queries about the existence of a court-ordered custody or visitation arrangement and provides space for any additional pertinent information.

Is it mandatory to provide documentation along with this form?

While the form itself requires the party completing it to declare that all the information provided is true and correct to the best of their knowledge, it also notes that the information may be shared with the other parent for verification purposes. Both parties involved may be asked to provide documentation to support the visitation claims made on this form, making it crucial that all entries are accurate and verifiable.

What happens if falsified information is provided on the DCSS 0053 form?

Providing falsified information on the DCSS 0053 form, or on any legal document, can have serious consequences, including legal repercussions. False statements can lead to adjustments in child support obligations, either increasing or decreasing the amount, and could potentially result in legal action for perjury or fraud. It is essential that all information on this form is accurate and truthful.

How can changes to visitation schedules be reported after submitting the DCSS 0053 form?

If there are any changes to the visitation schedule after the DCSS 0053 form has been submitted, it is imperative to report these changes to the Department of Child Support Services immediately. Keeping the visitation information current can ensure that child support calculations are accurate and reflect the actual time each parent spends with their child or children. This may require filling out a new form or contacting the department for guidance on how to proceed with reporting changes.

Common mistakes

When filling out the Department of Child Support Services Visitation Verification form, commonly known as DCSS 0053, individuals often make several mistakes that can affect the processing and accuracy of the submitted information. One common error is incorrectly reporting the visitation hours. Accurate reporting of the number of hours spent in visitation each month is crucial, yet some individuals may inadvertently enter incorrect totals or misinterpret the instructions, leading to either overstated or understated visitation hours. Ensuring that these hours are recorded accurately is essential for an accurate assessment of the noncustodial parent's involvement.

Another notable mistake is failing to complete a separate form for each child when the visitation schedule varies among siblings. The form's instructions clearly state the necessity of this step, yet it is sometimes overlooked. This oversight can lead to confusion and inaccuracies in documenting the visitation for each child, potentially affecting custody arrangements or support calculations. It's important to carefully review the visitation circumstances for each child and provide separate forms to capture the unique details accurately.

Additionally, respondents sometimes skip the section that asks about shared custody or different types of visitation, such as vacation or holiday visitation. This section provides critical information on the full scope of visitation arrangements beyond regular schedules. By neglecting to provide comprehensive details, including specifying dates and times for special visitations, individuals risk omitting significant aspects of the parenting agreement, which could have ramifications for both parties.

A further error involves the declaration section at the end of the form, where individuals must attest to the truthfulness of the information provided. Some may hurriedly sign without thoroughly checking the form for accuracy or completeness. Given that this information could be shared with the other parent for verification and might require supporting documentation, ensuring the accuracy of every detail prior to signing is paramount. Overlooking or misrepresenting information, even unintentionally, can lead to disputes or require corrections that delay the resolution of support or custody matters.

Documents used along the form

Understanding the importance of accurately completing and submitting the DCSS 0053 form, which is used for visitation verification in child support cases, necessitates familiarity with other forms and documents that are often used in conjunction. These additional documents can play crucial roles in providing a comprehensive overview of the child's wellbeing, the financial responsibilities of each parent, and the legal agreements governing custody and visitation. Below is a brief description of four such documents.

  • Income and Expense Declaration (Form FL-150): This form is essential for determining each parent's financial situation. It requires detailed information about income, monthly expenses, assets, and debts, helping the court decide on child support obligations.
  • Child Custody and Visitation Application Attachment (Form FL-311): Often used in conjunction with the DCSS 0053 form, this document outlines the requesting party's custody and visitation proposal. It provides a structured way to suggest a parenting plan to the court.
  • Request for Order (Form FL-300): This form is used to request court orders in family law cases. When changes to child support, custody, or visitation are needed, filling out this form begins the legal process of requesting such modifications.
  • Child Support Case Registry Form (Form FL-191): Required for all cases in which child support is ordered, this form ensures that the case is registered with the state's child support registry. It includes information on both parents and is used for processing and tracking child support payments.

Together, these documents form a network of information and legal requests that support the child support system's goal of ensuring the well-being and financial security of children in separated or divorced families. They are instrumental in defining the responsibilities and rights of each parent, as well as in establishing a structured and legally recognized arrangement for the care of the children involved.

Similar forms

The DCSS 0053 form, geared towards documenting visitation arrangements within child support and custody cases, shares similarities with various other legal documents, each serving a unique but related purpose in family law. The first such document is the Custody Agreement. Like the DCSS 0053 form, Custody Agreements lay out the terms under which parents will share the responsibilities and privileges of raising their child, including detailed schedules for visitation, albeit in a more comprehensive and legally binding format.

Next, the Parenting Plan form is another crucial document reflecting upon similar aspects as the DCSS 0053. It typically offers a detailed roadmap for how parents intend to share care and upbringing responsibilities, including living arrangements, visitation schedules, and decision-making. The chief difference lies in its broader scope, covering aspects of the child's life beyond mere visitation rights.

The Child Support Order bears resemblance to the DCSS 0053 form in that it often contains provisions related to visitation as part of the broader financial support framework. While primarily focused on establishing the financial obligations one parent has to the other for the child's upbringing, it frequently intersects with custody and visitation issues, ensuring that financial and physical support for the child are aligned.

Moreover, the Visitation Schedule is intimately linked with the DCSS 0053 form, essentially functioning as a subset or component of what the DCSS 0053 seeks to document. This schedule outlines the specific times and conditions under which the noncustodial parent can visit with the child, often included within broader custody agreements or as a standalone document agreed upon by both parties or ordered by a court.

The Paternity Declaration, while primarily aimed at legally establishing the fatherhood of a child, can influence documents like the DCSS 0053. Establishing paternity is often the first legal step toward addressing custody, visitation, and child support arrangements, making it a foundational document that impacts the rights and responsibilities documented in visitation verification forms.

Temporary Custody Orders share a functional relationship with the DCSS 0053 form. They outline interim custody and visitation arrangements while permanent solutions are being negotiated or awaited. This similarity lies in the focus on detailing how and when a noncustodial parent may spend time with their child during the transitional legal period.

The Modification of Custody or Visitation Order parallels the DCSS 0053 in that it may revise the terms of custody and visitation originally set forth. These modifications, necessitated by changing circumstances, directly affect the schedule and nature of visitation as would be documented on a form like the DCSS 0053, adjusting it to suit the child's best interests and parental capabilities.

Lastly, the Emergency Custody Order, while typically more urgent and temporary in nature, can detail visitation rights in exigent circumstances. Similar to the DCSS 0053 form, it may specify conditions under which a noncustodial parent can visit the child during the period the emergency order is in effect, ensuring the child's safety and well-being while maintaining parental contact.

Dos and Don'ts

Approaching the filling of the DCSS 0053 form with diligence ensures that the process reflects accurately the visitation records and adheres to the legal requirements. Below are lists of what should and should not be done for a smoother completion process.

Do:

  1. Read the entire form before beginning to fill it out, understanding each section thoroughly to avoid mistakes.
  2. Use a blue or black pen if filling out by hand to ensure legibility and official acceptance of the document.
  3. Be accurate with the dates and the number of hours for each visit. Estimations should be as close to the actual numbers as possible.
  4. If the visitation varies for different children, remember to complete a separate form for each child to provide a detailed account.
  5. Review the calendar year mentioned in the form instructions to avoid placing information in the wrong time frame.
  6. Double-check for any court-ordered custody or visitation arrangements and accurately indicate them in the specified section.
  7. Print your name legibly at the end of the form, and then sign and date it to authenticate the information provided.
  8. Keep a copy of the completed form for your records in case any discrepancies arise in the future.

Don't:

  • Don’t rush through the form without understanding the specific requirements for each section.
  • Don’t use a pencil or any non-permanent writing tool, as this can lead to alterations and questioning of the document’s validity.
  • Don’t guess the hours or be vague about the visitation details; accuracy is crucial for a fair assessment.
  • Don’t overlook the necessity of filling out separate forms for each child if their visitation hours differ, as combining them could lead to confusion.
  • Don’t ignore the importance of clearly marking any shared custody or special visitation arrangements, as these specifics are essential for legal considerations.
  • Don’t sign the form without verifying all the entered information. Any errors can complicate or invalidate the process.
  • Don’t forget to date the signature, as the form requires a current acknowledgment of the provided data.
  • Don’t submit the form without making a copy for personal keeping, as it serves as a crucial record for future reference.

Filling out the DCSS 0053 form with attentiveness ensures that all parties involved have a clear and documented understanding of the visitation schedule. It is an important step in maintaining an organized and legally compliant record of the noncustodial parent's time with their child(ren).

Misconceptions

There are several misconceptions about the DCSS 0053 form, often stemming from misunderstandings about its purpose, how it should be filled out, and its impact on child support and custodial arrangements. Here, we address nine common misunderstandings:

  1. It is only for the noncustodial parent to complete: This is incorrect. The form requires input from either the custodial party or the noncustodial parent, depending on who is completing it, to record visitation.

  2. Filling out the form is voluntary: While it might seem optional, accurately completing the form can have legal implications and might affect child support calculations or custody arrangements.

  3. It only tracks physical visitation: The form is designed to account for actual visitation hours, which could include overnight stays or vacation visitations, illustrating that it's more comprehensive than just tracking daytime visits.

  4. The form is only applicable for court use: While the form can be used as evidence in court regarding visitation disputes, it also serves as an official record for both parents and can be used for mediation or adjustments in child support.

  5. Visitation information won’t impact child support: This is a misconception. Documented discrepancies in agreed-upon versus actual visitation can influence the calculation of child support payments.

  6. One form suffices for multiple children: If visitation varies among children, a separate form for each child must be completed to accurately reflect the unique visitation schedule of each child.

  7. Digital submission is always acceptable: The preference or requirement for digital versus hardcopy submissions varies by jurisdiction. It's crucial to verify with local child support services or legal counsel.

  8. Information on the form is confidential: While sensitive, the information can be shared with the other parent for verification purposes, underscoring the necessity of accuracy and honesty when completing the form.

  9. It doesn’t need to be updated: Regular updates to the form may be necessary to reflect current visitation schedules accurately, especially if there's a significant change in patterns or custody arrangements.

Understanding and clarifying these misconceptions ensures that both custodial and noncustodial parents can accurately complete the DCSS 0053 form, adhering to legal requirements and supporting the best interests of their children.

Key takeaways

Filling out the DCSS 0053 form is crucial for documenting visitation in child support and custody matters. Here are key takeaways you need to know:

  • Accurate Completion: It's essential to fill in the visitation history with accuracy for the past 12 months, ensuring that the number of hours for each visit with the child(ren) is precisely recorded. This accuracy is key to providing clear evidence of visitation patterns.
  • Separate Forms for Each Child: If the visitation schedule varies among children, a separate DCSS 0053 form must be completed for each child. This differentiation ensures that each child's visitation is accurately documented and assessed.
  • Understanding Visitation Types: The form differentiates between shared custody, visitation only, and other arrangements. Clearly understanding each category is vital when selecting the one that accurately reflects your situation.
  • Detailing Visitation Schedules: Regular, vacation, summer, holiday, and overnight visitation should be detailed in the form. Including specific dates and times for each type of visitation provides a comprehensive view of the parenting time each parent has.
  • Court-Order Awareness: The form asks whether the visitation arrangement is court-ordered. Knowing the legal status of your visitation schedule is critical, as court-ordered arrangements carry legal obligations.
  • Honest Declaration: Signing the form requires a declaration that the information provided is true and correct to the best of your knowledge. This is a serious statement that underscores the importance of honesty in the documentation process.
  • Documentation May Be Required: Be prepared to provide additional documentation to support the visitation history claimed on the form. Keeping thorough records can ease this process.
  • Information Sharing: The completed form may be shared with the other parent for verification. This underscores the need for accuracy and truthfulness in reporting, as the information could be subject to scrutiny.

Understanding and carefully filling out the DCSS 0053 form can significantly impact the outcome of child support and custody proceedings. It acts as a formal record of the visitation that has occurred, which can influence decisions made by the court or child support services. Therefore, approach this document with the seriousness and diligence it deserves.

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