Information for Providers
A Guide for Providers in Washington State
WelcomeHospitals, midwives, birth clinics, health departments, physicians, and other organizations form the back-bone of Washington State's Paternity Affidavit 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 affidavit. We sincerely appreciate your efforts!
- What is the Paternity Affidavit Program?
- Who should use this Guide?
- How do I offer parents an opportunity to sign the Paternity Affidavit?
- 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 affidavit?
- What if a minor (under age 18) wants to sign the affidavit?
- What should I say if parents have questions about child support that I cannot answer?
- Can parents change their minds after they sign the affidavit?
- Does signing the paternity affidavit establish any custody or visitation rights?
- How to order materials
- How to contact someone who can answer further questions.
What is the Paternity Affidavit Program?
In 2008, more than 30,000 children were born to unmarried parents in Washington State. The Paternity Affidavit Program provides unmarried parents an opportunity to voluntarily sign a Paternity Affidavit. Once both parents sign the affidavit and it is notarized, the Washington State Department of Health (DOH) may enter the father's name on the birth certificate. The affidavit 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 Affidavit is filed at 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 more than 22,000 children sign a Paternity Affidavit last year.
Who should use this Guide?
Any person or organization who offers unmarried parents an opportunity to sign a Paternity Affidavit should read and follow this guide. Federal regulation (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 an affidavit acknowledging paternity. Other individuals or organizations such as birthing clinics, social service organizations, and educational institution may participate voluntarily.
How do I offer parents an opportunity to sign the Paternity Affidavit?
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 affidavit and booklets, and show the video. Encourage the parents to bring the affidavit to the place where they will give birth.
Step 1
Determine whether or not the parents are married to each other.
If parents are not married to each other:
- Give the parents a Paternity Affidavit (DOH/CHS 021) and a copy of the DSHS booklet entitled "Establish Paternity for Your Child's Sake" (DSHS 22-586). The Paternity Affidavit and booklet are available in English and Spanish.
- Ask parents to read the instruction page on the front of the affidavit and the Statement of Rights and Responsibilities on the back of the affidavit. Federal and State laws require us to provide parents this written information.
Step 2
Federal and state laws also require that parents be given oral information. Parents should not sign the affidavit 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 affidavit. The video is available in English and Spanish. Or,
- Ask the parents to call 1-800-356-0463. This toll free line offers oral information about the benefits and legal requirements of signing the affidavit. The phone message is available in English, Spanish and Vietnamese.
- You may read the instruction page and the legal information to the parents.
Step 3
Help parents complete the affidavit. Verify that it is filled out completely and accurately. Check carefully the following lines on the affidavit:
- Line 21: The mother must check either yes or no. If she checks yes, be certain that her husband also completes and has notarized the Denial of Paternity on line 42. DOH cannot accept an affidavit with the YES box checked unless accompanied by a denial statement from the husband.
- Line 28: 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 28 blank if the father will not provide his social security number or if he does not have one.
- Line 36: The father must check either yes or no to the first question. If the father answers "No" to the first question, he may leave the second question blank. If the father asks for further information or genetic testing, refer him to the "Establish Paternity for Your Child's Sake" booklet and to the Statement of Rights and Responsibilities on the back of the Paternity Affidavit.
- 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.
Step 4
Notarize the parents 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 affidavit lists some potential notary locations. Any Washington State Division of Child Support (DCS) office will notarize the affidavit without cost. Some parents will want to take the affidavit home with them. The parents must complete and return the notarized affidavit to you within 5 days of the birth. Remind them that if they return the completed affidavit to you before you send the birth certificate to DOH, you will forward the affidavit to DOH for filing. If parents do not return the completed affidavit within five days, they can choose one of the following options:
- Mail the affidavit to DOH with the filing fee. Or,
- Take the complete affidavit to the local DCS office within three months after the child's birth. DCS will notarize the affidavit without charge and forward it to DOH. DCS will pay the fee for the parents.
Step 5
Distribute copies to the appropriate people and places as follows:
- Mail the original (white) to the Center for the Health Statistics (CHS) at the same time you submit the birth certificate information. If the mother is married and the husband has signed a denial, include the denial with the affidavit.
- 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.
Step 6
The Washington State Division of Child Support (DCS) will pay you $20 for each correctly completed and notarized affidavit. Complete the State of Washington Invoice Voucher (Form DSHS 17-122).
- In the Vendor or Claimant section (Top left), write the name and address of the hospital, person, or organization which should receive payment.
- An authorized person must sign the invoice (top right). Include the phone number and the date signed.
- You may batch several affidavits with one invoice. If you are submitting 30 or less affidavits, list each affidavit on the invoice. If you are submitting more than 30 affidavits, you may attach a separate list.
- In the Date column enter the child's date of birth.
- In the Child's full name column enter the child's full name.
- Enter the total number of affidavits submitted.
- 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 affidavits to the invoice.
Mail the completed invoice voucher and the pink affidavit copies to:
DSHS/Division of Child supportATTN: Accounts Payable
PO Box 9162
Olympia, WA 98507-9162
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.
What if the mother is married but the husband is not the father?
The mother must complete line 21 of the paternity affidavit. If she checks yes, she indicates that she was married to someone other than the natural father at some time during the pregnancy. Both the mother and the natural father may sign the affidavit. But the husband must also complete and have notarized the Denial of Paternity (line 42).What if one parent wants to sign, but the other parent does not?
Signing the Paternity Affidavit is voluntary for both parents and should be used only when there is ONE possible father. The affidavit is valid only after both parents have signed. Sometimes the mother asks to sign the affidavit and indicates that she will give the affidavit to the father for his signature. You may notarize the mother's signature. But, you may not process the affidavit until the father also signs.Are there any other options available if one or both parents do not want to sign the affidavit?
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. Usually, that process includes genetic testing.What if a minor (under age 18) wants to sign the affidavit?
A Paternity Affidavit signed by a minor is valid. Minors who sign the Paternity Affidavit will be held to the same standard as adults.What should I say if parents have questions about child support that I cannot answer?
Do not attempt to provide legal advice. Encourage the parents to read the material and view the video. If parents still have questions, refer them to the child support office serving their area. The 1-800 number for a child support office near them is provided in the Establish Paternity for Your Child's Sake booklet. The booklet also provides information on attorney referral services through the Washington State Bar Association.Can parents change their minds after they sign the affidavit?
Either the man or the woman who signs a Paternity Affidavit may change his or her mind within a limited period of time. The legal term is called a rescission. To rescind a signature, the parent must initiate a court action within no more than 60 days after the Paternity Affidavit is filed at DOH.Does signing the paternity affidavit establish any custody or visitation rights?
No. Only the courts may address custody and visitation issues. Parents who sign a Paternity Affidavit may initiate a court action to address these issues. Refer the parents to the "Establish Paternity for Your Child's Sake" booklet for more information.How to order materials
Description of Materials
You will need the following materials to provide parents the opportunity to sign a Paternity Affidavit.
- The Paternity Affidavit (DOH/CHS 021). The affidavit 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 March 2002 or later revision.
- The Establish Paternity for Your Child's Sake booklet (DSHS 22-586). The booklet is currently available in English and Spanish. The booklet is also available in five other languages on-line:
- The Invoice Voucher (DSHS 17-122) 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 affidavit is available in English and Spanish
- The booklet entitled "How to Get a Genetic Test" (DSHS 22-959) is available for hospitals participating in the Bright Start Project.
Easy Ordering
You 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 1-800-867-9709. Select option 1. You will receive your order within 7-10 working days.
How to contact someone who can answer further questions.
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 affidavit 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.
- If you are unable to reach your local coordinator, you may call 1-800-867-9709. Select Option 2 to speak with the Statewide Coordinator.
| Everett: | Georgia Payne | 425-438-4901 |
| Fife: | Sean Bui | 253-680-0461 |
| Kennewick: | Janie Escalera | 509-374-2032 |
| Olympia: | Michele Smith | 360-664-6932 |
| Seattle: | Seanna DeLauter | 206-341-7223 |
| Spokane: | Michael Leitch | 509-363-5012 |
| Tacoma: | Sue Pierce | 253-476-7661 |
| Vancouver: | Joan Kjer | 360-397-9722 |
| Wenatchee: | David Murie | 509-886-6851 |
| Yakima: | Terese Padilla | 509-249-6075 |
