Form 1 Status of Application Report

Provision of Child Support Services in IV-D cases under the Hague Child Support Convention

A5_Status_of_App_Report_Article12

Annex B: Status of Application Report, Article 12

OMB: 0970-0488

Document [pdf]
Download: pdf | pdf
OMB Control No: XXXX-XXXX
Expiration date: mm/dd/yyyy
Convention on the International Recovery of Child Support and Other Forms of Family Maintenance

Status of Application Report – Article 12 1
(Application for Recognition or Recognition and Enforcement
( Article 10(1) a)  Article 10(2) a)  Article 30))

CONFIDENTIALITY AND PERSONAL DATA PROTECTION NOTICE

Personal data gathered or transmitted under the Convention shall be used only for the purposes for
which it was gathered or transmitted. Any authority processing such information shall ensure its
confidentiality, in accordance with the law of its State.
An authority shall not disclose or confirm information gathered or transmitted in application of this
Convention if it determines that to do so could jeopardise the health, safety or liberty of a person in
accordance with Article 40.

A determination of non-disclosure has been made by a Central Authority in accordance
with Article 40.
1. Requested Central Authority

2. Contact person in requested State

a. Address

a. Address (if different)

b. Telephone number

b. Telephone number (if different)

c. Fax number

c. Fax number (if different)

d. E-mail

d. E-mail (if different)

e. Reference number
e. Language(s)
 First Report /  Subsequent Report – Date of last Report: __________________ (dd/mm/yyyy)
3.

1

File identification
a. Requesting Central Authority file reference number:__________________________
b. Family name(s) of applicant:
_________________________________
or
b. Name of public body:
_________________________________
and
c. Family name(s) of the person(s) for whom
maintenance is sought or payable: _________________________________
_________________________________
_________________________________
d. Family name(s) of debtor:
_________________________________

The Status of Application Report can be used for the purpose of Article 12(3), (4) and (5). If the Report is being used to
provide updates, only include additional information that was not included in the previous reports.

Convention on the International Recovery of Child Support and Other Forms of Family Maintenance

4.

Status of the application in the requested State
a.

On __________________ (dd/mm/yyyy) the competent authority declared
the decision enforceable or registered the decision for enforcement
( declaration or registration attached for information purposes only;
 applicant has been notified of the declaration or registration;
 applicant will be notified of the declaration or registration)
b.

On or by __________________ (dd/mm/yyyy) the competent authority is
due to declare whether the decision is enforceable or is to be registered
for enforcement
c.

On __________________ (dd/mm/yyyy) the respondent lodged a
challenge or an appeal against the declaration or registration
d.

On __________________ (dd/mm/yyyy) the competent authority issued a
decision refusing recognition and enforcement ( decision attached for
information purposes only;  applicant has been notified of the decision;
 applicant will be notified of the decision)
e.

On __________________ (dd/mm/yyyy) the competent authority refused
recognition and enforcement as a result of a reservation under
Article 20(2). On __________________ (dd/mm/yyyy) a decision was
established for the benefit of the creditor in accordance with
Article 20(4).
f.

On __________________ (dd/mm/yyyy) the respondent lodged a further
appeal.
g.

On __________________ (dd/mm/yyyy) the application / decision was
sent to the enforcement authority
h.

Application is still pending before the Central Authority
i.

Application / decision sent to enforcement authority and enforcement is
impossible in the foreseeable future because:

Debtor without necessary resources

Debtor incarcerated

Other: __________________________________________________

5.


a.
b.
c.
d.
e.

f.

The following steps have been taken (past):
 Debtor /  creditor located


Voluntary payment secured (no enforcement measures were necessary)

Information concerning the financial circumstances of the debtor
gathered

Assets of the debtor located

Enforcement and other measures initiated
 Provisional measures
 Wage withholding
 Garnishment from bank account or other sources
 Deductions from social security payments
 Lien on or forced sale of property
 Tax refund withholding
 Withholding or attachment of pension benefits
 Credit bureau reporting
 Denial, suspension or revocation of licenses or passport
 Mediation, conciliation or similar processes
 Seizure of lottery or gambling winnings
 Prohibition from leaving the requested State
 Incarceration
 Other: ________________________________

Payments were secured (enforcement measures were necessary)

Convention on the International Recovery of Child Support and Other Forms of Family Maintenance

6.

g.



h.




a.
b.
c.

The following steps are being taken (present):

Locating the  debtor /  creditor

Securing voluntary payment (no enforcement measures are necessary)

Gathering of information concerning the financial circumstances of the
debtor

Locating the assets of the debtor

Initiating enforcement measures

Securing payments (enforcement measures are necessary)

Other: ________________________________________________________

d.
e.
f.
g.
7.


a.
b.
c.
d.
e.
f.
g.

Record of payments made by the debtor as of __________________
(dd/mm/yyyy) attached
Other: ________________________________________________________

The following steps will be taken (future):
 Debtor /  creditor to be located


Voluntary payment to be sought (no enforcement measures will be
necessary)

Information to be gathered concerning the financial circumstances of the
debtor

Assets of the debtor to be located

Enforcement measures to be initiated

Payments to be sought (enforcement measures will be necessary)

Other: ________________________________________________________

8.



Please provide the following additional information and / or documentation:
_____________________________________________________________________
_____________________________________________________________________

9.



The application has been examined by the competent authority and is being
returned because a declaration or registration has been refused on the ground
that recognition and enforcement of the decision is manifestly incompatible with
the public policy (“ordre public”) of the State addressed. 2

10.


a.
b.

A challenge or an appeal has been lodged on the following grounds:

There are no bases for recognition and enforcement under Article 20

Recognition or enforcement of the decision is manifestly incompatible
with the public policy ("ordre public") of the State addressed

The decision was obtained by fraud in connection with a matter of
procedure

Proceedings between the same parties and having the same purpose are
pending before an authority of the State addressed and those proceedings
were the first to be instituted

The decision is incompatible with a decision rendered between the same
parties and having the same purpose, either in the State addressed or in
another State, and this latter decision fulfils the conditions necessary for
recognition and enforcement in the State addressed

In a case where the respondent has neither appeared nor was represented
in proceedings in the State of origin, the respondent had neither proper
notice of the proceedings and an opportunity to be heard, nor proper
notice of the decision and the opportunity to challenge or appeal it on fact
and law

c.
d.
e.

f.

2

This Section is limited to the ex officio review as provided under Article 23. Additional reasons should be added to this list
for the purpose of the ex officio review under Article 24.

Convention on the International Recovery of Child Support and Other Forms of Family Maintenance

11.

g.
h.




i.





The requested Central Authority has refused to process the application for the
following reason(s):

Requesting Central Authority did not produce the additional documents
or information within the period provided under Article 12(9)

Requirements of the Convention manifestly not fulfilled ( reasons
attached)

a.
b.

The decision was made in violation of Article 18
The authenticity or integrity of any document transmitted in accordance
with Article 25(1) a), b) or d) or (3) b)
The debt for past due payments has been fulfilled.

Name: _______________________________ (in block letters)
Authorised representative of the Central Authority

Date: ________________
(dd/mm/yyyy)

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average 0.33 hour per response, including the time for
reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number.


File Typeapplication/pdf
File TitlePREAMBLE
AuthorHague Conference
File Modified2016-10-18
File Created2016-10-18

© 2024 OMB.report | Privacy Policy