| New Case Number Worksheet Form. This is a Ohio form and can be used in Domestic Relations Montgomery County (Court Of Common Pleas) . |
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DR-16 (rev. 8/99)Montgomery County Support Enforcement AgencyNew Case Number Work SheetThis is the information necessary to enter a case into the SETS system up to the point of the SESO (Support Order) screen. It is vital that we get as much of this information as possible so that we can properly clear the participants and load the case into the SETS system.Court Order #: SETS Case #: SEA Case #: Judge Custodial Parent/Caretaker Information: (PL) (DF) (P1) (P2) Absent Parent Information: (PL) (DF) (P1) (P2)NameNameAddress1Address1Address2Address2CityCityStateZip CodeStateZip CodeBirthdateSSNBirthdateSSNRaceSexPhone #RaceSexPhone #EmployerEmployerEmp Add1Emp Add1Emp Add2Emp Add2CityCityStateZip CodeStateZip CodeInsured?Insurance available?Insured?Insurance available?Begin Date:Plan TypeGroupIndivBegin Date:IndivGroupPlan TypeInsurance CoInsurance CoIns Addr1Ins Add1City/State/ZipCity/State/ZipPlan TypePlan NameGroup #Policy #Policy #Group #Plan NamePlan TypeMedicalMedicalDentalDentalDrugDrugEmp AssistanceEmp AssistanceUninsured ExpensesObligee Percentage:%Obligor Percentage:%Child Information:First NameMiddle NameDisabled? Pat Est? BOW?Social Security NumberBirthdateLast NameDate entered into SETS:DEO Initials: Date Skeleton on COS-E: Remember: You only need to build one case in SETS if the order is for both Child and Spousal Support. Therefore only one SEA Number is needed. Make sure you comment the COS-E IM Screen with the SETS Case Number and close it properly on the IG screen.Rev. 8/30/992002 © American LegalNet, Inc.
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