Dcss 0053 PDF Details

Navigating the complexities of child support and visitation can be a challenging process for many parents. The State of California, through its Health and Human Services Agency and the Department of Child Support Services, has implemented a crucial tool to assist in this intricate landscape: The Visitation Verification DCSS 0053 form. This document, last revised in August 2016, serves a dual role. First, it provides a structured way for parents to document the actual visitation hours that the noncustodial parent spends with the child or children over a specified 12-month period. This rigorous tracking is essential for maintaining accurate records that can influence child support calculations and ensure that visitation rights are respected. Secondly, the form contains sections that delve into the specifics of shared custody or visitation arrangements, including regular, vacation, summer, holiday, and overnight visitations. This comprehensive approach not only facilitates a transparent communication channel between the custodial and noncustodial parents but also aids the legal system in making informed decisions regarding custody and support issues. Completing the DCSS 0053 form requires meticulous attention to detail and honesty, as the information provided must be verified by both parties and is subject to documentation requests for accuracy. This form, therefore, stands as a testament to the state's commitment to upholding the well-being of children while balancing the responsibilities and rights of parents.

QuestionAnswer
Form NameDcss 0053
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesvisitation verification fillable form, dcss 0053, dcss verification form, dcss form form

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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

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Step 1: Click the "Get Form Now" button to begin.

Step 2: So, you may modify the visitation verification fillable form. This multifunctional toolbar will let you add, delete, customize, highlight, as well as undertake other commands to the content and fields within the form.

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step 1 to filling in dcss 0053 fillable

You have to enter the appropriate details in the field.

Entering details in dcss 0053 fillable stage 2

It is necessary to provide some information inside the field 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, Circle one ampm, Circle one ampm, Vacation Visitation If Yes please, Summer Visitation If Yes please, and Holiday Visitation If Yes please.

Filling in dcss 0053 fillable part 3

You'll need to identify the rights and responsibilities of each party in box Overnight Visitation If Yes please, Courtordered custodyvisitation, Additional Information, Yes, Yes, I declare to the best of my, PRINT NAME, SIGNATURE, DATE, and Page of.

dcss 0053 fillable Overnight Visitation If Yes please, Courtordered custodyvisitation, Additional Information, Yes, Yes, I declare to the best of my, PRINT NAME, SIGNATURE, DATE, and Page  of fields to insert

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