Form 4-11 at a glance
What it is: Form 4-11 is the Petition for Modification of an Order of Support under Article 4 of the Family Court Act.
Who signs: The Petitioner signs on the line marked Petitioner, next to Dated.
Under 1.a, check an individual and specify how you are related to the child(ren) and where you reside, or check assignee agency and specify its place of business.
What to bring and attach to Form 4-11
Form 4-11 (10/2016): the Personal Information Form 4-5/5-1d, containing social security numbers of parties and dependents, must be filed with this Petition.
A filled-in Form 4-11 example: an individual asks to change a support order
How to fill out Form 4-11, box by box
Petition for Modification of an Order of Support made by Family Court or Another Court
After PETITION FOR MODIFICATION OF AN ORDER OF SUPPORT MADE BY, check FAMILY COURT or ANOTHER COURT.
Enter the county after COUNTY OF and the Docket No., and name the Petitioner and Respondent.
Enter the Assignor on the line (Commissioner of Social Services, Assignee, on behalf of , Assignor).
1. Petitioner and Respondent, and where each resides
Under 1.b, specify where Respondent resides. 1 and 2: Unless the Court has ordered the address to be confidential on the ground that disclosure would pose an unreasonable health or safety risk. See Family Court Act §154-b; Form 21 (available at www.nycourts.gov).
2. The action in which you were petitioner or respondent
Under 2.a, check petitioner or respondent in an action instituted in the Supreme Court of the State of New York and specify the county, or check Other Court and specify the other court.
Under 2.b, specify the name of the action and the Index/Docket No., and check petitioner or respondent for Respondent in the action.
3. The judgment or order and its terms
Under 3.a, check judgment or order, enter the date it was entered in the action, check Respondent or Petitioner and specify the terms.
Under 3.b, enter the date of the order of support entered, check Respondent or Petitioner and specify the terms.
Under 3.a and 3.b, check judgment or order for the true copy that is attached and made a part of this Petition.
4. The names, addresses and dates of birth of all children affected
Under 4, enter the CHILD'S NAME, ADDRESS and DATE OF BIRTH of all children affected by this order.
5. Which court has not retained exclusive jurisdiction
Under 5.a, check judgment or order and check Supreme Court or Other Court, specifying it, where the court has not retained exclusive jurisdiction to modify the judgment or order.
Under 5.b, check if applicable: The other Court is a court of competent jurisdiction outside the State of New York.
6. Standing to seek a modification
Under 6, upon information and belief, check judgment or order and check the box if there has been a substantial change of circumstances, and specify it. 4 If incarceration is the basis for alleging substantial change in circumstances, so state and indicate whether or not the incarceration resulted from a charge and/or conviction for nonpayment of child support or an offense against the custodial parent or child who is the subject of the child support order. See Family Court Act §451(2)(a); Domestic Relations Law §236B(9)(b)(2)(i).
The ground: three years passed or a change in gross income
Check the ground that applies. Unless the parties have specifically agreed otherwise in a validly executed agreement or stipulation, three years have passed since the order was entered, last modified or adjusted. This ground only applies to original or modified support orders entered on or after October 13, 2010. Or unless the parties have specifically agreed otherwise in a validly executed agreement or stipulation, there has been a change in either party's gross income by fifteen percent or more since the order was entered, last modified or adjusted. This ground only applies to original or modified support orders entered on or after October 13, 2010.
7. How the judgment or order should be modified
Specify the basis for this allegation. Under 7, check judgment or order and specify how it should be modified.
8. Relief earlier from the judgment or order directing payment prior to the accrual of arrears
Under 8, delete if inapplicable; check judgment or order and specify the reason(s) you did not make an application earlier for relief from the judgment or order directing payment prior to the accrual of arrears.
9. Child support services
Under 9, applicable to individual petitioners; if agency, skip to 10. Check a box only if applicable. You are hereby applying for child support services from the Support Collection Unit (the IV-D program pursuant to Title 6-A of the Social Services Law) through the filing of this Petition, unless you check I have already applied for child support services from the Support Collection Unit, or I do not need to apply now because I have continued to receive child support services after the public assistance or care case, or foster care case, for my family has closed, or I do not wish to apply for child support services, or I am not eligible to apply for child support services because I am petitioning for spousal support only.
10. No previous application, and WHEREFORE
Under 10, no previous application has been made to any judge or court, including a Native American tribunal, or is presently pending before any judge or court, for the relief requested in this petition (except as you specify). Under WHEREFORE, check judgment or order of the Supreme Court or Other Court, specify it, and enter the date of the judgment or order to be modified.
Dated, Petitioner and Attorney
Enter the date after Dated, then Print or type name; add the Signature of Attorney, if any, Attorney's Name (Print or Type) and Attorney's Address and Telephone Number.
More rules for Form 4-11
A court order of support resulting from a proceeding commenced by this application (petition) shall be adjusted by the application of a cost of living adjustment at the direction of the Support Collection Unit no earlier than twenty-four months after such order is issued, last modified or last adjusted, upon the request of any party to the order or pursuant to paragraph (2).
Where any party fails to provide, and update upon any change, the Support Collection Unit with a current address, as required by section four hundred forty-three of the Family Court Act, to which an adjusted order can be sent, the support obligation amount contained therein shall become due and owing on the date the first payment is due under the terms of the order of support which was reviewed and adjusted occurring on or after the effective date of the adjusted order, regardless of whether or not the party has received a copy of the adjusted order.
Sources
[1] Form 4-11 (10/2016), Support-Petition for Modification, Family Court of the State of New York (the Official source link on this page).
