Fillable AUTHORIZED AGENCY REQUEST FOR A FILED VOLUNTARY DECLARATION (California)

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AUTHORIZED AGENCY REQUEST FOR A FILED VOLUNTARY DECLARATION (California)

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CLICK HERE TO SUBMIT
ASKPOP@DCSS.CA.GOV
CALIFORNIA DEPARTMENT OF CHILD SUPPORT SERVICES
Required fields are marked with *
Child's First Name*
Child's Middle Name
Child's Last Name*
Child's Date of Birth*
Birth Parent's First Name*
Child's County of Birth
Birth Parent's Last Name
Other Parent's Last Name
Birth Parent's DOB
Other Parent's First Name
Other Parent's DOB
Other Parent's SSN
Required Requestor Information
Job Title*
County
Division
Phone Number - Direct Line*
Requestor's Complete Email Address*
Requestor's First and Last Name*
State*
Unit
Request Date (MM/DD/YYYY)*
Authorized Agency Type*
RECORD VERIFICATION
For State Use Only
VDOP on File No VDOP on File
Date Parentage Established:
POP Analyst / Processed Date
:
REQUEST TYPE*:
CERTIFIED - Verified request form AND certified copy of the VDOP
VERIFICATION - Verified request form ONLY
This form is used by Authorized Agencies Only. Please submit this request by selecting the Submit Button on
Page 2 and allow up to 5 working days for processing. A photo copy of the requestor's work issued I.D. must
be submitted with the request. Requests are processed and returned to the requestor via encrypted email only.
If you have any questions, please contact a State Parentage Opportunity Program (POP) Analyst by calling
(866) 249-0773 or by emailing ASKPOP@DCSS.CA.GOV.
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
AUTHORIZED AGENCY REQUEST FOR A FILED
VOLUNTARY DECLARATION OF PARENTAGE (VDOP)
DCSS 0919 (01/01/2020)
Birth Parent's SSN
Page 1 of 2
Complete all known fields
SELECT ONE
SELECT ONE
WARNING
POP information must be kept confidential. You may be subject to disciplinary actions, including
termination, as well as civil and/or criminal penalties if you unlawfully access or disclose POP information.
The information below outlines your responsibilities as a requestor.
To keep POP information confidential, I must:
Access POP information solely for business purposes;
Disclose POP information solely to parents, the child, the Local Child Support Agency, County
Welfare Department, County Counsel, Department of Public Health, and Courts. (Family Code
§7571(i));
Safeguard POP information no matter what form it takes (i.e., stored on the network, stored on a CD,
and printed on paper);
Store POP information (in any format) only in confidential locations;
Secure all POP information contained on paper documents from observation by or disclosure to
unauthorized persons at all times (i.e., store paper documents in locked drawers);
Secure all POP information accessible from my computer by locking my computer screen (i.e., by
using the Ctrl+Alt+Del function keys) whenever I leave my work area;
Transmit POP information solely by secure methods;
Secure POP information from unauthorized access at the end of the workday by locking paper
documents or removable media in file cabinets or drawers and shutting down my computer.
ACKNOWLEDGEMENT OF UNDERSTANDING
I have read the security measures described above and I agree to use them. If I need information about
how to access, use, disclose, store, or transmit POP information confidentially, I will consult my employer’s
Information Security Officer or the Department of Child Support Services Information Security Officer by
calling (916) 464-5045 or by emailing ISO@DCSS.ca.gov.
REQUIRED BUSINESS NEED
I declare under the penalty of perjury under the laws of the State of California that I am an employee of
a Local Child Support Agency (LCSA), County Welfare Department, County Counsel, Department of
Public Health, or Courts, and my job duties require me to review VDOP information to determine when:
Parentage has already been es
tablished for children born to unmarried parents
Cases must be referred to a LCSA because the parents are unmarried, and parentage has
not been established
A birth certificate can be amended to add the father’s name
Page 2 of 2
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AUTHORIZED AGENCY REQUEST FOR A FILED VOLUNTARY DECLARATION (California)

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Completed 1 June 2021

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