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The DCSS 0053 form, officially known as the Visitation Verification form, plays a crucial role in documenting the visitation history between a noncustodial parent and their child or children. This form is particularly important for families navigating child support and custody arrangements in California. It requires the person completing the form to provide detailed information about the visitation that has occurred over the past twelve months. Specifically, it asks for the number of hours the noncustodial parent has spent with the child each month. If there are multiple children involved, separate forms should be filled out for each child to ensure accuracy. Additionally, the form includes sections to indicate whether the custody arrangement is shared or if visitation is being exercised alone. It also prompts the user to specify regular, vacation, summer, holiday, and overnight visitation hours, offering a comprehensive overview of the visitation schedule. By completing the DCSS 0053, parents can affirm the accuracy of their visitation records, which may be shared with the other parent for verification purposes. This form not only serves as a record but also reinforces the importance of transparency and communication in co-parenting situations.

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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

Form Specifications

Fact Name Details
Form Purpose The DCSS 0053 form is used to verify visitation between a noncustodial parent and their child(ren) over the past 12 months.
Governing Law This form is governed by California Family Code Section 3020, which outlines the best interests of the child in custody arrangements.
Completion Requirement Individuals must complete the visitation history section by providing the number of hours the noncustodial parent visited each month.
Shared Custody Options The form allows users to indicate whether the arrangement is shared custody, visitation only, or neither.
Documentation Signers must be aware that the information may be shared with the other parent, and documentation may be requested for verification.
Signature Requirement The form must be signed and dated by the person completing it, affirming the truthfulness of the provided information.

Dcss 0053: Usage Guidelines

After completing the DCSS 0053 form, you will submit it to the appropriate child support services office. This form will help document visitation history and arrangements related to child custody. Be sure to keep a copy for your records.

  1. Begin by entering the CSE Case Number at the top of the form.
  2. Fill in your name in the space provided for the person completing the form.
  3. Indicate your status by checking either Custodial Party or Noncustodial Parent.
  4. In Part 1, record the visitation history for the last 12 months:
    • Fill in the months from January to December on the left side of the chart.
    • Write the corresponding year next to the months.
    • Enter the number of hours the noncustodial parent visited with the child(ren) for each month.
    • Complete the right side of the chart with the remaining months and hours for the following year.
    • Calculate the total hours for both parts and write them in the designated TOTAL boxes.
  5. Move to Part 2 and check the appropriate box for Shared Custody, Visitation Only, or Neither.
  6. Fill in the Regular Visitation hours:
    • Specify the day and time for the visitation.
    • Provide the ending day and time.
  7. If applicable, indicate if there is Vacation Visitation, Summer Visitation, or Holiday Visitation and provide the specific dates and times.
  8. For Overnight Visitation, indicate whether it occurs and provide details if applicable.
  9. Indicate if there is a Court-ordered custody/visitation arrangement and check Yes or No.
  10. Provide any Additional Information if necessary.
  11. Sign and print your name at the bottom of the form, along with the date.

Your Questions, Answered

What is the purpose of the DCSS 0053 form?

The DCSS 0053 form is designed to document visitation arrangements between a noncustodial parent and their child or children. It provides a structured way to record the actual visitation history over the past 12 months, detailing how many hours the noncustodial parent spent with the child during that time. This form can be crucial in child support cases, as it helps establish the level of involvement the noncustodial parent has in their child’s life.

Who should complete the DCSS 0053 form?

The form should be completed by either the custodial party or the noncustodial parent. The person filling out the form must indicate their role by selecting either “Custodial Party” or “Noncustodial Parent.” This clarity helps ensure that the information provided is accurate and relevant to the child’s custody and visitation arrangements.

How do I fill out the visitation history section?

To fill out the visitation history, you will need to provide details for each month over the past 12 months. Start by listing the months on the left side of the chart, indicating the year as necessary. Next, record the number of hours the noncustodial parent visited with the child for each month. If visitation varies for each child, a separate form must be completed for each child to maintain clear records.

What if there are different visitation arrangements for holidays or vacations?

The form allows you to specify different types of visitation, including regular, vacation, summer, and holiday visitation. If any of these apply, you should check the appropriate boxes and provide the specific dates and times for each type of visitation. This ensures that all arrangements are documented and can be referenced in any future discussions or legal matters regarding custody.

Is the information on the DCSS 0053 form confidential?

While the information provided on the DCSS 0053 form is intended to be used for legal purposes, it is important to note that it may be shared with the other parent for verification. Both parties may also be required to provide supporting documentation. Therefore, it is crucial to ensure that all information is accurate and truthful, as it can impact custody and visitation decisions.

What should I do after completing the DCSS 0053 form?

Once you have completed the form, it should be signed and dated to affirm that the information is correct to the best of your knowledge. After signing, you will need to submit the form to the appropriate agency or court handling your child support case. Keeping a copy for your records is also advisable, as it can serve as a reference in future discussions or legal proceedings.

Common mistakes

  1. Incorrect Case Number: Failing to enter the correct CSE case number can lead to delays in processing the form.

  2. Missing Signature: Not signing the form can render it invalid. Always ensure that the form is signed before submission.

  3. Inaccurate Visitation Hours: Providing incorrect hours for visitation can create discrepancies. Double-check the hours entered for accuracy.

  4. Not Completing All Sections: Omitting any part of the form, especially the visitation history, can lead to incomplete information.

  5. Failure to Specify Dates: When detailing vacation or holiday visitation, be sure to include specific dates and times. Vague entries can cause confusion.

  6. Choosing the Wrong Custody Type: Selecting the incorrect option for custody/visitation (Shared Custody, Visitation Only, or Neither) can affect the interpretation of the form.

  7. Not Providing Additional Information: If there are special circumstances or arrangements, failing to include this information can lead to misunderstandings.

  8. Using an Outdated Form: Always check that you are using the most current version of the DCSS 0053 form. Using an outdated version can result in rejection.

Documents used along the form

The DCSS 0053 form is used to verify visitation details between a noncustodial parent and their child or children. Along with this form, several other documents may be required to support the visitation process or provide additional context. Below are some commonly associated forms and documents.

  • DCSS 0054 - Custody and Visitation Order: This document outlines the legal custody and visitation arrangements established by the court. It provides clear guidelines for both parents regarding time spent with the child.
  • DCSS 0055 - Child Support Order: This form details the financial support obligations of the noncustodial parent. It ensures that the child's needs are met while also considering visitation rights.
  • DCSS 0056 - Parenting Plan: A parenting plan is a comprehensive document that outlines how parents will raise their child together. It includes visitation schedules, decision-making responsibilities, and communication methods between parents.
  • DCSS 0057 - Visitation Modification Request: This form is used when either parent seeks to change the existing visitation agreement. It must be filled out and submitted for court approval to ensure the best interests of the child are prioritized.
  • Proof of Visitation Log: This is an informal document where parents can keep track of actual visitation times. It helps provide evidence if disputes arise regarding visitation compliance.
  • Child’s School Records: These records may be requested to confirm the child's attendance and participation in school activities. They can provide context for visitation arrangements, especially during school-related events.

These documents work together to ensure that both parents understand their rights and responsibilities regarding custody and visitation. Having the proper paperwork in place can help facilitate smoother interactions and reduce conflicts over time.

Similar forms

  • Child Support Guidelines Worksheet: This document outlines the financial obligations of parents regarding child support. Similar to the DCSS 0053 form, it requires detailed information about visitation and parenting time, which can influence the support calculations.
  • Visitation Agreement: This is a legal document that establishes the visitation rights of a noncustodial parent. Like the DCSS 0053 form, it includes specific details about visitation schedules and conditions.
  • Parenting Plan: A comprehensive document that outlines how parents will share responsibilities for their children. It parallels the DCSS 0053 form by detailing visitation arrangements and ensuring both parents are on the same page.
  • Child Custody Evaluation Report: This report is created during custody disputes and assesses the best interests of the child. It often includes visitation information, similar to what is required on the DCSS 0053 form.
  • Order of Custody and Visitation: This court order specifies custody arrangements and visitation schedules. It shares similarities with the DCSS 0053 form in its focus on visitation details and compliance.
  • Motion for Modification of Custody: This legal request seeks to change existing custody arrangements. Like the DCSS 0053 form, it often requires documentation of visitation history to support the request.
  • Child Visitation Log: A record kept by parents detailing the visitation history. This log mirrors the DCSS 0053 form by tracking visitation hours and dates for reference.
  • Affidavit of Parentage: This document establishes legal parenthood and may include visitation rights. It relates to the DCSS 0053 form by addressing the rights and responsibilities of parents concerning their children.
  • Family Court Mediator’s Report: This report summarizes mediation sessions regarding custody and visitation. It often contains similar information about visitation arrangements as found in the DCSS 0053 form.

Dos and Don'ts

When filling out the DCSS 0053 form, it is crucial to follow specific guidelines to ensure accuracy and compliance. Here is a list of things you should and shouldn't do:

  • Do read the instructions carefully before starting.
  • Do provide accurate visitation hours for each month.
  • Do fill out a separate form for each child if visitation differs.
  • Do ensure all information is true and complete before signing.
  • Do keep a copy of the completed form for your records.
  • Don't leave any sections blank; fill in all required fields.
  • Don't submit the form without reviewing it for errors.
  • Don't provide false information; this can have legal consequences.
  • Don't forget to sign and date the form before submission.

Misconceptions

Misconceptions about the DCSS 0053 form can lead to confusion for parents navigating the child support system. Here are seven common misunderstandings:

  • It is only for custodial parents. Many believe that only custodial parents can fill out this form. However, both custodial and noncustodial parents can complete it, depending on their involvement in visitation.
  • It requires detailed visitation records. Some think that they need to provide extensive documentation for every visit. In reality, the form simply asks for a summary of visitation hours over the last 12 months.
  • It is only necessary in court cases. A common myth is that the DCSS 0053 form is only relevant during court proceedings. This form is also useful for informal agreements and tracking visitation for personal records.
  • It applies to all children in a family. Some parents assume that one form can cover all children. If visitation varies by child, a separate form must be completed for each child.
  • It is optional. Many people think that filling out the DCSS 0053 is optional. In fact, it may be required for certain child support cases to ensure accurate visitation records.
  • It has to be filled out by a lawyer. There is a belief that legal representation is necessary to complete the form. In truth, parents can fill it out themselves without needing an attorney.
  • It is only relevant for visitation disputes. Some think this form is only useful when there are conflicts over visitation. However, it can also help clarify visitation schedules and ensure both parents are on the same page.

Key takeaways

Filling out the DCSS 0053 form is an important step in documenting visitation. Here are some key takeaways to keep in mind:

  • Understand the Purpose: This form is used to verify visitation between the noncustodial parent and the child(ren).
  • Complete for Each Child: If visitation varies for different children, fill out a separate form for each child.
  • Document Visitation History: Record the visitation hours for the last 12 months. Be specific about the number of hours each month.
  • Follow Instructions Carefully: Ensure you fill in the months and years correctly, as mistakes can lead to confusion.
  • Check the Right Boxes: Indicate whether you have shared custody, visitation only, or neither. This helps clarify the arrangement.
  • Sign and Date: Don’t forget to sign and date the form. Your signature confirms that the information provided is accurate.

Using the DCSS 0053 form correctly can make a significant difference in your custody and visitation discussions. Stay organized and thorough to ensure a smooth process.