Form HFS 3304 Important Disclosure Statement Regarding Legal Representation - Illinois

Form HFS3304 is a Illinois Department of Healthcare and Family Services form also known as the "Important Disclosure Statement Regarding Legal Representation". The latest edition of the form was released in April 1, 2012 and is available for digital filing.

Download a PDF version of the Form HFS3304 down below or find it on Illinois Department of Healthcare and Family Services Forms website.

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IL Dept of Healthcare and Family Services
Division of Child Support Services
Date:
CP Name:
CP RIN:
NCP Name:
NCP RIN:
Case No.
IMPORTANT DISCLOSURE STATEMENT REGARDING LEGAL REPRESENTATION
1.
The (Attorney General/States Attorney) does not represent you. The (
) represents the
Department of Healthcare and Family Services exclusively. If you want an attorney to represent
you, you must retain a private attorney.
2.
The (
) will make available to its client, the Department of Healthcare and Family
Services, any and all information revealed during the progress of this case, including unreported
child support, excess assistance, and your financial assets and income.
3.
The Department provides services to both the custodial parent and non-custodial parent, and
may provide services to any other custodian, guardian or foster care agency if your child[ren] are
placed in their care. The Department may refer these types of cases to the (
) for
court action: (1) Legal paternity (2) Child support and medical support establishment (3)
Enforcement (4) Modification of child support and medical support, either to increase or decrease
the amount.
4.
The Department’s obligation to provide services to both parents may result in the (
)
representing the Department in setting child support, and in reducing that support at a later date.
It may also result in the [Attorney General] [State’s Attorney] representing the Department in
setting child support against one parent, and in setting support against the other parent if custody
changes.
5.
The (
) has no authority to and will not become involved in visitation, custody, or
property matters.
6.
If you are currently represented by a private attorney, or retain an attorney at any point in the
future, you must inform the (
) and provide the Department or (
)with
copies of any new orders relating to child support, medical support, or custody obtained by your
attorney as long as you receive child support services.
I certify that I have read the above disclosure, and I understand that the (
) is not my
attorney and does not represent me. I acknowledge that I was given a copy of the disclosure.
Date
Signature
HFS 3304 (R-4-12)
IL478-2182
IL Dept of Healthcare and Family Services
Division of Child Support Services
Date:
CP Name:
CP RIN:
NCP Name:
NCP RIN:
Case No.
IMPORTANT DISCLOSURE STATEMENT REGARDING LEGAL REPRESENTATION
1.
The (Attorney General/States Attorney) does not represent you. The (
) represents the
Department of Healthcare and Family Services exclusively. If you want an attorney to represent
you, you must retain a private attorney.
2.
The (
) will make available to its client, the Department of Healthcare and Family
Services, any and all information revealed during the progress of this case, including unreported
child support, excess assistance, and your financial assets and income.
3.
The Department provides services to both the custodial parent and non-custodial parent, and
may provide services to any other custodian, guardian or foster care agency if your child[ren] are
placed in their care. The Department may refer these types of cases to the (
) for
court action: (1) Legal paternity (2) Child support and medical support establishment (3)
Enforcement (4) Modification of child support and medical support, either to increase or decrease
the amount.
4.
The Department’s obligation to provide services to both parents may result in the (
)
representing the Department in setting child support, and in reducing that support at a later date.
It may also result in the [Attorney General] [State’s Attorney] representing the Department in
setting child support against one parent, and in setting support against the other parent if custody
changes.
5.
The (
) has no authority to and will not become involved in visitation, custody, or
property matters.
6.
If you are currently represented by a private attorney, or retain an attorney at any point in the
future, you must inform the (
) and provide the Department or (
)with
copies of any new orders relating to child support, medical support, or custody obtained by your
attorney as long as you receive child support services.
I certify that I have read the above disclosure, and I understand that the (
) is not my
attorney and does not represent me. I acknowledge that I was given a copy of the disclosure.
Date
Signature
HFS 3304 (R-4-12)
IL478-2182

Download Form HFS 3304 Important Disclosure Statement Regarding Legal Representation - Illinois

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