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					U7.12 PATERNITY INTERVIEW QUESTIONS

U7.12.2 INTERVIEW QUESTIONS FOR THE FATHER

  1.   What is your relationship to the child you are seeking to establish paternity for (i.e. natural father, other)?

       _______________________________________

  2.   If other, please explain.__________________________________

  3.   Please state the full legal name of the child you would like to establish paternity for?

       _____________________________________________________

  4.   What is the child’s date of birth? ___________________________

  5.   In what city, county, and state was the child born?

       City: ________________ County: ______________ St: ____

  6.   Do you remember the date the child’s mother got pregnant? ____ (yes or no)

  7.   If so, what was the month and year? __ __ __ (mmddyy)

  8.   Did her pregnancy go the full term? ____ (yes or no)

  9.   If no, please explain why (i.e. premature)?

 10.   Do you remember the city, county, and state you were in when she got pregnant?___ (yes or no)

 11.   In what city, county state did she get pregnant?

       City: ________________ County: ______________ St: ____

 12.   What is the child’s mother’s maiden name? _______________________________________________

 13.   Please state the full legal name of the woman you conceived this child with?

       First:_______________________ Mid Initial:______ Last: ______________________________

 14.   Did you live together? ____ (yes or no)

 15.   If so, from what date to what date. _________________________________________________

 16.   Which city, county, or state?

       City: ________________ County: ______________ St: ____

 17.   Did she ever tell you that you were the father of this child? ____ (yes or no)

 18.   Did she ever admit that you were the father of this child? ____ (yes or no)

 19.   Are you named the father on the child’s birth certificate? ___ (yes or no)

 20.   If so, can you provide us a copy of the birth certificate? ____ (yes or no)

 21.   Did you ever sign an acknowledgement of paternity? ____ (yes or no)
22.   If so, can you provide us with a copy of the acknowledgement? ____ (yes or no)

23.   Were you present at the child birth? ____ (yes or no)

24.   Did you visit the child at the hospital following the birth? ____ (yes or no)

25.   If so, did you sign an acknowledgement of paternity at the hospital? ____ (yes or no)

26.   Did you ever offer to pay abortion expenses? ____ (yes or no)

27.   Did you ever offer to pay medical expenses? ____ (yes or no)

28.   Did you pay for birth related expenses? ____ (yes or no)

29.   Did you ever claim the child on your tax returns? ____ (yes or no)

30.   Have you ever provided food, clothing, gifts, or financial support for this child?____ (yes or no)

31.   Please describe these food, items, or type of financial support.___________________________

32.   Did you ever live with this child? ____ (yes or no)

33.   Please describe where and when you lived with child.

      City: ________________ County: ______________ St: ____ Dates: _______________ (from/to)

34.   Did you ever visit the child? ____ (yes or no)

35.   What were the dates and circumstances of any visits between you and the child.

      __________________________________________________________________________________________

      __________________________________________________________________________________________

36.   Does the child resemble you? ____ (yes or no)

37.   Please describe any physical resemblance between you and the child.

      __________________________________________________________________________________________

      __________________________________________________________________________________________

38.   Do you have any photos you can leave with us? ____ (yes or no)

39.   Are there any witnesses to your relationship with the child’s mother? ____ (yes or no)

40.   If so, what are the names and addresses of these people?

      __________________________________________________________________________________________

      __________________________________________________________________________________________

41.   What might be some relevant facts known by each of these people?

      __________________________________________________________________________________________

      __________________________________________________________________________________________

42.   Are you employed? ______ (yes or no)
43.   If so, where? __________________________________________________________________

44.   How many hours do you work?______________________________

45.   What is your hourly wage? _________________________________

				
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