Fillable Printable New York Acknowledgment of Paternity for a Child Born to an Unmarried Woman
Fillable Printable New York Acknowledgment of Paternity for a Child Born to an Unmarried Woman
New York Acknowledgment of Paternity for a Child Born to an Unmarried Woman
LDSS 4418 (Rev. 1/14)
Acknowledgment of Paternity
For a Child Bor n t o an Unmarried Woman
Before signing an Acknowledgment of Paternity you should read the following information about your
legal rights and the consequences of signing an Acknowledgment of Paternity. This information will
help you decide whether to sign a voluntary Acknowledgment of Paternity.
An Acknowledgment of Paternity is a document that is signed by unmarried parents to establish the
child’s legal father. Both parents must voluntarily sign.
Before signing an Acknowledgment of Paternity, you may wish to speak to a lawyer. You have a right
to seek legal representation and supportive services, including counseling, to help you decide whether
to sign the Acknowledgment of Paternity.
You CANNOT sign an Acknowledgment of Paternity if:
• The mother was married at any time during the pregnancy or when the child was born;
• The mother is unmarried but more than one man could be the child’s father; or
• The child has no t bee n bor n.
DO NOT sign an Acknowledgment of Paternity if, after reading this written notice and receiving oral
notice, you have any doubts about the child’s paternity.
An Acknowledgment of Paternity that has been voluntarily signed by both parents has the same legal
force and effect as a court order determining the child’s legal father and establishes the duty of both
parents to provide support for the child. This means that if the Acknowledgment of Paternity is not
challenged, you do not have to go to a court or administrative proceeding to determine or confirm the
child’s father.
When a man signs an Acknowledgment of Paternity:
• He gives up his right to a court hearing to determine if he is the child’s father;
• He may establish custody and visitation rights;
• He may be required to give his consent before the child can be placed for adoption;
• It establishes the child’s right to inherit from the father if the Acknowledgment of Paternity is filed
with the registrar in the district where the birth certificate was filed; and
• It may establish the child’s right to inherit from the father if the Acknowledgment of Paternity is
only filed with the Putative Father Registry.
The child may have the last name of either parent. The child’s name will not affect the child’s legal
status.
Page 1 of 4
What effect does signing an Acknowledgment of Paternity have?
Who can sign it?
What is an Acknowledgment of Paternity?
If an Acknowledgment of Paternity is not signed by both parents:
• The man will not have a duty to support the child and his name cannot be on the birth certificate until
there has been a hearing in court where he is determined to be the father of the child. If the court
determines the man to be the father of the child, the court may make an order of support which may
be retroactive to the birth of the child.
• If the mother applies for or receives public assistance, the mother’s refusal to sign the
Acknowledgment of Paternity cannot be considered a failure to cooperate in establishing paternity for
the child.
If a court hearing is required because both parents do not sign the Acknowledgment of Paternity:
• The man may have a right to free legal representation if he is unable to pay for a lawyer; and
• The man has a right to genetic marker tests or DNA tests to help the court determine if he is the
father.
If you signed the Acknowledgment of Paternity at a hospital or social services district:
• The original Acknowledgment of Paternity will be filed for you with the registrar of the district
where the birth certificate is filed; and
• The registrar will mail you a certified copy of the Acknowledgment of Paternity; and
• For births in a New York hospital not located in New York City, the registrar will file a copy of the
Acknowledgment of Paternity with the State Department of Health and with the Putative Father
Registry; or
• For births in a New York hospital located in New York City, the registrar (New York City
Department of Health and Mental Hygiene) will file a copy of the Acknowledgment of Paternity with
the Putative Father Registry.
If you did NOT sign the Acknowledgment of Paternity at a hospital or social services district:
• You must mail or take the original Acknowledgment of Paternity to the registrar of the district
where the birth certificate is filed, or in New York City to the New York City Department of
Health and Mental Hygiene, Office of Vital Records, Attention: Corrections Unit Room 144, 125
Worth Street CN-4, New York, NY 10013-4089;
• The registrar will mail you a certified copy of the Acknowledgment of Paternity; and
• For births in a New York hospital not located in New York City, the registrar will file a copy of the
Acknowledgment of Paternity with the State Department of Health and with the Putative Father
Registry; or
• For births in New York City, the registrar (New York City Department of Health and Mental
Hygiene) will file a copy of the Acknowledgment of Paternity with the Putative Father Registry.
The Putative Father Registry is a record of the names and addresses of all persons who sign an
Acknowledgment of Paternity or who are determined by the court to be the father of a child born to an
unmarried mother. This information shall be released to a court or authorized agency upon request, but
shall not be released to any other person without a court order for good cause shown.
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What is the Putative Father Registry?
What happens after you sign?
What happens if you don’t sign?
Yes. Either parent has the right to withdraw the Acknowledgment of Paternity by filing a petition to
vacate with the family court. The petition can only be filed within the following time limits, which
depend upon the age of the parent at the time the parent signs the Acknowledgment of Paternity:
The parent is 18 years or older when
signing the Acknowledgment of Paternity
The parent is under 18 years old when
signing the Acknowledgment of Paternity
Whichever
is earlier
Within 60 days of the date of signing the
Acknowledgment of Paternity.
Within 60 days after that parent’s 18
th
birthday.
Within 60 days of the date on which an
answer to a petition is required in a
proceeding relating to the child and in
which such parent is a party.
Within 60 days after the date on which an
answer to a petition is required in a
proceeding relating to the child and in
which such parent is a party, provided
the parent was advised at any such
proceeding of the right to file a petition
to vacate.
If the time
limits have
expired
Either parent may only challenge the Acknowledgment of Paternity, in court, if it was
signed based on fraud, duress, or mistake of material fact. The burden of proof is on
the party wishing to withdraw the Acknowledgment of Paternity.
If the petition to vacate is filed within the correct time limit or, if after the time limit expired, the parent
has successfully challenged the Acknowledgment of Paternity in court, the court will order genetic
marker tests or DNA tests to determine the child’s father. The court will not order this testing, however,
if it finds that it is not in the best interests of the child. Neither parent’s legal obligations, including the
obligation to support the child, may be suspended during the challenge to the Acknowledgment of
Paternity except if the court finds good cause.
If the court determines, following a genetic marker test or DNA test, that the person who signed the
Acknowledgment of Paternity is the father of the child, the court shall make a finding of paternity and
enter an order of filiation that states he is the father. If the court determines that the person who signed
the Acknowledgment of Paternity is not the father of the child, the Acknowledgment of Paternity will be
vacated and the court will immediately provide a copy of the order to the registrar and to the Putative
Father Registry. If a party is receiving child support services, a copy will be provided to the child
support enforcement unit.
Yes. If the Acknowledgment of Paternity is not signed at the time of birth, then a new birth certificate
will be issued with the father’s name included and, if you changed the child’s last name when completing
the Acknowledgment of Paternity, the child’s last name will be changed on the new birth certificate.
Questions regarding this form as it relates to the birth certificate process should be directed to the
registrar of the district where the Acknowledgment of Paternity has been or will be filed or in New York
City to the New York City Department of Health and Mental Hygiene.
Page 3 of 4
Can you get a new birth certificate after signing the form?
Can you withdraw the Acknowledgment of Paternity after signing?
If your child was born in a New York hospital not in New York City, and you are signing the
Acknowledgment of Paternity after the original birth certificate was filed, the New York State
Department of Health will issue you a free birth certificate.
If your child was born in a New York City hospital, and you are signing the Acknowledgment of
Paternity after the original birth certificate was filed, the father will be issued one free birth certificate. If
the child is less than one year old, the mother may exchange the original birth certificate at no cost; after
one year there will be a replacement cost.
There are benefits to establishing paternity for the mother, the father, and the child.
For the child:
• Legal record of the identity of both parents.
• Father’s name on the birth certificate.
• Information on family medical history if needed for the purpose of the child’s medical treatment.
• Emotional benefits of knowing both parents.
• Financial support from both parents, including child support, social security benefits, veterans
benefits, military allowances, and inheritance.
• Health or life insurance from either parent, if available.
For the mother:
• Help in sharing parental responsibilities.
• Information about medical history if needed for the purpose of the child’s medical treatment.
• Improved financial security for the child.
• Access to health insurance, if available.
For the father:
• Legal establishment of parental rights.
• Father’s name on the birth certificate.
• Right to seek court ordered custody or visitation.
• Right to be informed and to have a say in adoption proceedings, if any.
Hospital staff are available to speak with you if you have any questions about this form or about
establishing paternity. Hospital staff may also give you the telephone number of the local child support
enforcement unit to answer any other questions you may have about the Acknowledgment of Paternity or
establishing paternity.
Additional information about the form and an educational video about the voluntary acknowledgment of
paternity process are available on the New York State Division of Child Support Enforcement website at
www.childsupport.ny.gov.
Page 4 of 4
What if you still have questions?
Why is establishing paternity important?
Do you have to pay for a new birth certificate?
LDSS-4418 (Rev. 1/14)
New York State Office of Temporary and Disability Assistance
New York State Department of Health
Pursuant to Se ction 4135-b of P ublic H e a lth Law
ACKNOWLEDGMENT OF PATERNITY
(Please type or print clearly in blue or black ink.)
Check where signed: Hospital Child Support Office Birth Registrar Other
We und erstand that signing this Acknowled gment of Paternity is voluntary and will establish paternity of our child and have the same force and effect as an order of filiation
determining paternity and entered after a court hearing including an obligation to provide support for our child. Except that only if this Acknowledgment o f Paternity is fi led
wit h the Regis trar wher e the birth certificate is filed will the Acknowledgment of Paternity have such force and effect with respect to inheritance rights. We have received
written and oral notice of our legal rights (including the ti meframes to withdraw ), responsibiliti es, alternative s a nd the con sequen ces of signin g the Acknowl edgment of
Paternity, and we understand wha t the notice states. A copy of the written notice has been provided to us. We certify that the information we provide below is true.
CHILD
First
name
Middle
name
Last
name
Sex Male Female
Date of birth
(MM/DD/YYYY)
/ /
Facility of birth
City of birth
Count y of birth
If the child’s birth certificate was already filed and you wish to change the child’s last name, complete the following section:
Last name on
original birth certificate
New
last name
FATHER
First
name
Middle
name
Last
name
Street address (house/apt. number)
City
State
Zip
Plac e of birth
City
State
Country
Date of birth
(MM/DD/YYYY)
/ /
Social Security number - -
I hereby acknowledge that I am the biological father of the child named above.
Signature
Date
(MM/DD/YYYY)
/ /
WITNESS
SECTION
(Witness cannot
be related to
moth er or father.)
Witness Signature
Pri nt Name
Date (MM/DD/YYYY)
/ /
Witness Signature
Pri nt Name
Date (MM/DD/YYYY)
/ /
MOTHER
First
name
Middle
name
Last
name
Maiden name (last name only)
Street address (house/apt. number)
City
State
Zip
Place of birth
City
State
Country
Date of birth
(MM/DD/YYYY)
/ /
Social Security number - -
I hereby cons ent to the Acknowledgment of Paternity for my child named above , and ack nowledge tha t the man named above is the only pos s ible father of my child who was born
to me. I state that I was not marr ied at any time dur ing the pr e gnancy or when the child was born OR, I state that I have s ubseque ntly mar r ied the c hild’s biological fathe r .
Signature
Date
(MM/DD/YYYY)
/ /
WITNESS
SECTION
(Witness cannot
be related to
moth er or father.)
Witness Signature
Pri nt Name
Date (MM/DD/YYYY)
/ /
Witness Signature
Pri nt Name
Date (MM/DD/YYYY)
/ /
For Officia l Us e Only
The above Acknowledgment of Paternity is hereby filed with the ________________________________________________ regi stra r on _____/_____/_____.
If this do cum ent is to amen d a bir t h certif icate, I certif y t ha t I have ex amined th e original r ecord this s eeks to amend and the information on this document matches.
Ther e are no o missions or app arent erro r s that render it un acceptable for amending the bi r th record. This document is the r efor e approve d.
_____________________________________________________________ __________ _____/_____/_____
State Registrar/Deputy City Regi stra r S ignature MM/DD/YYYY
Recorded Dist ri c t __ __ _____________________________________
Hospital Code (PFI Number) ________________________________
Register Number _________________________________________
Mailing address of father must be pr inted here.
LDSS-4418
Name ___________________________________________
Address _______________________________ Apt. ______
City_______________________ State _______ Zip_______
(Fold Here)
(Fold Here)
Name ___________________________________________
Address _______________________________ Apt. ______
City_______________________ State _______ Zip_______
Mailing address of mother must be printed here.
FATHER
MOTHER
