T1414 Attachment-4_Data-Elements_2021-0323.pdf
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- Solicitation number
- 22DPP00696
- Issued by
- New Jersey
About this file
This document appears to be an attachment detailing the data elements required for a Certificate of Parentage Database as part of the T1414 - Hospital Based Paternity Acknowledgement Program and Database contract opportunity in New Jersey. The contract involves Mercer County and Trenton City jurisdictions, and covers the collection of information related to a child's birth, as well as the mother's and father's details, including names, addresses, contact information, employment details, and social security numbers. The contract requires the successful bidder to provide a database and services to manage this data on behalf of the state.
The pricing terms, set asides, incumbent information, funding sources, and other salient details are not included in this attachment. However, the comprehensive list of data elements to be collected and maintained suggests this is a significant state and local contract opportunity focused on tracking and managing parental acknowledgement information.
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Text version
ATTACHMENT 3: Data Elements on the Certificate of Parentage Database
Agency Information
AGENCY/ENTITY COMPLETING FORM HOSPITAL/BIRTH FACILITY NAME
Child’s Information
NAME ON ORIGINAL BIRTH CERTIFICATE DATE OF BIRTH
NEW LAST NAME TO BE CITY/TOWN OF BIRTH
SEX COUNTY OF BIRTH
SOCIAL SECURITY NUMBER
Mother’s Information
NAME MAILING ADDRESS STATE
PHONE NUMBER MAILING ADDRESS ZIP CODE
SOCIAL SECURITY NUMBER EMPLOYER NAME AND ADDRESS
DATE OF BIRTH EMPLOYER CITY/TOWN
CITY/TOWN OF BIRTH EMPLOYER STATE
COUNTY OF BIRTH EMPLOYER ZIP CODE
STATE OF BIRTH MARITAL STATUS AT CONCEPTION/BIRTH
COUNTRY OF BIRTH DATE MOTHER SIGNED
MAILING ADDRESS DATE NOTARY PUBLIC/WITNESS SIGNED
MAILING ADDRESS CITY/TOWN
Father’s Information
NAME MAILING ADDRESS CITY/TOWN
PHONE NUMBER MAILING ADDRESS STATE
SOCIAL SECURITY NUMBER MAILING ADDRESS ZIP CODE
DATE OF BIRTH EMPLOYER NAME AND ADDRESS
CITY/TOWN OF BIRTH EMPLOYER CITY/TOWN
COUNTY OF BIRTH EMPLOYER STATE
STATE OF BIRTH EMPLOYER ZIP CODE
COUNTRY OF BIRTH DATE FATHER SIGNED
MAILING ADDRESS DATE NOTARY PUBLIC/WITNESS SIGNED
File details come from the government source that posted it. Updated .