F.C.A. 4131, 424a; Art. 5B D.R.L. 236B, 240Form 417 (Financial Disclosure Affidavit) 10/2012FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ............................................................................................. In
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Who needs the New York Financial Disclosure Affidavit?

The New York Financial Disclosure Affidavit, also labelled as form 4-17 FDA, is an official court ordered document used in the State of New York form. It must be filled out by a petitioner or a respondent in a child support case to explain how much income is made and how it is spent.

What is the purpose of the NY Financial Disclosure Affidavit

The Court of the New York State use the financial information provided by both parents on the sworn statement form 4-17 to set the amount of child support one spouse will get from the other spouse.

When is the Financial Disclosure Affidavit due?

Upon the receipt of the notice to file the Financial Disclosure affidavit, the party will be informed about the allowed due dates for its submission.

Is the FDA 4-17 form accompanied by any other documents?

The Financial disclosure Affidavit is a sworn statement and there is a list of documents need to provide sufficient evidence of the information indicated on the FDA. The obligatory attachments include:

  • A current and representative paycheck stubs;

  • Copies of the latest state and federal income tax returns (the whole package);

  • A copy of the W-2 wage and tax statement(s) that were filed with the returns;

  • Information relating to all accident, life and health insurance plans available to you for the provision of insurance, health care, dental care, optical care, prescription drug and other pharmaceutical and health- related benefits for the child(ren). There is also a number of other documents that might be required depending on the situation. They all are prescribed in the instructions accompanying the fillable fields of the form.

How to fill out the Financial Disclosure Affidavit?

The Form must clearly provide the following information:

  • The name and address of the person making the affidavit;
  • Income information covering all of its sources;
  • All the assets owned by the petitioner or respondent;
  • Deductions from income;
  • Expenses for health insurance, child care, education, etc.,
  • Factors to affect the variance from the percentage;
  • The expenses of the person completing the affidavit form;
  • Current liabilities, loans and debts.  

What should I do with the completed NY Financial Disclosure affidavit?

The FDA must be completed in three copies:

  • One will be delivered to the other party to the case of their lawyer;
  • Another copy should be kept in your private files;
  • The and other copy must be presented during the court hearing.

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