Illinois Rescission of Voluntary Acknowledgment of Parentage or Denial of Parentage (HFS 3416E)
Illinois Department of Healthcare and Family ServicesParentage and paternityForm HFS 3416EFree downloadLast verified November 10, 2026
Withdraws a signed Voluntary Acknowledgment of Parentage or Denial of Parentage. It is filed with the Illinois Department of Healthcare and Family Services, which then notifies the state vital records office to change the birth certificate.
Who can use this form
- The birth parent, the genetic or intended parent, or the spouse who signed the acknowledgment or the denial.
- Only one person needs to sign.
What to send with it
- The form, signed in front of a witness age 18 or older who is not named on the form.
- The Department of Healthcare and Family Services must receive it within 60 days of the effective date of the acknowledgment or denial, or by the date of a proceeding relating to the child, whichever is earlier.
Where to send it
- Mail to
- HFS - Administrative Coordination Unit (ACU) PO Box 19152 Springfield, Illinois 62794-9152
- State fee
- Not provided
- Typical processing
- Not provided
- Issued by
- Illinois Department of Healthcare and Family Services
- Form revision
- R-01-26
- Source
- Official government page