Custodial Party Child Support Application PDF Details

As a custodial party in a child support application, you have the right to receive financial assistance from the non-custodial parent. In order to ensure that you receive the support you need, it is important to understand how the child support application process works and what steps you need to take. This blog post will provide an overview of the custodial party child support application process and offer some tips for ensuring that you get the financial help you deserve.

You can find more details about the custodial party child support application by looking through the table our team prepared for you.

QuestionAnswer
Form NameCustodial Party Child Support Application
Form Length11 pages
Fillable?Yes
Fillable fields219
Avg. time to fill out23 min 16 sec
Other nameschild support application arkansas, how to apply for child support in arkansas, arkansas child support application, child support in arkansas

Form Preview Example

APPLICATION FOR CHILD SUPPORT SERVICES (CSS)

___________________________________County

For Office Use Only: Date Sent ______/ ______/

Date Received ______/ ______/

Fee paid by: CP NCP County CSS

Important Security Information

We share your address and other identifying information with other state and federal agencies only for child support reasons. The information you provide may become available to the other parent. Contact us immediately if the following conditions exist:

Your case information should not be given out because of family violence.

oConfidentiality laws protect all information provided to CSS. CSS offices throughout the United States and some countries have access to this information through State and Federal Child Support Case Registries. If family/domestic violence is an issue, you must alert CSS to further safeguard this information.

Going through the child support process poses a threat to you or your child (ren).

oIf you have concerns about you or your child (ren)'s safety, there are some protections available in the child support process. Please let your county worker know about your concerns. If you have concerns for you or your child (ren)’s safety, please complete the last page of this application: Request for Nondisclosure of Personal Information.

GETTING STARTED

A $20.00 non-refundable application fee (check, money order or exact cash if applying in person) is required to process this application. Please do not mail cash. If you have applied for or are receiving TANF this fee may not be required.

WHAT WE NEED FROM YOU:

To start the process, please supply the following legal documents:

1.One (1) application for each non-custodial/custodial parent

2.Copy of a state-issued birth certificate and social security card for each child

3.Copy of personal identification (i.e. driver’s license)

4.A photo of the other parent, if available; it will be returned to you

5.Verification of your income (i.e. pay stubs, tax returns)

6.Copy of Marriage Certificate (if not available, supply date of marriage and/or other evidence of marital status)

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7.Copy of Court Order(s) signed by a judge or magistrate (if not available supply date, county, state of filing and court case number):

o Petition and/or Divorce Decree and/or Separation Agreement o Paternity Orders

o Certified Copy of Child and/or Spousal Support Order o All modified orders

o Allocation of Parental Responsibility Orders o Probate Orders

o Dependency and Neglect Orders o Adoption Orders

o Orders Terminating Parental Rights

8.Complete payment records of all support paid to the custodial party directly, through court or a state disbursement unit

9.Are you related to anyone working in the county Department of Human Services offices? No:___ Yes:____ If yes, who:_______________

Note: Your application may be delayed if you do not provide the necessary documentation.

SERVICES PROVIDED BY CSS

CSS is authorized by law to provide the following services:

1.Establish child/medical support orders and paternity

2.Modify child/medical support orders

3.Enforce child/medical support orders, including spousal maintenance when combined with child support

4.Process payments through the Family Support Registry (FSR); once an FSR account number is assigned to you, you will be able to register on the CSS website (www.childsupport.state.co.us) to view your account information online

5.Collect past due child support from the non-custodial parent’s federal and state tax refunds and lottery winnings

6.Collect past due child support from the non-custodial parent through other enforcement remedies

7.Ask another state’s child support agency to establish, modify or enforce an order on our behalf.

CSS has authority to hold an IRS joint tax refund prior to release of funds for up to six months. Interest will not be paid on funds that are held.

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HOW WE WORK TOGETHER

Please read and initial each of the following statements. By initialing each statement, you understand and agree:

CSS represents the People of the State of Colorado. No attorney-client relationship or privilege exists between either party or the CSS staff.

CSS does not handle parental responsibility (custody), parenting time (visitation) or property settlement. Your county may have additional resources to address those issues. Please ask your county worker.

CSS will not accept the Application for Services if all the children associated with the applicant are emancipated.

CSS will not enforce maintenance once current child support ends.

CSS determines the appropriate actions to be used when providing services.

If there is a change that could cause an adjustment to the amount of the order (e.g. financial, medical, etc.), a modification may be initiated by the department or by any one of the parties.

A written request from the applicant to stop CSS services may be made. However, if you are receiving TANF or assigned arrears are owed, the case may remain open. CSS may also close your case by using criteria established by current state and federal regulations (e.g. not being able to locate you, you do not supply a forwarding address, you do not provide required documents to take the next step to work your case, etc.).

CSS will provide to the applicant a yearly statement that summarizes the amount of child support that has been collected. I have an opportunity to receive the information through electronic means, if I choose to do so.

Each individual county determines optional services. Inquire about services available in the county of application.

YOUR RESPONSIBILITIES

You are the best source of information regarding the other party. The information you provide may help in the progress of your case. There may be a delay in the progress of your case due to lack of information and/or involvement with another state.

You are required to cooperate with CSS in the processing of your case. Failure to do so may result in case closure.

If you are a caretaker/relative (e.g. grandparent, aunt, uncle, adult sibling, stepparent, etc.) you

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are required to open a child support case against both biological parents. CSS will not close only one of the two cases against the biological parents at your request.

You may be required to complete and sign an affidavit agreeing to the amount of child support arrears owed (if there is a current child support order).

If you have special needs or need special accommodations under the Americans with Disabilities Act, you must contact the county of application.

You must notify the CSS office in writing if any of the following changes occur. Failure to do so may affect your child support payments or medical support payments.

1.Change to your legal name, residence/mailing address, telephone or contact numbers, place of employment, or health insurance or if you know of changes about the other party.

2.If child support payments are made directly to the custodial party instead of through the FSR.

3.If a child no longer lives with the custodial party due to emancipation or child goes to live with the other parent or caretaker.

4.If parenting time (visitation) changes for longer than one month.

5.If you retain a private attorney or private collection agency regarding child support, parenting time (visitation) or parental responsibility (custody).

6.If an action has been filed with a court that CSS was not involved with (e.g. separation, divorce, parental responsibility, etc.).

If a payment is sent in error or is unfunded (i.e. bounced check), it is your responsibility to pay back the unfunded amount. You may repay in full or CSS will deduct 10% or $10.00 (whichever is greater) from each payment received until the balance is paid in full. The non-custodial parent will still owe the unfunded amount.

Once a Family Support Registry (FSR) account number has been assigned, sending or receiving direct payment may result in case closure. The FSR is the central payment processing center for Colorado.

The provision of your Social Security Number (SSN) is mandatory (§42 U.S.C. 666(a) (13)). However, if you do not have a SSN, your application for services will not be denied. SSNs are used by the CSS Program to locate individuals to establish paternity or support obligations, modify and enforce support obligations and to distribute child support payments.

Please note:

Arrears owed to the custodial party are before TANF arrears are paid to the State of Colorado, unless there is a federal tax intercept.

Federal law requires CSS to withhold $25.00 one time each year from the child support collected on a non-public assistance case, if over $500.00 is collected during the year.

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Are you applying for help with any of the following issues (please check all that apply): Modify your child support amount_______ Change parent with physical care______

DNA testing for multiple alleged fathers_____ Collection of alimony/maintenance______

Print Legal Name:

Signature of applicant: _____________________________________ Date:____________________

For more child support information and additional forms you may visit our website at: www.childsupport.state.co.us

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APPLICANT INFORMATION

Relationship to

Mother

Father

Other, explain

the child(ren):

 

 

 

Legal Name:

Last

First

Middle

Maiden/Other

Social Security # or ITIN #:

 

 

 

 

Date of Birth:

 

Gender:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth:

City

 

State

 

 

 

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residence

Street

 

Apt/unit

 

City

 

 

State

 

Zip

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing

Street

 

Apt/unit

 

City

 

 

State

 

Zip

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(if different)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact

 

Home

Cell

 

Work

 

Email address:

 

 

Numbers

 

 

 

 

 

 

 

 

 

Would you like to opt into receive text

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

messages concerning your case?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Emergency contact (if you can’t be reached)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

Street

 

Apt/unit

 

 

 

City

 

State

 

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer and or Union

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

Street

 

 

 

 

City

 

 

State

 

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Occupation/Trade

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is it ok to contact you at work? Yes

Work Schedule:

 

 

 

 

 

 

or No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What was the situation

 

 

 

 

 

 

 

 

 

 

 

 

(Leading up to custody)?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there an attorney involved in this

Yes

 

 

 

No

 

 

 

 

 

case?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, Attorney’s Information:

Address

 

 

 

City

 

State

 

Zip

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Have the children ever received public

 

 

Yes

 

No

 

 

 

 

 

assistance?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes: what type was

 

 

 

TANF

 

 

Medicaid

 

 

 

 

Foster Care

 

 

received?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What County/State?

 

 

 

 

 

 

Begin Date:

 

 

 

 

End Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you are the mother, are you pregnant

 

If yes, what is the due date?

 

 

now?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, Who is the father of the expected child?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER PARENT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relationship to the

 

 

Mother

 

Father

 

 

Possible Father (paternity NOT

child(ren):

 

 

 

 

 

established)

 

 

 

 

 

 

 

 

 

 

 

 

 

Is Parent Deceased?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Legal Name:

 

 

Last

 

First

 

 

Middle

 

 

Maiden/Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security # or ITIN #:

 

Date of Birth

 

 

 

 

 

Gender

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth:

 

City

 

State

 

 

 

 

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current or last

 

Street

 

Apt/unit

 

City

 

State

 

Zip

known Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address

 

Street

 

Apt/unit

 

City

 

State

 

Zip

(if different)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact Numbers

 

Home

 

Work

 

Cell

 

Email address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Emergency contact (if other parent can’t be

 

Name

 

 

 

 

 

 

 

 

 

reached)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

Street

 

Apt/unit

 

 

City

 

State

 

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current or last

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

known employer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and or Union

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

Street

 

City

 

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Occupation/Trade

Physical Description: Height:

 

 

 

Weight:

 

 

Hair Color:

 

 

Eye Color:

Identifying Marks (scars, tattoos,

 

 

 

 

 

 

 

 

 

 

 

piercings)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Race: Caucasian

 

African American

Hispanic

 

 

Asian

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In Prison:

 

 

 

 

 

 

Which facility:

 

 

 

 

Date of release:

 

 

 

 

 

 

 

 

 

 

 

Currently or previously

 

 

 

 

 

DOC #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the military:

 

 

 

 

 

Branch of Service

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are they disabled?

 

 

 

 

 

If yes, do they receive SSI?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List any assets they may have: i.e. Real estate, bank

 

 

 

 

 

 

 

 

accounts, license to work a profession(plumber,

 

 

 

 

 

 

 

 

electrician)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List any vehicles(model, make, year, color)

Driver’s License Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other parent’s

 

Name/Maiden Name

Address

 

 

 

 

 

Phone

mother’s information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Parent’s

 

Name

 

 

 

 

Address

 

 

 

 

 

Phone

Father’s information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List any other biological Child(ren)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child(ren)’s other biological

 

 

 

 

 

 

 

 

 

 

 

 

 

 

parent:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there any other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

information that will help us

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

locate the other parent?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does the other parent have

 

If yes, Name:

 

 

Address

 

 

 

Phone #:

an attorney: Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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CHILD (REN)’S INFORMATION

 

Child 1

Child 2

Child 3

Legal Name

 

 

 

 

 

 

 

Gender (M or F)

 

 

 

 

 

 

 

Date of Birth

 

 

 

 

 

 

 

Social Security Number

 

 

 

 

 

 

 

City & State of Birth

 

 

 

 

 

 

 

State or County of

 

 

 

Conception

 

 

 

 

 

 

 

Who are listed as the Parents

 

 

 

on the Birth Certificate?

 

 

 

 

 

 

 

Child Support Order #, County

 

 

 

and State

 

 

 

 

Child 4

Child 5

Child 6

Legal Name

 

 

 

 

 

 

 

Gender (M or F)

 

 

 

 

 

 

 

Date of Birth

 

 

 

 

 

 

 

Social Security Number

 

 

 

 

 

 

 

City & State of Birth

 

 

 

 

 

 

 

State or County of

 

 

 

Conception

 

 

 

Who are listed as the Parents

 

 

 

on the Birth Certificate?

 

 

 

Child Support Order #, County

 

 

 

and State

 

 

 

PARENT OF THE APPLICATION, RELATIONSHIP STATUS

 

Were the Parents of the child (ren) ever married to one another?

If yes, Date and State of Marriage, Common Law or Civil Union.

Date Separated:

Date Divorced:

In what city, county, state?

Date of last contact with the other parent:

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If Paternity has been

Genetic Testing

 

Acknowledgement of

Court Order

established, How?

 

 

Paternity

 

 

 

 

 

 

Did this person ever live with the child (ren) in the

If yes, When and Where?

 

State of Colorado?

 

 

 

 

 

 

 

 

 

MEDICAL INSURANCE INFORMATION

A copy of the benefit card used to process medical claims MUST be provided.

Is your child (ren) on Medicaid?

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

Does your child (ren) have health insurance

Yes

 

 

No

 

coverage other than Medicaid?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, name the children covered by the

 

 

 

 

 

other insurance:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other insurance company’s information:

 

 

 

 

 

 

 

 

 

 

 

 

Insurance Company Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

Policy Number:

 

 

 

 

 

 

 

 

 

 

 

Phone number:

 

 

 

Group Number:

 

 

 

 

 

 

 

 

 

Date Insurance began:

 

Type of coverage: Medical

Dental

Vision

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

Who provides other insurance coverage?

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

Social Security Number

 

 

 

 

 

 

 

 

 

Relation to the covered child(ren)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

Phone number:

 

 

 

 

 

 

 

 

 

 

 

 

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How to Edit Custodial Party Child Support Application Online for Free

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step 1 to writing apply for child support online arkansas

In the No: Yes: If yes, Note: Your application may be, SERVICES PROVIDED BY CSS, CSS is authorized by law to, child support, assigned to you, and lottery winnings field, write down the information you have.

part 2 to finishing apply for child support online arkansas

The software will request data to easily submit the section Please read and initial each of, CSS represents the People of the, CSS does not handle parental, CSS will not accept the, CSS will not enforce maintenance, CSS determines the appropriate, If there is a change that could, and A written request from the.

step 3 to filling out apply for child support online arkansas

Please be sure to describe the rights and responsibilities of the sides inside the A written request from the, CSS will provide to the applicant, Each individual county determines, YOUR RESPONSIBILITIES, You are the best source of, and If you are a caretaker, relative section.

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