Custodial Party Child Support Application – Fill Out and Use This PDF

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.

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

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.

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

Occupation/Trade

MEDICAL INSURANCE INFORMATION

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