The Department of Children and Families (DCF) is responsible for the welfare of children and families in the state of Florida. One important part of their work is providing financial assistance to families in need. The DCF website offers a number of resources for those seeking help, including the Form Dcf F Dwsc12181. This form can be used to apply for benefits such as Temporary Assistance for Needy Families (TANF), Medicaid, and Food Stamps. Families who are eligible may receive financial assistance to help them meet their basic needs. In this blog post, we will provide an overview of the Form Dcf F Dwsc12181, including what information is required and how to submit it. We will also take a look at some common benefits that may be available to qualifying families. If you are interested in applying for benefits through the DCF, this post will provide a helpful starting point.
Question | Answer |
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Form Name | Form Dcf F Dwsc12181 |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | dcf_f_dwsc12181 what to do with tn child support stale dated check form |
DEPARTMENT OF CHILDREN AND FAMILIES
Division of Family and Economic Security
REQUEST FOR
PLEASE SEE INSTRUCTIONS ON THE BACK OF THIS PAGE
Mail to:
Bureau of Child Support
P.O. Box 7935
Madison WI
Information provided on this form (including any attachments) may be shared with others only for the purpose(s) of administration of the child support program and other related programs [Wis. Statutes, s.49.83]
The provision of your Social Security number is mandatory under Section 466(a) (42U.S.C.666(a)). Your Social Security number will be used for identification purposes. If you do not provide your Social Security number, your application will be denied.
Payee Name on the Original Check |
Claimant (Your) Telephone Number |
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Payee Social Security Number |
KIDS Personal Identification Number (PIN) if known |
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Payee Name for the New Check |
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Street Address of the Person Making This Claim |
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Zip Code |
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Signatures Must be Notarized
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*Signature of person making the claim for |
If more than one person, signature of other person making the |
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claim for |
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Print Name |
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Print Name |
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Notarization is Required |
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Place Seal Here |
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Subscribed and affirmed to me |
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This __________ day of _______________, __________ |
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Notary Public, State of ____________________________ |
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My Commission (is permanent) _____________________ |
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OR |
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Official Use |
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Agency |
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Expires ________________________________________ |
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Person Handling |
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Request Approved |
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Send this document to the address provided in the upper
*If the payee is deceased, the person making the claim on behalf of the payee’s estate should complete this form as completely as possible and attach a letter explaining that they are acting on behalf of the estate. Attach notarized copies of your appointment or authorization to act in this capacity.
INSTRUCTIONS FOR COMPLETION OF A
REQUEST FOR
Payee Name on the Original Check
Please insert the name of the person named on the check you are asking a
Claimant (Your) Telephone Number
Please insert YOUR telephone number here. You are the claimant. This may be the person named on the check or someone else.
Payee Social Security Number
This is the social security number of the person named on the check. This may be you or someone else. The provision of your Social Security number is mandatory under Section 466(a) (42U.S.C.666(a)). Your Social Security number will be used for identification purposes. If you do not provide your Social Security number, your application will be denied.
KIDS Personal Identification Number (PIN) if Known
This is the PIN (as assigned in the KIDS child support system) of the person for whom the check was written, the person named on the check.
Check Number if Known
If you have the check or the check number, write it in this box. The check number is written boldly on the check. If more than one check, fill out the attached Check List form.
Street Address of the Person Making This Claim
This is where the check will be mailed if your claim is approved. This may be the address of the person named on the check or someone else. If it is not the address of the person named on the check, please attach an explanation.
City, State, and Zip Code
Please provide these as part of the street address above.
Signature of Person Making the Claim for
This is the signature of the person making the claim for the check. It may or may not be the person named on the check. It is the signature that must be notarized. If it is not the person named on the check, please attach an explanation. If the person making this claim is acting on behalf of the payee’s estate, then you must attach notarized copies of your authorization to act in this capacity. If the form is not properly notarized, it cannot be processed.
If more than one person, please provide the signature of the other person making a claim for
If more than one person is making the claim for
Print Name
Please carefully and clearly print your name(s) in the boxes provided.
DCF is an equal opportunity employer and service provider. If you have a disability and need to access this information in an alternate format, or need it translated to another language, please contact (608)