Form Jfs 07076 PDF Details

In today's complex legal and social landscape, the application for child support services stands as a crucial step for many parents seeking financial support for their children from an absent parent. The Form JFS 07076, specifically designed for non-public assistance applicants in the State of Ohio, outlines the process for applying for such services through the County Child Support Enforcement Agency (CSEA). This form is instrumental for parents or guardians who are not receiving Aid to Dependent Children (ADC) or Medicaid, as these individuals automatically qualify for child support services upon receiving either form of assistance. The form meticulously details the conditions under which applicants can request the agency’s assistance, which encompasses locating absent parents, establishing or modifying child support and medical support orders, enforcing existing orders, and several other vital services. Interestingly, the form emphasizes the cooperation required from recipients, the nominal fee involved, and clarifies the agency’s role, asserting it represents the state's children's best interests rather than any individual applicant. Comprehensive in nature, it also seeks detailed information from the applicant regarding personal details, the child or children involved, and specifics about the absent parent or parents, ensuring the agency has all necessary information to proceed with the case. This introduction to the form highlights its critical role in facilitating the child support process, offering a beacon of hope for custodial parents striving to secure financial support for their children’s well-being.

QuestionAnswer
Form NameForm Jfs 07076
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesApplicationforC hildSupportServ ices Non PublicAssistance montgomery county ohio jfs 07076 form

Form Preview Example

APPLICATION FOR CHILD SUPPORT SERVICES

NON-PUBLIC ASSISTANCE APPLICANT

IMPORTANT: If you are receiving ADC or Medicaid, do not complete this application, because you became eligible for child support services when you became eligible to receive ADC or Medicaid.

I the undersigned,

 

request Child Support Services from the

County Child Support Enforcement

 

 

 

 

 

Agency. I understand and agree to the following conditions:

 

 

 

A.I am a resident of the County in which services are requested.

B.Recipients of child support services shall cooperate to the best of their ability with the CSEA. (See attached rights and responsibility information).

The Child Support Enforcement Agency can assist you in providing the following services:

1.Location of Absent Parents.

The agency can assist in finding where an absent parent is currently living, in what city, town or state. The applicant can request "Location Services Only", if the sole need is to find the whereabouts of the absent parent.

2.Establishment or Modification of Child Support and Medical Support.

The CSEA can assist you to obtain an order for support if you are separated, have been deserted or need to establish paternity (fatherhood). The CSEA can also assist you in changing the amount of support orders (modification), and to establish a medical support order.

3.Enforcement of Existing Orders.

The CSEA can help you collect current and back child support.

4.Federal and State Income Tax Refund Offset Submittals for the Collection of Child Support Arrearages.

The agency can assist in collecting back support (arrearages) by intercepting a non-payor's federal and state income tax refunds on some cases.

5.Withholding of Wages and Unearned Income for the Payment of Court Ordered Support.

The agency can help you get payroll deductions for current and back child support and can intercept unemployment compensation to collect child support.

6.Establishment of Paternity.

The agency can obtain an order for the establishment of paternity (fatherhood), if you were not married to the father of the child. An absent parent may request paternity services.

7.Collection and Disbursement of Payments.

The CSEA can collect the child support for you, and send you a check for the amount of the payments received. Back support collected will be paid to you until all of the back support you are owed is paid.

If you received ADC in the past and support was assigned to the state, back support collected will be paid to the state after you receive back support owed to you.

8.Interstate Collection of Child Support.

The agency can assist you in collecting support if the payor is living in another state or in some foreign countries.

C.The only fee you can be charged for services is a one dollar application fee. Some counties pay this fee for the applicants.

D.In providing IV-D services, the CSEA and any of its contracted agents (e.g., prosecutors, attorneys, hearing officers, etc.) represent the best interest of the children of the state of Ohio and do not represent any IV-D recipient or the IV-D recipient's personal interest.

APPLICANT INFORMATION (INFORMATION ABOUT YOU)

Name

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

Social Security Number (SSN)

Current Marital Status (Check One)

 

 

 

 

 

 

Single

Married

Divorced

Separated

 

 

 

Deserted

Widowed

 

 

 

 

 

 

 

 

 

 

 

Type(s) of Service(s) Requested: All services listed

 

Location of absent parent only

 

 

 

Other (please explain)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I understand that the Child Support Agency - within 20 days of receiving this application will contact me by a written notice to inform me if my case has been accepted for child support services (IV-D Services).

Signature of Applicant

Date

JFS 07076 (Rev. 5/2001) (Formerly DHS 7076)

Applicants Name (Last, First, Middle)

Address (Street/Route, P.O. Box)

City, State, Zip Code

Telephone Number (Home)

(Work)

INFORMATION ON CHILDREN

Child 1

Child 2

Child 3

Child 4

a.Name

b.Sex

c.SSN

d.Date of Birth (DOB)

e.Name(s) of Absent Parent

f.Has Paternity (Fatherhood) Been Established?

g.Is There An Order For Support

Yes No

ABSENT PARENT INFORMATION OR PARENT ORDERED TO PAY CHILD SUPPORT

 

Absent Parent #1

Absent Parent #2

 

 

 

Name

Address

(City, State, Zip Code)

SSN

Date of Birth (DOB)

Name of Employer

Address of Employer

(City, State, Zip Code)

Amount of Support Ordered

(Wk, Bi-Wk, Mo)

Case Number on Support Order

Date of Support Order

Location Where Order Was Issued

(City, County, State)

Military Service

Give Date and Branch Entered

Arrest Record: Give Date and Place

of Arrest

If the absent parent has been on Public

Assistance: Give Date and Place

Give Name and Address of Current

Spouse of Absent Parent

Absent Parent #3

Have you ever been on public assistance?

Yes

No

When (Date)

Where (City and State)

County

FOR AGENCY USE ONLY

Case Name

Date Requested

Date Mailed or Provided

Case Number

Date Returned or File Date

How to Edit Form Jfs 07076 Online for Free

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Concentrate while completing this form. Make sure that every field is filled in correctly.

1. First of all, once completing the Form Jfs 07076, begin with the section that contains the subsequent blanks:

Step # 1 for filling out Form Jfs 07076

2. After filling in the previous section, head on to the next step and fill in all required particulars in all these fields - APPLICANT INFORMATION INFORMATION, Date of Birth, Name, Social Security Number SSN, Current Marital Status Check One, Single Deserted, Married Widowed, Divorced, Separated, Types of Services Requested All, Location of absent parent only, I understand that the Child, Signature of Applicant, Date, and JFS Rev Formerly DHS.

Form Jfs 07076 conclusion process detailed (portion 2)

3. The third stage is usually simple - fill in all of the blanks in Telephone Number Home, Work, INFORMATION ON CHILDREN, Child, Child, Child, Child, Applicants Name Last First Middle, Address StreetRoute PO Box, City State Zip Code, a Name, b Sex, c SSN, d Date of Birth DOB, and e Names of Absent Parent to complete the current step.

Tips to complete Form Jfs 07076 part 3

4. The subsequent paragraph will require your details in the subsequent parts: Address City State Zip Code, SSN, Date of Birth DOB, Name of Employer, Address of Employer City State Zip, Amount of Support Ordered Wk BiWk, Case Number on Support Order, Date of Support Order, Location Where Order Was Issued, Military Service Give Date and, Arrest Record Give Date and Place, If the absent parent has been on, Give Name and Address of Current, Have you ever been on public, and Yes. Just be sure you fill in all requested details to move forward.

Tips to fill in Form Jfs 07076 portion 4

Always be really mindful when completing Give Name and Address of Current and Yes, as this is the section where most people make errors.

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