CS-202 |
COMMONWEALTH OF KENTUCKY |
(R. 6/14) |
Cabinet for Health and Family Services |
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Department for Income Support |
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Child Support Enforcement |
AUTHORIZATION FOR ELECTRONIC DEPOSIT OF CHILD SUPPORT PAYMENTS
Custodial parents may choose to receive their child support payments by electronic deposit to a checking or savings account or prepaid debit card. Please complete this form and return to the address or fax number listed below to ensure timely receipt of your child support payments. Child support system records will be updated to match the address, telephone number and financial account information provided below.
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Social Security Number of Custodial Parent: |
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Name of Custodial Parent: |
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Telephone Number: ( |
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Mailing Address of Custodial Parent: |
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City: |
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State: |
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ZIP Code: |
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I would like to receive my child support payments by (choose only one): |
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Checking Account |
Savings Account |
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Prepaid Debit Card |
Name and address of Financial Institution (bank, credit union, etc): |
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Telephone Number of Financial Institution: |
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Account Number: |
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Routing Number: |
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I hereby authorize Child Support Enforcement (CSE) to deposit my child support payments to the account above and agree to the following conditions:
If all information provided above is correct and complete, deposit of my child support payments into this account will begin within one week. If all information provided above is not correct and complete, deposit of my child support payments into this account will be delayed. All child support payments will be deposited to this account regardless of the number of child support cases I may have open in the State of Kentucky. I must allow two to three working days from the date the CSE Agency disbursed the payment to have the funds available in my account. I authorize CSE to adjust any overpayment made to my account. If funds are returned by the Financial Institution for any reason, CSE will hold those funds. CSE will attempt to contact me to obtain new account information but will not release the funds until new account information is received. It is my responsibility to keep CSE informed of my most recent mailing address and telephone number.
No separate notice will be sent to me when child support payments are deposited into this account. I can obtain payment information 24 hours a day, 7 days a week by calling (800) 443-1576 or accessing the Kentucky Child Support Interactive (KCSI) website at http://csws.chfs.ky.gov/csws/.
It is my responsibility to immediately notify CSE and complete a new authorization form when my account information changes. If I close my child support case, the account information on file at the time I closed my case will remain in effect until I complete a new authorization form. I can make changes to my account information electronically through the KCSI website at http://csws.chfs.ky.gov/csws/, by downloading the authorization form from this website, or obtaining it from my local CSE office and returning it to the address or fax number provided below.
I must return this form by fax to (502) 564-7938 or mail to the address listed below:
Child Support Enforcement Attn: EFT Coordinator P.O. Box 2150
Frankfort, Kentucky 40602-2150
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Printed Name of Custodial Parent |
Signature of Custodial Parent |
Web site: http://chfs.ky.gov/dis/cse.htm |
An Equal Opportunity Employer M/F/D |
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