Massachusetts Form Am 3 PDF Details

Navigating the financial responsibilities of child support can be a challenging process, especially when circumstances change in ways that affect one's ability to pay. For those in Massachusetts facing such difficulties, the Department of Revenue Child Support Enforcement Division offers a form of relief through the Request for Equitable Adjustment, known as the Massachusetts AM 3 form. This valuable tool is designed exclusively for individuals owing arrears to the Commonwealth, providing a structured avenue to request an adjustment of the debt that acknowledges the payer's current financial realities. Crucially, it's important to note that arrears owed directly to a custodial parent cannot be adjusted through this process. Applicants are required to submit a comprehensive set of documents alongside the application, including a completed Statement of Financial Condition, verification of income, medical records in cases of disability, and more, to enable a thorough review by the Department of Revenue (DOR). Permissions for DOR to access applicants' credit reports are also part of the application process, underscoring the thoroughness with which each request is evaluated. Successful applications can provide crucial financial relief, underlining the importance of this form for eligible individuals striving to manage their child support commitments responsibly.

QuestionAnswer
Form NameMassachusetts Form Am 3
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesSSITANF, FCRA, request for equitable adjustment form, false

Form Preview Example

Commonwealth of Massachusetts

Department of Revenue

Child Support Enforcement Division

REQUEST FOR EQUITABLE ADJUSTMENT

Name:

APPLICATION

SSN:

Case No:

 

IMPORTANT! You can request equitable adjustment of arrears owed to the Commonwealth only.

Arrears owed to a custodial parent are not eligible for equitable adjustment.

Check List of Required Items

The following documentation must be submitted with your application or your application will be returned as incomplete. Indicate if any of the items are not applicable by writing N/A. DOR may require you to provide additional documentation as the evaluation of your request proceeds.

Unless DOR has specifically asked for the original document, please submit copies only. DOR will not return any documents to you.

Completed Request for Equitable Adjustment (this two-page form).

Completed Statement of Financial Condition.

Verification of Income

Complete pay stubs for the past 3 months, or financial statements for the past 2 years if you are self-employed.

Information from the Social Security Administration (SSA).

Social Security Earnings Statement (required for all applicants). Go to www.ssa.gov for instructions on requesting an Earnings Statement. If you receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), attach a copy of the award letter.

Bank Information

Complete bank statements for all checking, savings and other bank accounts for the past 3 months.

Medical Records

Copies of any doctors’ letters, reports or medical records that support any claim of medical disability.

Power of Attorney

Power of Attorney if this offer is submitted by a designated representative.

Authorization to Request Consumer Credit Report

I, ____________________, hereby authorize DOR to obtain, and all consumer credit reporting agencies to furnish,

my full credit report in accordance with §§ 1681b(a)(2), (4) and (5), 1681b(f), 1681e and any other applicable sections of the Fair Credit Reporting Act (FCRA). (15 USC § 1681 et. seq.). I agree that DOR’s use of my credit report for collection and enforcement of my child support order is a permissible purpose as that term is defined in § 1681b of the FCRA. This authorization does not expire and any revocation of this authorization must be made in writing to DOR. Copies of this authorization are as good as the original.

____________________________________________

____________________________

Signature

Date

Mail your completed and signed application, with copies of all required documents, to:

Department of Revenue

Child Support Enforcement Division

Attn:

AM-3 2/23/10

REQUEST FOR EQUITABLE ADJUSTMENT

Name

 

Social Security Number

Date of Birth

 

 

 

 

 

 

Address

 

City/Town

State

Zip Code

 

 

 

 

 

Home Phone Number

Work Phone Number

Cell Phone Number

E-mail

 

To the Deputy Commissioner of the Child Support Enforcement Division (DOR):

1.I submit this request for equitable adjustment of past-due child support that I owe to the Commonwealth of Massachusetts. DOR’s records indicate and I believe that I owe a total of $___________ to the Commonwealth, including interest and penalty.

2.I understand that any past-due child support owed to the custodial parent is NOT subject to equitable adjustment and that even if this request is approved, DOR will continue its enforcement actions to collect any past-due support owed to the custodial parent.

3.Submission of this request for equitable adjustment does not waive any rights I might have to challenge the amount stated in paragraph 1 in the event no equitable adjustment is made.

4.I have attached a completed Statement of Financial Condition which shows that I do not have the present financial ability to pay the past-due support in full.

5.The past-due support I owe to the Commonwealth should be equitably adjusted because (check all that apply):

a. The past-due support accrued during periods I received needs-based benefits (e.g., SSI,TANF/AFDC, state

veterans’ benefits). Type of benefit: ________________________________ Dates received: ___________________

b. The past-due support accrued during periods I was unable to pay my child support because:

I had the following disability: _____________________________________________________________________

Dates of disability: ________________________ Received SSDI Yes No Injured at work Yes No

I was unemployed and did not receive unemployment benefits.

Reason for unemployment: ______________________________________________________________________

Dates of unemployment: ________________________

I was incarcerated. Dates and place of incarceration: __________________________________________________

Other. Please explain: __________________________________________________________________________

_____________________________________________________________________________________________

If you checked any box in Paragraph 5b: Did you file for modification of your support order during the period you were

unable to pay support? Yes No Explain: ______________________________________________________________

c. I have custody of the minor child for whom I owe support. Yes No Attach custody order or proof of residence.

d. I am reconciled and reside with the custodial parent and the minor child for whom I owe past-due support. Date of reconciliation/marriage: __________ Has support order been terminated by the court? Yes No

I certify under the pains and penalties of perjury that the information provided above is true and accurate to the best of my knowledge and belief. I understand that if I fail to provide complete information or provide false information, my request for equitable adjustment will be denied. I also understand that DOR may continue its enforcement actions while this request for equitable adjustment is under consideration.

Signature

Date

AM-3 2/23/10

How to Edit Massachusetts Form Am 3 Online for Free

1681e can be completed online effortlessly. Just use FormsPal PDF editing tool to get it done in a timely fashion. Our editor is continually evolving to present the very best user experience achievable, and that's thanks to our dedication to continuous enhancement and listening closely to user opinions. To get the ball rolling, take these simple steps:

Step 1: Just press the "Get Form Button" in the top section of this webpage to see our form editing tool. This way, you will find all that is required to work with your file.

Step 2: With this online PDF editing tool, you may accomplish more than just fill out blanks. Try each of the features and make your documents seem high-quality with custom text put in, or fine-tune the original content to perfection - all that backed up by an ability to incorporate any type of images and sign the PDF off.

This PDF doc will involve specific details; in order to guarantee accuracy and reliability, please heed the guidelines further down:

1. The 1681e needs particular details to be inserted. Make sure the following fields are filled out:

1681b conclusion process shown (portion 1)

2. Just after the previous section is filled out, go on to type in the relevant information in these - Verification of Income, Complete pay stubs for the past, Information from the Social, Social Security Earnings Statement, Bank Information, Complete bank statements for all, Medical Records, Copies of any doctors letters, Power of Attorney, Power of Attorney if this offer is, Authorization to Request Consumer, I hereby authorize DOR to obtain, USC et seq, Signature, and Date.

Stage no. 2 of filling out 1681b

3. Throughout this stage, look at Mail your completed and signed, and Attn. All of these need to be filled out with highest accuracy.

Attn, Mail your completed and signed, and Attn inside 1681b

4. This specific subsection comes next with all of the following form blanks to consider: REQUEST FOR EQUITABLE ADJUSTMENT, Social Security Number, Date of Birth, CityTown, State, Email, Zip Code, Name, Address, Home Phone Number, Work Phone Number, Cell Phone Number, To the Deputy Commissioner of the, I submit this request for, and I understand that any pastdue.

Tips on how to prepare 1681b stage 4

A lot of people frequently make mistakes when completing I submit this request for in this part. You need to go over whatever you type in here.

5. While you draw near to the completion of the document, you'll find a few more requirements that should be satisfied. Mainly, The pastdue support I owe to the, a The pastdue support accrued, veterans benefits Type of benefit, The pastdue support accrued during, I had the following disability, Dates of disability Received SSDI, I was unemployed and did not, Reason for unemployment Dates of, I was incarcerated Dates and, Other Please explain, If you checked any box in, I have custody of the minor child, I am reconciled and reside with, and I certify under the pains and should be done.

Stage # 5 of filling in 1681b

Step 3: Before moving forward, make sure that all form fields have been filled in the proper way. The moment you believe it's all fine, click on “Done." Right after getting a7-day free trial account here, it will be possible to download 1681e or email it promptly. The form will also be readily accessible through your personal account page with your each change. FormsPal guarantees your data confidentiality by having a secure method that never saves or shares any type of personal data involved. Feel safe knowing your docs are kept protected each time you use our tools!