Sc Application Child PDF Details

Filling out the South Carolina Department of Social Services Custodial Parent’s Application for Child Support Services marks a critical step towards ensuring the financial support and well-being of a child. When a custodial parent decides to embark on this process, they engage with a comprehensive system designed to locate non-custodial parents, establish paternity, and enforce child support obligations. The application provides two distinct pathways - "Locate Only" and "Full Service" - each tailored to meet different needs. "Locate Only" focuses solely on finding the non-custodial parent, while "Full Service" encompasses a full spectrum of services, including establishing paternity, obtaining a child support order, and enforcing it. Applicants must complete the form with accuracy and detail, providing extensive information about themselves, the non-custodial parent, and their child or children. This includes employment details, potential income sources, and residence information, which are vital for the successful location and communication with the non-custodial parent. Additionally, the application delves into the legal rights of the applicant, emphasizing the importance of understanding the implications of signing the form, such as the authorization and assignment of rights to the South Carolina Department of Social Services. This process not only seeks to secure financial support but also aims to establish legal paternity and foster a stable environment for the child's growth and development.

QuestionAnswer
Form NameSc Application Child
Form Length10 pages
Fillable?Yes
Fillable fields461
Avg. time to fill out31 min 34 sec
Other names with section 466(a)(13) of the Social Security Act

Form Preview Example

South Carolina Department of Social Services

CUSTODIAL PARENT’S APPLICATION FOR CHILD SUPPORT SERVICES

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PART I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Custodial Parent Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Person with whom child or children is/are living)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

oamea

 

 

 

 

 

 

 

 

 

 

 

 

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Middle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sffix

 

 

Maidename

 

 

 

 

 

 

 

 

 

 

SSRace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SexntMatalStat

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Mailingdcoa

 

 

 

 

 

 

 

 

 

 

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Middle

Sffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Statei

 

 

 

 

 

 

 

 

 

 

 

 

 

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W

 

 

 

 

 

 

 

 

 

 

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d

 

 

 

 

 

 

 

 

 

 

 

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WoStaime

 

 

 

 

 

 

 

 

 

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aceofMaageity

 

 

 

 

 

 

 

 

 

 

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at

 

 

 

eofMaage

 

 

 

 

 

 

 

 

 

 

 

 

fnotcntlymaedhaveyoevebeenmaed

 

 

 

 

 

 

 

 

e

 

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ameofoSo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ateandaceofMaage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fivodateandaceofivo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSo

 

 

 

 

 

 

 

 

 

 

 

 

 

Non-Custodial Parent Information

 

 

 

 

 

amea

 

 

 

 

 

 

 

 

 

i

 

 

 

 

 

 

 

 

 

 

 

 

MiddleSffix

 

 

 

 

 

 

 

 

 

 

 

SexRace

 

 

 

 

 

 

 

 

SS

 

 

 

 

 

 

 

 

 

 

ateofth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

aceofhity

 

 

 

 

 

 

 

State

 

 

 

 

 

 

ia

 

 

 

 

 

 

 

 

 

 

 

 

ickname

Maidename

 

 

 

 

 

 

 

 

ve’icen

 

 

 

 

 

 

 

 

 

 

 

mbe

 

 

 

 

 

 

ve’icenate

 

 

 

 

 

 

ve’icenState

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ntMatalStatfMaed

 

 

 

 

 

 

 

 

 

So’ame

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

aSchooltendedby

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d

 

 

 

 

 

 

 

ity

 

 

 

Stateiode

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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ityStat

 

 

 

 

 

 

 

 

 

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iode

 

 

 

 

 

 

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e o nknownateaivedheomeel

 

 

 

 

 

 

 

 

 

 

 

 

 

ehone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Give directions to and a description of the NCP’s home:

Mailingdcoa

 

 

 

i

Middle

 

 

 

 

 

 

Sffix

 

 

 

 

 

 

d

 

 

 

 

 

 

 

 

ity

 

 

 

 

 

 

 

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ellone

 

 

 

ild

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

eafithefollowinginfotiononthenonodia

 

 

 

 

 

 

 

 

lant’cntolaemloye

 

 

 

 

 

 

yeofloyment

 

 

 

thecntlyemloyed

 

 

 

 

 

 

e

o nknown

 

 

 

 

 

 

 

 

 

 

 

 

 

loye’ame

 

 

 

 

Woeleh

 

 

 

one

 

 

 

 

 

 

 

loye’d

 

 

 

ity State

 

 

 

iode

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ateaWodWhat

 

 

 

 

ithemonthlylaShif

 

 

 

 

 

 

 

tWod

 

 

alccation

 

 

theSkill

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ealithenameandaddofanyotheaemloye

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ame

d

 

 

 

 

 

 

 

 

 

 

 

ateaWod

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What are the names of the non-custodial parent’s parents? (Please indicate their names even if they are deceased.)

Father:Mother:

aSffixiMiddleMaidenameaiMiddle

StetoxStetox

ityStateiodeityStateiode

elehoneelehone

SSo

eight eetncheWeig

 

 

 

 

 

 

 

 

 

 

 

 

htb aiolo

 

 

 

 

 

 

 

 

 

 

 

 

 

olo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

dentifyingMaSca

 

 

 

 

 

 

 

 

 

 

 

 

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e

 

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ity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

iode

 

 

 

 

 

 

ncationateReleaat

 

 

 

 

 

 

 

 

 

 

 

 

 

e

ncationocation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ncationity

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

iode

 

 

 

 

 

 

doStatVSecembe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

donch

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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iaed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

evennknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

dotate

 

 

 

 

 

 

 

 

 

 

 

 

doiaeate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does the NCP have income other than employment income?

Yes

No Unknown

 

 

fyeofincome

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nt

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nt

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nt

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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ameofnk

 

 

 

 

 

 

 

 

 

 

 

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ye

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

heckingSaving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ameofnk

 

 

 

 

 

 

 

 

 

 

 

ntmbe

 

 

 

 

 

 

 

 

 

 

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heckingSaving

t

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

oetheownanyeyaleatecaetc

 

 

 

 

 

 

 

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ealityeandlocation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Whatithenameoftheinwithwhomthehamedica

linncecovege

 

aeame

yeofnnce

licy

mbe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case Information

 

 

 

 

 

 

oyohaveanattoeyactivelyekingo

e

ofyeattoey’name

 

 

 

 

 

 

 

 

 

 

 

 

oyohaveaviocooeeablied

e

ofyevideooenmbe

 

 

 

 

 

 

eaattachacoyofthecooe

 

 

 

 

 

 

 

 

 

 

ameofo

 

 

 

 

ity

 

 

State

 

 

 

 

 

 

ntofSofyodo

 

 

 

nothaveacooedoetheayvolntaly

 

 

 

e

o

 

 

 

 

 

 

encyofSo

 

 

ateaymentReceive

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SoMethod

yowillingtobmittoaateityte

omment

icttoohghtheo fectiveateofSoe

e o

SSo

Child Information

(Complete a separate section for each child)

hild’amea

 

 

 

 

 

 

i

 

 

 

 

 

 

 

 

 

 

 

MiddleSffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SexRaceSS

 

 

 

 

 

 

 

ateofh

 

 

 

 

 

 

 

 

 

aceofh

 

 

 

 

 

 

 

aateitybeeneabliedfothichild

 

oWhatiyolationitothichild

 

 

 

 

 

 

Wetheantmaedatthetimeofthechild’bih

 

 

 

 

 

 

e

ofnodebethelationi

 

 

 

 

 

 

fMaedateofMaageace

 

 

 

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete Only If You Are NOT The Mother of This Child

 

 

 

 

 

 

Whoathechild’antMothe

 

 

 

 

 

athe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relationioftheantatthetimeofbih

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fMaedateace

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

 

Wathemotheevemaedtoanyoneel

 

 

 

e

 

o

ame

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fMaedateace

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full Service Applicants Only

(Answer if you are the MOTHERof this child. However, if you were married to the father when the child was born and this is his child, omit the following questions. If the father is already under a court order to support this child, please return a copy to us and omit the following questions.)

nwhichatedidyobecomegnant

 

 

 

 

 

Whendidyogetgnant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nthayea

 

idthefathehavehinametonthebihceificat

 

 

eognavolntaateityacknowledgement

 

 

 

e

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Whatdidthechildweighatbih

b

 

 

 

 

 

zWathechild

y

nime

ate

 

 

 

 

idthefathe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

yanynt

e

o Vitthechild

 

e

o

 

 

 

 

 

yooffetoaythemedicalbillofyognancy

 

 

 

e

 

omitbeingthefathe

 

e

o

avehiicttakenwiththechild

 

e

 

oVitthehoital

 

e

 

o

 

 

 

ioion

e

offetomayo

 

 

 

 

 

e

 

o

 

 

 

 

 

Weyohavingxallationwithanyoneothethant

 

 

 

 

 

hefathedngthemonthyogotgnant

 

 

 

e

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ngthemonthbefo

 

 

 

 

ngthemonthafte

 

 

 

 

 

 

 

 

 

fyetoanyoftheeionvidenameandadd

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSo

Child Information

(Complete a separate section for each child)

hild’amea

 

 

 

 

 

 

i

 

 

 

 

 

 

 

 

 

 

 

MiddleSffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SexRaceSS

 

 

 

 

 

 

 

ateofh

 

 

 

 

 

 

 

 

 

aceofh

 

 

 

 

 

 

aateitybeeneabliedfothichild

 

oWhatiyolationitothichild

 

 

 

 

 

Wetheantmaedatthetimeofthechild’bih

 

 

 

 

 

 

e

ofnodebethelationi

 

 

 

 

 

fMaedateofMaageace

 

 

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete Only If You Are NOT The Mother of This Child

 

 

 

 

 

Whoathechild’antMothe

 

 

 

 

 

athe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relationioftheantatthetimeofbih

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fMaedateace

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

Wathemotheevemaedtoanyoneel

 

 

 

e

 

o

ame

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fMaedateace

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full Service Applicants Only

(Answer if you are the MOTHERof this child. However, if you were married to the father when the child was born and this is his child, omit the following questions. If the father is already under a court order to support this child, please return a copy to us and omit the following questions.)

nwhichatedidyobecomegnant

 

 

 

 

 

Whendidyogetgnant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nthayea

 

idthefathehavehinametonthebihceificat

 

 

eognavolntaateityacknowledgement

 

 

 

e

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Whatdidthechildweighatbih

b

 

 

 

 

zWathechild

y

nime

ate

 

 

 

idthefathe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

yanynt

e

o Vitthechild

 

e

o

 

 

 

 

 

yooffetoaythemedicalbillofyognancy

 

 

 

e

 

omitbeingthefathe

 

e

o

avehiicttakenwiththechild

 

e

 

oVitthehoital

 

e

 

o

 

 

 

ioion

e

offetomayo

 

 

 

 

 

e

 

o

 

 

 

 

 

Weyohavingxallationwithanyoneothethant

 

 

 

 

 

hefathedngthemonthyogotgnant

 

 

 

e

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ngthemonthbefo

 

 

 

 

ngthemonthafte

 

 

 

 

 

 

 

 

fyetoanyoftheeionvidenameandadd

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSo

Child Information

(Complete a separate section for each child)

hild’amea

 

 

 

 

 

 

i

 

 

 

 

 

 

 

 

 

 

 

MiddleSffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SexRaceSS

 

 

 

 

 

 

 

ateofh

 

 

 

 

 

 

 

 

 

aceofh

 

 

 

 

 

 

aateitybeeneabliedfothichild

 

oWhatiyolationitothichild

 

 

 

 

 

Wetheantmaedatthetimeofthechild’bih

 

 

 

 

 

 

e

ofnodebethelationi

 

 

 

 

 

fMaedateofMaageace

 

 

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete Only If You Are NOT The Mother of This Child

 

 

 

 

 

Whoathechild’antMothe

 

 

 

 

 

athe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relationioftheantatthetimeofbih

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fMaedateace

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

Wathemotheevemaedtoanyoneel

 

 

 

e

 

o

ame

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fMaedateace

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full Service Applicants Only

(Answer if you are the MOTHERof this child. However, if you were married to the father when the child was born and this is his child, omit the following questions. If the father is already under a court order to support this child, please return a copy to us and omit the following questions.)

nwhichatedidyobecomegnant

 

 

 

 

 

Whendidyogetgnant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nthayea

 

idthefathehavehinametonthebihceificat

 

 

eognavolntaateityacknowledgement

 

 

 

e

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Whatdidthechildweighatbih

b

 

 

 

 

zWathechild

y

nime

ate

 

 

 

idthefathe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

yanynt

e

o Vitthechild

 

e

o

 

 

 

 

 

yooffetoaythemedicalbillofyognancy

 

 

 

e

 

omitbeingthefathe

 

e

o

avehiicttakenwiththechild

 

e

 

oVitthehoital

 

e

 

o

 

 

 

ioion

e

offetomayo

 

 

 

 

 

e

 

o

 

 

 

 

 

Weyohavingxallationwithanyoneothethant

 

 

 

 

 

hefathedngthemonthyogotgnant

 

 

 

e

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ngthemonthbefo

 

 

 

 

ngthemonthafte

 

 

 

 

 

 

 

 

fyetoanyoftheeionvidenameandadd

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSo

Child Information

(Complete a separate section for each child)

hild’amea

 

 

 

 

 

 

i

 

 

 

 

 

 

 

 

 

 

 

MiddleSffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SexRaceSS

 

 

 

 

 

 

 

ateofh

 

 

 

 

 

 

 

 

 

aceofh

 

 

 

 

 

 

aateitybeeneabliedfothichild

 

oWhatiyolationitothichild

 

 

 

 

 

Wetheantmaedatthetimeofthechild’bih

 

 

 

 

 

 

e

ofnodebethelationi

 

 

 

 

 

fMaedateofMaageace

 

 

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete Only If You Are NOT The Mother of This Child

 

 

 

 

 

Whoathechild’antMothe

 

 

 

 

 

athe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relationioftheantatthetimeofbih

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fMaedateace

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

Wathemotheevemaedtoanyoneel

 

 

 

e

 

o

ame

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fMaedateace

 

 

 

 

fivodate

 

 

 

 

 

 

 

 

 

 

ace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full Service Applicants Only

(Answer if you are the MOTHERof this child. However, if you were married to the father when the child was born and this is his child, omit the following questions. If the father is already under a court order to support this child, please return a copy to us and omit the following questions.)

nwhichatedidyobecomegnant

 

 

 

 

 

Whendidyogetgnant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nthayea

 

idthefathehavehinametonthebihceificat

 

 

eognavolntaateityacknowledgement

 

 

 

e

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Whatdidthechildweighatbih

b

 

 

 

 

zWathechild

y

nime

ate

 

 

 

idthefathe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

yanynt

e

o Vitthechild

 

e

o

 

 

 

 

 

yooffetoaythemedicalbillofyognancy

 

 

 

e

 

omitbeingthefathe

 

e

o

avehiicttakenwiththechild

 

e

 

oVitthehoital

 

e

 

o

 

 

 

ioion

e

offetomayo

 

 

 

 

 

e

 

o

 

 

 

 

 

Weyohavingxallationwithanyoneothethant

 

 

 

 

 

hefathedngthemonthyogotgnant

 

 

 

e

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ngthemonthbefo

 

 

 

 

ngthemonthafte

 

 

 

 

 

 

 

 

fyetoanyoftheeionvidenameandadd

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSo

PART II

What to Expect

(Please read this page and the next carefully and DETACHfor your records.)

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Central Inquiry:

Tax Intercept Unit: o

Additional information can be found at www.state.sc.us/dss/csed/index.html

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