Sc Application Child PDF Details

The SC Application Child Form is a required document for children seeking South Carolina residency. This form gathers important information about the child and their family, which is used to determine eligibility for residency.

We've compiled some general information about the sc application child. You might want to learn its size, the typical time necessary to prepare the form, the fields you'll need to fill in, and so forth.

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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withctionoftheSocialSectySocialSectymbe adbytheSothalinahildSoSeceivionto

ainlocatingindividalfotheoofeabliingateityand

eabliingmodifyingandenfongchildoobligati on

atelicationReeed

atelicationMailed

atelicationReceived

Child Support Services

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Full Service Applicants Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Authorization and Assignment of Rights

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

dohebyalytotheSothalinaeamentof

 

 

 

 

 

 

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hildhildn

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

hildhildn

 

fowhom

 

 

 

 

 

 

 

havecaandcody

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

heagnmentibjecttotheteandconditionof

 

 

 

 

 

 

itleVoftheSocialSectyaamendedS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ndeandthatwhenthialicationfoceiacce

 

 

 

 

 

 

tedoneoftheeolewithwhommaydimycaiana

 

 

 

 

 

 

 

 

 

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bytheateofSothalinaandmainanattoey

 

 

 

 

 

 

fotheateSbmionofthialicationconittemyackno

 

 

 

 

 

 

 

 

 

 

 

wledgmentand

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ethattheSSobtainandoenfomedical

 

 

 

 

 

 

ofmtheifitiavailableataanableco

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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o

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aboveinfotioniteandcomletetothebeofmyknowl

 

 

 

 

 

 

 

 

edgeandbeliefandigiven

fotheoofceivingcendeitleVoft

 

 

 

 

 

 

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inchild

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Permission to Recoup An Overpayment: onwttennotificationofaymentefmhildSo

 

 

 

 

Seceivionagetoallow

SStotaintoentofanyftchild

 

 

 

 

 

 

oaymenttococtanyoveaymentceived

 

 

 

 

 

 

 

e

 

 

 

o

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

licant’Signat

 

 

 

 

 

 

 

 

 

ate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Custodial Parent Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

oamea

 

 

 

 

 

 

 

 

 

 

 

 

i

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Middle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sffix

 

 

Maidename

 

 

 

 

 

 

 

 

 

 

SSRace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SexntMatalStat

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

aceofhity

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

 

 

 

 

hdate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Redentiald

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

omeelehone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ity

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

 

 

i

 

 

 

 

 

 

 

ode

 

 

 

 

 

 

 

ellone

 

 

 

 

 

 

 

 

 

 

 

 

ild

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailingdcoa

 

 

 

 

 

 

 

 

 

 

i

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Middle

Sffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d

 

 

 

 

 

 

 

 

 

 

 

ity

 

 

 

 

 

 

 

 

 

 

Statei

 

 

 

 

 

 

 

 

 

 

 

 

 

ode

 

 

 

 

oloye’ame

 

 

 

 

 

 

 

 

 

 

 

W

 

 

 

 

 

 

 

 

 

 

oelehone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d

 

 

 

 

 

 

 

 

 

 

 

ity

 

 

 

 

 

 

 

 

 

 

 

 

Statei

 

 

 

 

 

 

 

 

 

 

 

ode

 

 

 

 

WoStaime

 

 

 

 

 

 

 

 

 

Wodime

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

fntlyMaedSo’amed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

aceofMaageity

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

 

 

 

 

at

 

 

 

eofMaage

 

 

 

 

 

 

 

 

 

 

 

 

fnotcntlymaedhaveyoevebeenmaed

 

 

 

 

 

 

 

 

e

 

ofyevidethefollowing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Redentiald

 

 

 

 

 

 

 

 

ityStat

 

 

 

 

 

 

 

 

 

e

iode

 

 

 

 

 

 

thiaddcnt

 

e o nknownateaivedheomeel

 

 

 

 

 

 

 

 

 

 

 

 

 

ehone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

Mailingdcoa

 

 

 

i

Middle

 

 

 

 

 

 

Sffix

 

 

 

 

 

 

d

 

 

 

 

 

 

 

 

ity

 

 

 

 

 

 

 

Stateiode

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

oethehaveaoliceco

 

 

 

 

e

 

o

nknown

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ity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

iode

 

 

 

 

 

 

ncationateReleaat

 

 

 

 

 

 

 

 

 

 

 

 

 

e

ncationocation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ncationity

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

iode

 

 

 

 

 

 

doStatVSecembe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

donch

 

 

 

 

 

 

 

 

 

 

 

 

 

 

iveRetid

iaed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

evennknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

dotate

 

 

 

 

 

 

 

 

 

 

 

 

doiaeate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does the NCP have income other than employment income?

Yes

No Unknown

 

 

fyeofincome

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nt

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nt

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nt

 

 

 

 

 

 

 

 

 

 

 

 

 

 

oethehaveanybankaccontat

 

 

 

 

e

o

nknown

 

 

 

 

 

ameofnk

 

 

 

 

 

 

 

 

 

 

 

ntmbe

 

 

 

 

 

 

 

 

 

 

ye

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

heckingSaving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ameofnk

 

 

 

 

 

 

 

 

 

 

 

ntmbe

 

 

 

 

 

 

 

 

 

 

ye

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

heckingSaving

t

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

oetheownanyeyaleatecaetc

 

 

 

 

 

 

 

e

o

nknown

 

 

 

 

 

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

d

 

 

weeklySmimonthly MnthlyWeeklyanal

 

 

 

 

 

 

 

 

 

 

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.)

heSothalinaeamentofSocialSeceSSvidechild

ocetoodialnt

aianthghithildSoSeceivionSSom

comletethealicationtooena

cawiththeSS

 

heSSittohelacodialantto

 

•ocatethenonodialant

 

•abliateityifthechildchildnwaweboo

tofwedlock

•abliachildomedicalooeagainthe

 

•Wowiththeaateamilyoafftoenfot

hechildooe

•Reviewthecafomodificationofthechildoo

eontheeoftheothe

lcaaccetedbytheSSahandledonaficomefi

dbalaimfovitationcody

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Central Inquiry:

Tax Intercept Unit: o

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

SSo

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