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Child Support Agency Guardian Application for Service

Information provided on this form (including attachments) may only be shared with others for the purpose(s) of the administration of the child support program and other related programs.

Section A

Requested Services From Child Support Agency

Section I - Guardians Information

Guardian: Information

Guardian Name :

Guardian: Home Address	Guardian: Mailing Address

Guardian: Enrollment Information

Guardian: Background Information

Section II - Mothers Information

Mother: Information

Mothers Name :

Mother: Home Address	Mother: Mailing Address

Mother: Enrollment Information

Mother: Place of Birth

Mother: Background Information

Mother: Employment Information

Mother: Military Background

Section III - Fathers Information

Father: (Not Husband)

Name:

Father: Information

Fathers Name :

Father: Home Address	Father: Mailing Address

Father: Enrollment Information

Father: Place of Birth

Father: Background Information

Father: Employment Information

Father: Military Background

Father: Unknown Location

Section IV - Child(ren) Information

Section V - Additional Information

Attachments:

Additional Information:

TAX INTERCEPT INFORMATION: I understand that the Oneida Nation Child Support Agency will submit any certifiable past-due child support debts to the State of Wisconsin tax/lottery intercept programs. I understand that I am applying for State IV-D services for purposes of submitting arrearages for Federal tax refund intercept programs. I understand that if I receive the other parent's intercepted tax refund money that is later recalled by the federal Internal Revenue Service (IRS) or the state Department of Revenue (DOR), I must immediately
return the money. If I cannot repay all the money at once, I will follow a payment plan until the amount is repaid in full. (If the tax refund is recalled, you will receive a letter with information about how to return the money and how to set up a payment plan.

CHILD SUPPORT ORDERS: I understand that the law does not permit percentage orders in child support agency cases.

If I am opening a new child support case or reopening a closed child support case with the child support agency and have a percentage order, I understand that the child support agency is not responsible for reconciling the order.

The child support agency is required to change the percentage order into a dollar amount order. By submitting this application, I am agreeing to cooperate with the agency in changing the order. Disclaimer: The Oneida Nation will bring any necessary administrative or court actions to establish paternity (legal fatherhood) or to establish or enforce a support order. However, the child support attorney does not represent either parent but rather represents the Oneida Nations' interest in enforcing support.

I hereby request child support services under the Child Support Enforcement Program under Title IV-D of the Social Security Act. I understand that I must cooperate with the child support agency by providing information that affects my case and by keeping my appointments with the agency.

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Timestamp

Audit

February 15, 2021 10:02 am CST

Child Support Agency Guardian Application for Service Uploaded by Josh Swanson - jswanson@oneidanation.org IP 74.62.93.28

February 15, 2021 10:55 am CST

CC Message - jswanson@oneidanation.org added by Josh Swanson - jswanson@oneidanation.org as a CC'd Recipient Ip: 74.62.93.28

February 15, 2021 1:07 pm CST

CC Message - jswanson@oneidanation.org added by Josh Swanson - jswanson@oneidanation.org as a CC'd Recipient Ip: 74.62.93.28

February 15, 2021 1:12 pm CST

Guardian Application for Service - strongfamily@oneidanation.org added by Josh Swanson - jswanson@oneidanation.org as a CC'd Recipient Ip: 74.62.93.28

March 9, 2021 9:01 am CST

Guardian Application for Service - strongfamily@oneidanation.org added by Josh Swanson - jswanson@oneidanation.org as a CC'd Recipient Ip: 74.62.93.28

March 9, 2021 11:43 am CST

Guardian Application for Service - strongfamily@oneidanation.org added by Josh Swanson - jswanson@oneidanation.org as a CC'd Recipient Ip: 74.62.93.28