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.
Services Requesting: Are you applying for services for an unborn child?: Are you requesting genetic testing?:
Guardian: Maiden Name or Alias: Guardian: Social Security Number: Guardian: Gender: Guardian: Contact Phone: Guardian: Email Address:
Guardian: Has a disability: Describe Guardians Disability:
Guardian: Relationship to child(ren): Guardian: Please check services receiving or have received:
Guardian: Do you have a court order awarding you placement?: Court or Tribe that awarded you placement:
Mother: Maiden Name or Alias: Mother: Social Security Number: Mother: Contact Phone: Mother: Email Address:
Mother of child(ren) has a disability?: Describe Mothers Disability:
Mothers current relationship to the Father: Mother: Please check services receiving or have received:
Mother: Is Employed:
Is the Father of the Child Married to the Mother:
Name: Social Security Number: Address:
Father: Alias: Father: Social Security Number: Father: Contact Phone: Father: Email Address:
Father of child(ren) has a disability: Describe Fathers Disability:
Fathers current relationship to the Mother: Father: Please check services receiving or have received:
Father: Is Employed:
Is the Fathers Location Known?: Distinguishing marks, tattoos, scars, or birthmarks:
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 immediatelyreturn 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.
Full Legal Name:
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Child Support Agency Guardian Application for Service
Agree & Sign