The following requested information is needed for the Office of Child Support Enforcement (OCSE) to provide child and medical support services to you. You may be asked to provide additional information or fill out other forms. You will be asked to update this information from time to time. The more information we have, the better we are able to help you.

Please fill out the questionnaire completely.

To complete the questionnaire we need:

• Information About You
• Information About the Noncustodial Parent
• Information About the Child(ren)
• Information About Medical Coverage
• Application Fee of $25.00 per Noncustodial Parent

We will also need the following:

• Copies of child support orders, if there was one, and any modified (changed) orders. Also include copies of any guardianship or custody orders, juvenile orders, temporary orders, probate orders, or order of adoption.
• Orders of Protection or other documents about any risk of violence or danger from the other parent.
• Payment records from the clerk of court or a child support agency in another state.
• Copies of the child’s or children’s birth certificates and an Acknowledgment of Paternity, if one was signed.