Request for Paternity/Child Support Services Forms

Organization Name

Provider Number

Do not use punctuation in this field. (Hospitals: Enter the Illinois Medicaid number assigned to your facility. County Clerks, and Registrars, etc.: Enter the provider number you currently use (i.e., phone number).

Street Address

(Cannot deliver to Post Office Box)

City

State

Zip Code

Attention

Indicate name of unit such as Family Birth Center, Health Information Management, County Clerk's Office, etc., after the staff person's name to ensure proper delivery.

Phone

Please do not use punctuation in the phone number

E-mail Address

HFS 3416B

Voluntary Acknowledgment of Paternity

HFS 3416BS

Voluntary Acknowledgment of Paternity – Spanish

HFS 3416D

Illinois Denial of Paternity

HFS 3416DS

Illinois Denial of Paternity - Spanish

HFS 3416E

Rescission of Illinois Voluntary Acknowledgment of Paternity

HFS 3416ES

Rescission of Illinois Voluntary Acknowledgment of Paternity - Spanish

HFS 3416A

Two Parents: Give Your Child HOPE Brochure

HFS 3416AS

Two Parents: Give Your Child HOPE – Spanish Brochure

HFS 3416

Request for Application for Child Support Services

HFS 3282

Paternity Information You Should Know Brochure

HFS 3282S

Paternity Information You Should Know – Spanish Brochure

HFS 3416H

Request for a Certified Copy of the Voluntary Acknowledgment of Paternity

HFS 3418

Pre-Natal Brochure – Give Your Child the Gift that Will Last a Lifetime

HFS 3418S

Pre-Natal Brochure – Give Your Child the Gift that Will Last a Lifetime – Spanish

HFS 11036

Envelope, Addressed to Division of Child Support Services, Administrative Coordination Unit

Additional Forms Needed

Additional Forms Needed, Not Listed Above