Applicant's Information:

Use this on-line application only if your county is listed in the selection box.

Other Parent's Information:

Child's Information:

Other Important Information:

All information you provide is kept confidential but we understand that domestic violence may also be an issue for you or your family. For your protection, we can mark your case with a Family Violence Indicator.

IMPORTANT: PLEASE READ! By selecting the Submit button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting Submit you consent to be legally bound by this Agreement's terms and conditions.

I understand the Division will protect my privacy as required by law, and I authorize the Division to disclose information about my case to the courtor another party necessary in the course of establishing and enforcing, paternity and child support orders, for as long as I am a client.

I authorize the Division of Child Support Services to explore, pursue or utilize all sources of information legally available in support of its investigations on my behalf and to choose the appropriate course of legal action. I have received and read the program fact sheet provided at hfs/SiteCollectionDocuments/hfs3316.pdf. To the best of my knowledge, the information I have supplied is true, correct and complete.

Please attach any supporting documents such as a divorce decree, parenting time orders, existing child support order or any payment records, if applicable.  Only one attachment is allowed.  Scan multiple documents as one and attach.

    Multiple files can be uploaded by holding down Shift or Ctrl while selecting.