Fillable Printable Custodial Parent Application for Child Support Services - South Carolina

Custodial Parent Application for Child Support Services - South Carolina

DSS Form 2700-1 (JUL 11) Edition of FEB 08 is obsolete.

South Carolina Department of Social Services

CUSTODIAL PARENT’S APPLICATION FOR CHILD SUPPORT SERVICES

Date Application Requested:

Date Application Mailed:

Date Application Received:

The disclosure of your Social Security Number is mandatory, in accordance

with section 466(a)(13) of the Social Security Act. Social Security Numbers

are used by the South Carolina Child Support Enforcement program to

assist in locating individuals for the purposes of establishing paternity and

establishing, modifying and enforcing child support obligations.

Child Support Enforcement Services

The South Carolina Department of Social Services, Child Support Enforcement Division (CSED), offers the

following services to Non-TANF applicants who complete and sign the application. It is important that you

carefully read the entire application and complete it to the best of your ability. If the application is not

complete, we will return the application to you for completion. Please read Part II, “What to Expect,” and

detach for your records.

Locate Only Service

“Locate Only” service means that one complete search for the NCP will be made. This will include a search of

all sources available to the CSED. If found, you will be provided with a verified address and/or employer for

the NCP. Your case will then be closed. Successful results are not guaranteed.

“Locate Only” service does not include scheduling the case for a hearing to determine paternity, secure or

enforce child support, or review for medical support. If you would like these services, please choose “Full

Service.”

Full Service

“Full Service” means every reasonable effort will be made to:

•Locate the non-custodial parent (NCP) if his/her location is unknown. There is no guarantee that the NCP

will be located.

•Establish paternity, if the parents of the child/ren were never married and it is legally feasible to do so.

•Obtain an order for support based on child support guidelines, if legally feasible to do so. Obtain medical

support, if available to the NCP at a reasonable cost.

•Provide enforcement services that could include any of the following: wage withholding; federal and state

tax refund offsets; establishing liens on real or personal property, posting bonds or security to guarantee

payments, revoking licenses, credit bureau reporting; and obtaining medical support. An additional fee will

be required when utilizing tax refund offsets.

You also have the right to request that we review your child support order for possible modification every

three years. The review of the case may result in an increase or decrease of the child support award.

To obtain either of the services listed above, you must:

•Send the completed application to:

South Carolina Department of Social Services

Child Support Enforcement Division

P.O. Box 810

Columbia, South Carolina 29202-0810

•Attach a money order or cashier’s check for $25.00 made payable to the SC DSS. Pursuant to federal law,

we are required to charge a one-time, non-refundable application fee for each case opened by the CSED.

If you send in your application without the required $25.00 fee, the application will be returned to you

without being processed. Please note that we are unable to accept personal checks.

•Completely fill out Part I. This must be completed before we can accept your application.

•Sign and date the application where indicated.

•Cooperate fully with CSED in providing the needed information to proceed with the case.

•Pay any fees that may be required (for example, tax intercept fees).

DSS Form 2700-1 (JUL 11) PAGE 2

Custodial Parent Information

(Person with whom child or children is/are living)

Your Name: Last:First:Middle:Suffix:

Maiden Name:SSN:Race:Sex:Current Marital Status:

Place of Birth: City:State:Birthdate:

Residential Address:Home Telephone:

City:State:Zip Code:

Cell Phone: E-Mail Address:

Mailing Address: c/o Last:First: Middle: Suffix:

Address:City:State:Zip Code:

Your Employer’s Name:Work Telephone:

Address:City:State:Zip Code:

Work Start Time:Work End Time:

If Currently Married, Spouse’s Name/Address:

Place of Marriage: City:State:Date of Marriage:

If not currently married, have you ever been married?

Yes

No If yes, provide the following:

Name of Former Spouse:Date and Place of Marriage:

If Divorced, Date and Place of Divorce:

Full Service Applicants Only

If you are applying for Full Service, complete the Authorization and Assignment of Rights, sign and have two witnesses sign.

Authorization and Assignment of Rights

1.I do hereby apply to the South Carolina Department of Social Services (SCDSS), Child Support Enforcement Division (CSED) for Non-TANF

services under Title IV-D of the Social Security Act. I hereby authorize the SCDSS to act in my behalf in enforcing and collecting my child support.

2.In consideration for legal services and other assistance provided in obtaining child support, I hereby voluntarily assign and transfer unto SCDSS

all the support rights, including those past, present and future, which I have against

for the support of

for whom I have care and custody.

3.The assignment is subject to the terms and conditions of Title IV-D of the Social Security Act, as amended (42 USC 654(6)).

4.I understand that when this application for services is accepted, one of the people with whom I may discuss my case is an attorney who is an

employee of the CSED. None of the services provided to me establish an attorney-client relationship with the CSED. The attorney is employed

by the state of South Carolina and remains an attorney for the state. Submission of this application constitutes my acknowledgment and

acceptance of this condition.

5.I request that the CSED obtain and/or enforce medical support from the NCP if it is available at a reasonable cost:

nYes

nNo, I have satisfactory insurance.

6.I do hereby attest under penalties of perjury that the above information is true and complete to the best of my knowledge and belief and is given

for the purpose of receiving services under Title IV-D of the Social Security Act. I have read all application instructions and pages nine and ten,

“What to Expect”, and agree to the conditions and fees as outlined in this application.

7.I understand, that as part of the 2005 Deficit Reduction Act passed by Congress, beginning October 1, 2007, all applicants who have never

received public assistance (AFDC/TANF) will be charged a $25.00 fee each year after $500.00 in child support has been collected and paid out.

This fee will not be charged until at least $500.00 is collected and paid out. If you have more than one eligible case, the fee will be charged on

each case meeting the $500.00 threshold.

8.Permission to Recoup An Overpayment: Upon written notification of payment error from Child Support Enforcement Division, I agree to allow

CSED to retain up to 10 percent of any future child support payments to correct any overpayment I received.

nYes

nNo

(Child/Children)

(Non-Custodial Parent)(Child/Children)

Applicant’s SignatureDateWitness’s SignatureDate

Witness’s SignatureDate

PART I

“Locate Only” Applicants

I request “Locate Only” services and understand that DSS will not pursue paternity or support establishment on my behalf.

Under penalty of perjury, I declare that the information given in this application is true and complete to the best of my knowledge and belief. I have

read all application instructions and pages nine and ten, “What to Expect”, and agree to the conditions and fees as outlined in this application.

Applicant’s Signature: Date:

DSS Form 2700-1 (JUL 11) PAGE 3

Non-Custodial Parent Information

Name: Last:First:Middle:Suffix:

Sex:Race:SSN:Date of Birth:

Place of Birth: City:State:Alias:

Nickname:Maiden Name:Driver’s License Number:

Driver’s License Date:Driver’s License State:

Current Marital Status:If Married, NCP’s Spouse’s Name:

Last School Attended by NCP:

Address:City:State:Zip Code:

Residential Address:City:State:Zip Code:

Is this address current?

nYes

nNo

nUnknownDate Last Lived There:Home Telephone:

Give directions to and a description of the NCP’s home:

Mailing Address: c/o Last:First: Middle: Suffix:

Address:City:State:Zip Code:

Cell Phone: E-Mail Address:

Please furnish the following information on the non-custodial parent’s current or last employer:

Type of Employment:Is the NCP currently employed?

nYes

nNo

nUnknown

Employer’s Name:Work Telephone:

Employer’s Address:City:State:Zip Code:

Date Last Worked: What is the NCP’s monthly salary? $Shift Worked:

Usual Occupation:Other Skills:

Please list the names and addresses of any other past employers:

Name:Address: Date Last Worked:

What are the names of the non-custodial parent’s parents? (Please indicate their names even if they are deceased.)

Father:Mother:

Last/Suffix/First/Middle:Maiden Name/Last/First/Middle

Street or P.O. BoxStreet or P.O. Box

City/State/Zip Code:City/State/Zip Code:

Telephone:Telephone:

DSS Form 2700-1 (JUL 11) PAGE 4

(Checking/Savings)

NCP’s Height:FeetInchesWeight:Lbs.Hair Color: Eye Color:

Identifying Mark/Scars: Does the NCP have a police record?

nYes

nNo

nUnknown

Arrest Date:Offense:

Arrest City:State:Zip Code:

Incarceration Date:Release Date: Incarceration Location:

Incarceration City:State:Zip Code:

Armed Forces Status:VA Service Number:Armed Forces Branch:

A- ActiveR-RetiredD-Discharged

N-Never InU-Unknown

Armed Forces Entry Date:Armed Forces Discharge Date:

Does the NCP have income other than employment income?

nYes

nNo

nUnknown

If yes, source of income:Amount:

Amount:

Does the NCP have any bank accounts/assets?

nYes

nNo

nUnknown

Name of Bank:Account Number:Type:

Assets:

Does the NCP own any property (real estate, car, etc)?

nYes

nNo

nUnknown

Please list type and location:

What is the name of the insurer with whom the NCP has medical insurance coverage?

Carrier Name:Type of Insurance:Policy Number:

Case Information

Do you have an attorney actively seeking support?

nYes

nNoIf yes, attorney’s name:

Do you have a previous court order established?

nYes

nNo If yes, provide support order number:

(Please attach a copy of the court order)

Name of Court: City: State:

Amount of Support:If you do not have a court order, does the NCP pay voluntarily?

nYes

nNo

Frequency of Support:Date Last Payment Received:

B-BiweeklyS-SemimonthlyM-MonthlyW-WeeklyD-Seasonal

Support Method:D-Direct to YouC-Through the CourtEffective Date of Support Order:

Are you willing to submit to a paternity test?

nYes

nNo To pay the cost of such test?

nYes

nNo

Comments:

(Checking/Savings)

DSS Form 2700-1 (JUL 11) PAGE 5

Child Information

(Complete a separate section for each child)

Child’s Name: Last:First:Middle:Suffix:

Sex:Race:SSN:Date of Birth:Place of Birth:

Has paternity been established for this child?

nYes

nNo What is your relationship to this child?

Were the parents married at the time of the child’s birth?

nYes

nNo If no, describe the relationship:

If Married: Date of Marriage:Place:If Divorced: Date:Place:

(Month/Day/Year)

Full Service Applicants Only

(Answer if you are the MOTHER of this child. However, if you were married to the father when the child was born and this is his child,

omit the following questions. If the father is already under a court order to support this child, please return a copy to us and omit the

following questions.)

1.In which state did you become pregnant?When did you get pregnant?

2.Did the father have his name put on the birth certificate or sign a voluntary paternity acknowledgement?

nYes

nNo

3.What did the child weigh at birth?Lbs. Oz. Was the child?

nEarly

nOn Time

nLate

4.Did the father:

Buy any presents?

nYes

nNoVisit the child?

nYes

nNo

Pay or offer to pay the medical bills of your pregnancy?

nYes

nNo Admit being the father?

nYes

nNo

Have his picture taken with the child?

nYes

nNo Visit the hospital?

nYes

nNo

Discuss Abortion?

nYes

nNoOffer to marry you?

nYes

nNo

5.Were you having sexual relations with anyone other than the father during the month you got pregnant?

nYes

nNo

During the month before?During the month after?

If yes to any of these questions, provide names and addresses:

Complete Only If You Are NOT The Mother of This Child

Who are the child’s parents? Mother:Father:

Relationship of the parents at the time of birth:

If Married: Date:Place:If Divorced: Date:Place:

Was the mother ever married to anyone else?

nYes

nNoName:

If Married: Date:Place:If Divorced: Date:Place:

Full Service Applicants Only

(Answer if you are the MOTHER of this child. However, if you were married to the father when the child was born and this is his child,

omit the following questions. If the father is already under a court order to support this child, please return a copy to us and omit the

following questions.)

1.In which state did you become pregnant?When did you get pregnant?

2.Did the father have his name put on the birth certificate or sign a voluntary paternity acknowledgement?

nYes

nNo

3.What did the child weigh at birth?Lbs. Oz. Was the child?

nEarly

nOn Time

nLate

4.Did the father:

Buy any presents?

nYes

nNoVisit the child?

nYes

nNo

Pay or offer to pay the medical bills of your pregnancy?

nYes

nNo Admit being the father?

nYes

nNo

Have his picture taken with the child?

nYes

nNo Visit the hospital?

nYes

nNo

Discuss Abortion?

nYes

nNoOffer to marry you?

nYes

nNo

5.Were you having sexual relations with anyone other than the father during the month you got pregnant?

nYes

nNo

During the month before?During the month after?

If yes to any of these questions, provide names and addresses:

DSS Form 2700-1 (JUL 11) PAGE 6

Child Information

(Complete a separate section for each child)

Child’s Name: Last:First:Middle:Suffix:

Sex:Race:SSN:Date of Birth:Place of Birth:

Has paternity been established for this child?

nYes

nNo What is your relationship to this child?

Were the parents married at the time of the child’s birth?

nYes

nNo If no, describe the relationship:

If Married: Date of Marriage:Place:If Divorced: Date:Place:

Complete Only If You Are NOT The Mother of This Child

Who are the child’s parents? Mother:Father:

Relationship of the parents at the time of birth:

If Married: Date:Place:If Divorced: Date:Place:

Was the mother ever married to anyone else?

nYes

nNoName:

If Married: Date:Place:If Divorced: Date:Place:

(Month/Day/Year)

DSS Form 2700-1 (JUL 11) PAGE 7

Full Service Applicants Only

(Answer if you are the MOTHER of this child. However, if you were married to the father when the child was born and this is his child,

omit the following questions. If the father is already under a court order to support this child, please return a copy to us and omit the

following questions.)

1.In which state did you become pregnant?When did you get pregnant?

2.Did the father have his name put on the birth certificate or sign a voluntary paternity acknowledgement?

nYes

nNo

3.What did the child weigh at birth?Lbs. Oz. Was the child?

nEarly

nOn Time

nLate

4.Did the father:

Buy any presents?

nYes

nNoVisit the child?

nYes

nNo

Pay or offer to pay the medical bills of your pregnancy?

nYes

nNo Admit being the father?

nYes

nNo

Have his picture taken with the child?

nYes

nNo Visit the hospital?

nYes

nNo

Discuss Abortion?

nYes

nNoOffer to marry you?

nYes

nNo

5.Were you having sexual relations with anyone other than the father during the month you got pregnant?

nYes

nNo

During the month before?During the month after?

If yes to any of these questions, provide names and addresses:

Child Information

(Complete a separate section for each child)

Child’s Name: Last:First:Middle:Suffix:

Sex:Race:SSN:Date of Birth:Place of Birth:

Has paternity been established for this child?

nYes

nNo What is your relationship to this child?

Were the parents married at the time of the child’s birth?

nYes

nNo If no, describe the relationship:

If Married: Date of Marriage:Place:If Divorced: Date:Place:

Complete Only If You Are NOT The Mother of This Child

Who are the child’s parents? Mother:Father:

Relationship of the parents at the time of birth:

If Married: Date:Place:If Divorced: Date:Place:

Was the mother ever married to anyone else?

nYes

nNoName:

If Married: Date:Place:If Divorced: Date:Place:

(Month/Day/Year)

DSS Form 2700-1 (JUL 11) PAGE 8

Full Service Applicants Only

(Answer if you are the MOTHER of this child. However, if you were married to the father when the child was born and this is his child,

omit the following questions. If the father is already under a court order to support this child, please return a copy to us and omit the

following questions.)

1.In which state did you become pregnant?When did you get pregnant?

2.Did the father have his name put on the birth certificate or sign a voluntary paternity acknowledgement?

nYes

nNo

3.What did the child weigh at birth?Lbs. Oz. Was the child?

nEarly

nOn Time

nLate

4.Did the father:

Buy any presents?

nYes

nNoVisit the child?

nYes

nNo

Pay or offer to pay the medical bills of your pregnancy?

nYes

nNo Admit being the father?

nYes

nNo

Have his picture taken with the child?

nYes

nNo Visit the hospital?

nYes

nNo

Discuss Abortion?

nYes

nNoOffer to marry you?

nYes

nNo

5.Were you having sexual relations with anyone other than the father during the month you got pregnant?

nYes

nNo

During the month before?During the month after?

If yes to any of these questions, provide names and addresses:

Child Information

(Complete a separate section for each child)

Child’s Name: Last:First:Middle:Suffix:

Sex:Race:SSN:Date of Birth:Place of Birth:

Has paternity been established for this child?

nYes

nNo What is your relationship to this child?

Were the parents married at the time of the child’s birth?

nYes

nNo If no, describe the relationship:

If Married: Date of Marriage:Place:If Divorced: Date:Place:

Complete Only If You Are NOT The Mother of This Child

Who are the child’s parents? Mother:Father:

Relationship of the parents at the time of birth:

If Married: Date:Place:If Divorced: Date:Place:

Was the mother ever married to anyone else?

nYes

nNoName:

If Married: Date:Place:If Divorced: Date:Place:

(Month/Day/Year)

DSS Form 2700-1 (JUL 11) PAGE 9

PART II

What to Expect

(Please read this page and the next carefully and DETACH for your records.)

The South Carolina Department of Social Services (DSS) provides child support services to Custodial Parents

(guardians) through its Child Support Enforcement Division (CSED). You must complete the application to

open a case with the CSED.

The CSED uses its resources to help a custodial parent (CP) to:

•Locate the non-custodial parent (NCP).

•Establish paternity if the child/children was/were born out of wedlock.

•Establish a child support/medical support order against the NCP.

•Work with the appropriate Family Court staff to enforce the child support order.

•Review the case for modification of the child support order upon the request of the CP or the NCP.

All cases accepted by the CSED are handled on a first come, first served basis. Claims for visitation, custody

or other issues that are often associated with child support are not handled by CSED.

You must complete this application as thoroughly and accurately as possible and return it to the address

indicated so that the CSED may determine your eligibility for child support services. When completing the

application you may not know the answer to all of the questions, but you should provide as much accurate

information as possible. Please double check any information about which you are not certain. The more

accurate the information you provide, the faster and more efficiently CSED can process your case.

South Carolina law requires that you notify the CSED in writing when you move, change your name, change

jobs or change your telephone number (at home or at work) so that staff will be able to contact you without

delay. You must notify the CSED of these changes within 10 days of the change. If you do not notify the

CSED as required, the court or the CSED may take actions on your case without your knowledge.

If you cannot provide a current address for the non-custodial parent, CSED’s first step is to locate the person.

Our Parent Locate Unit will use the information that you provide to obtain a home or work address. The time it

takes depends on how much information you have provided. The NCP’s Social Security number is always

helpful, but this does not mean our parent locators will be able to find the NCP right away. If you apply for

“Parent Locate Services Only,” we will notify you when we obtain information about a home and/or work

address. We will not take further action unless you request it.

If you apply for “Full Service” and if we locate the NCP, your case will be turned over to a child support

specialist in one of CSED’s regional offices for legal action. If you already have a court order for child support,

CSED will take steps to enforce that order. You should attach a copy of your support order or divorce decree

and any modifications to that order.

If you do not have a court order for child support, the regional office staff will bring legal action to obtain a

court order. The regional office will notify you in writing of any court hearings or conferences that you must

attend.

Please keep in mind that we cannot tell you how long these proceedings may take. It may take longer under

any of the following circumstances: the NCP moves or quits his or her job after the location is determined; the

NCP refuses to admit paternity or to pay child support, thus requiring additional court hearings; or the NCP is

located outside of South Carolina.

Please understand that we need your full cooperation throughout this entire process. Your failure to cooperate

could result in CSED closing the case. Before CSED takes any action to close a case, we will send you a

letter indicating what will be required to avoid case closure. You may also close your case at any time by

mailing to CSED a written statement requesting case closure. As a state agency operating under state law

and federal law, legal requirements and policies may conflict with what you request. If a conflict of interest

arises, CSED staff will contact you to discuss the situation.

DSS Form 2700-1 (JUL 11) PAGE 10

When the NCP makes child support payments to the Clerk of Court, the clerk will send all of these payments

directly to you. If you have ever received Temporary Assistance to Needy Families (TANF), formerly known as

Aid to Families with Dependent Children (AFDC), the clerk will send your child support payments to CSED’s

Financial Services Division for processing. CSED will forward to you 100% of your current monthly child

support obligation if you no longer receive TANF. If the NCP pays child support in excess of the monthly

obligation, CSED will pay to you any and all arrearages/reimbursements due to you. Once all sums due to

you have been paid, DSS will begin retaining collections in excess of the monthly obligation to be applied

toward any arrearage or reimbursement due to the state. Through this action the state and federal

governments recoup money for the AFDC or TANF payments made to you.

In addition to working with the appropriate Family Court staff to enforce your child support order, CSED will

refer the case to our Tax Intercept Unit for assistance in collecting the past-due child support. If the NCP has

a qualifying arrearage, CSED will refer the NCP to the South Carolina Department of Revenue and/or the

Internal Revenue Service (IRS) for the possible interception of any refund that the NCP might be due from the

year’s tax returns. You may be charged a nominal fee for the successful use of this service. If you have

received AFDC or TANF and arrearages are owed to the state, the money collected by tax offset must first be

applied to satisfy that arrearage.

You are protected by Title VI of the Civil Rights Act and can make written complaints to the Director, South

Carolina Department of Social Services, P.O. Box 1520, Columbia, South Carolina 29202-1520, within 180

days, if at any time you believe you are denied services or otherwise discriminated against because of race,

color, creed, sex, religion or national origin.

Listed below are the telephone numbers of CSED offices.

Thank you for your cooperation. The Department of Social Services pledges to make every effort to help you

obtain the child support owed to your family.

Central Inquiry: (803) 898-9210/1-800-768-5858Financial Services: (803) 898-9210/1-800-768-6779

Columbia Regional Office: (803) 898-9282Charleston Regional Office: (843) 953-9700

Tax Intercept Unit: (803) 898-9314/1-800-922-0852Florence Regional Office: (843) 661-4750

or 1-888-454-5360

Greenville Regional Office: (864) 282-4650

Additional information can be found at www.state.sc.us/dss/csed/index.html