Simplified Application For Child Support Services
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4STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
DEPARTMENT OF CHILD SUPPORT SERVICES
INSTRUCTIONS FOR COMPLETING THE SIMPLIFIED APPLICATION FOR CHILD
SUPPORT SERVICES
DCSS 0373 (07/12/13)
The processing of your case depends upon the information you provide on this form. Please provide as much
information as possible. Answer every question completely. If you do not know the answer, print "UNKNOWN."
If the question does not apply, print "N/A."
Before you begin, please read the Child Support Handbook. This book explains the services available through
the local child support agency. Also, read the Child Support Enforcement Program Notice. This notice explains
your responsibility to the local child support agency and the local child support agency's responsibility to you.
The local child support attorneys or Attorney General or any of their representatives are not your attorney or
the child(ren)'s attorney.
Please complete all the forms in BLACK INK and PRINT clearly.
FACTS ABOUT CUSTODIAL PARTY OR
Comments: You may use this section as extra
GUARDIAN AND CHILD(REN)
space, if needed, or add any additional information
you think might help us establish or enforce an order
This section is about the person or party who has
for the child(ren). You may include information about
primary custody of the child(ren). Please complete
the other person's temper, whether they own rifles or
the entire section. If you are the custodial party, be
handguns, if they have made threats against you or
sure to give us a telephone number where you may
the child(ren), etc.
be reached during the day.
If the children named in the application have
FACTS ABOUT NONCUSTODIAL PARENT
different noncustodial parents, a separate
application must be completed for each
If you are the Custodial Party, this section may
noncustodial parent. If you need additional space for
require you to look through old papers to find some
any section, attach a separate sheet of paper or use
of the information requested. The more information
the Comment Section provided at the end of the first
we have in this section the better and faster we will
page.
be able to serve you.
Please list all the child(ren) of the parents named for
If at all possible, please provide the noncustodial
whom support services are being requested.
parent's Social Security Number or numbers. If you
Complete the full name of each child, including first
do not know the exact date of birth, provide the
name, middle name, last name, and suffix (Jr., Sr.,
approximate age.
III, etc.)
Please provide any and all financial information
There are several questions within this section
about the noncustodial parent. Attach additional
related to determining the biological father of the
page(s) as needed or use the Comment Section on
child(ren) named in the application. One question
the first page.
asks whether a Declaration of Paternity has been
signed. The Declaration of Paternity is a legal form
If you are the noncustodial party, be sure to give us
that, when signed (usually at the hospital or clinic)
a telephone number where you may be reached
by both parents, says the man is the legal father.
during the day.
Signing the form and submitting it to the Department
of Child Support Services legally establishes the
man as the child's father without having to go to
SIGNATURE OF APPLICANT
court.
We will not be able to open this case without your
A second question asks whether a Paternity
signature. Your signature indicates that you have
Judgment has been established. A Paternity
answered the questions on the application to the
Judgment is an order from the court that, through
best of your ability and that you want to open this
the legal process, determines the biological father of
case. It also indicates that you have read the
the child(ren). Determining the biological father is
information provided above the signature line
necessary before child support can be ordered by
carefully.
the court.
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