Form Csf 03 0574 - Application For Child Support Services Oregon Child Support Program
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FOR OFFICE USE ONLY
Date application requested: __________________
Oregon Child
:
Date application mailed to requestor
Support Program
_______________________________
Application for Child Support Services
DO NOT COMPLETE THIS APPLICATION IF YOU ARE APPLYING FOR ONLY SPOUSAL SUPPORT SERVICES
To apply for child support services, complete, sign and date this application. Within two days after we receive
your application, we will enter your case in our computer system. The child support office will contact you if more
information is needed to work your case.
The attachment explains information about the Child Support Program (CSP) that you need to know.
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You can take the application to your local child support office or mail it to: CSP, 4600 25
Ave NE, Suite 180,
Salem Oregon 97301
Applicant=s Name (Please print)_______________________________________________________________
Has paternity been established for all children?
[ ] Yes [ ] No
Is there an existing support order?
[ ] Yes [ ] No
If yes: Court Case #
County
State
Do you want the existing order reviewed for a possible modification? [ ] Yes
[ ] No
Are there arrears owed under the existing support order?
[ ] Yes
[ ] No
If there are arrears, do you want collection of these arrears?
[ ] Yes
[ ] No
Have you ever had a child support case with another state. If yes, which state?
Are there any other support, custody, divorce or juvenile court orders about your child(ren) or about you and the other
parent? [ ] Yes [ ] No
If yes, Court Case #
County
State
Is there a pending legal action in any state for child support?
[ ] Yes [ ] No
If yes, Court Case #
County
State
Information about Non-Custodial Parent
Information about Custodial Parent/Guardian
Full name ________________________________ Full name ____________________________________
Address _________________________________
Address ____________________________________
________________________________________
____________________________________________
Phone (_____)_____________________________ Phone (_____)________________________________
Soc. Sec. Number__________________________ Soc. Sec. Number _____________________________
Birth date _________________________________ Birth date ____________________________________
Employer name and address
Employer name and address
_________________________________________
_________________________________________
_________________________________________
_________________________________________
Page 1 of 4 - APPLICATION FOR CHILD SUPPORT SERVICES
CSF 03 0574 (Rev. 11/07/12)
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