Request For An Administrative Review Of The Support Order (Page 3 of 4) in pdf

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The order is not in compliance with the guidelines due to the termination of the support obligation for a child

of the existing support order.

In administrative support order(s) over which a court has not taken jurisdiction, to consolidate children of the

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same parents for whom paternity has been established into a single administrative support order that is in

compliance with the Ohio Child Support Guidelines.

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I want to access available or improved health insurance coverage for the child. The requesting party must

provide to the CSEA relevant evidence or information supporting the allegation that access to new or

improved health insurance is available.

10.

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I have

The other party has experienced an increase or decrease in the cost of

ordered health

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insurance coverage or

child care for the child which is expected to result in a change of more than ten

percent to the child support obligation based on the current Child Support Guidelines calculation. The

requesting party must provide to the CSEA relevant evidence or information supporting an allegation of an

increase or decrease in the cost of health insurance or child care.

11.

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The private health insurance that is currently being provided in accordance with the child support order is no

longer reasonable in cost and/or accessible. The requesting party must provide to the CSEA relevant

evidence or information supporting an allegation that the private health insurance is no longer reasonable in

cost and/or accessible

12.

I am the Obligor and I assert that my annual gross income is now below 150% of the federal poverty level

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and I should not be ordered to pay cash medical support (the federal poverty guidelines can be found at

or by contacting the CSEA). The Obligor must provide to the CSEA

relevant evidence or information supporting an allegation that his or her annual gross income is below 150%

of the federal poverty level.

13.

I am the obligor and I am a member of the uniformed services who has been called to active service for a

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period of more than thirty (30) days.

If I have checked this box, I have attached a military Power of

Attorney to permit a designated person to act on my behalf in the administrative review.

14.

A temporary adjustment order pursuant to rule 5101:12-60-05.2 of the Ohio Administrative Code was issued,

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the obligor’s term of active military service has ended, and the obligor has provided the CSEA written

documentation sufficient to establish that the obligor's employer has violated the Uniformed Services

Employment and Reemployment Rights Act, 38 U.S.C. 4301 to 4333.

All child support cases are required to be administered under Ohio law by the local CSEAs. However, unless a case is

designated as a “IV-D case,” the case is considered to be a “non IV-D case” and is ineligible for certain child support services,

including administrative review and adjustment of child support orders. A “IV-D case” is a case in which a person files an

application for child support services with the local CSEA or when the children are receiving public assistance such as Ohio

Works First, Medicaid, or Foster Care Maintenance.

If you have a “non-IV-D case” and you want an administrative review and adjustment, you must submit to the CSEA a signed

application for services and a formal written request to receive an administrative review for adjustment. You must accept all

services available and be subject to all enforcement remedies of the child support enforcement program. If you do not cooperate

with the CSEA in providing all the necessary information to enforce the order, the IV-D case shall be closed for failure to

cooperate and no IV-D services shall be provided to you. Once the IV-D application has been filed with the CSEA and is

accepted, the case becomes a IV-D case.

Within 15 days of receiving your request for an administrative review and adjustment and any required evidence, the CSEA will

review your request and determine whether a review should be conducted. Both parties to the order will be notified of the date

and location of the administrative review. The notice will be mailed to the last known address of both parties. The notification

will also request that you provide financial information and any other information necessary to properly review the child support

order. If your request is denied, the CSEA will send you notice of the denial.

Please be aware that you may not dismiss your request for an administrative review on or after the scheduled review

date. In addition, requesting an administrative review may cause the monthly obligation to increase, decrease, or remain

unchanged.

JFS 01849 (Eff. 07/2005)

Page 2 of 3

Request For An Administrative Review Of The Support Order Page 3

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