Form Cs-Fm42 - Electronic Remittance Of Child Support Payments Request For Waiver
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1CS-FM42
R. 02/08
Rule 12E-1.032
Florida Administrative Code
Effective 06/08
Child Support Enforcement
Electronic Remittance of Child Support Payments
Request for Waiver
To ask for a waiver from the requirement to send employer deducted child support payments to the
State Disbursement Unit electronically, fill in this form, sign and date it, and mail it to the address given
below. You may send support payments by check while we process your waiver request.
Employer name: ____________________________________________________________________
Address: __________________________________________________________________________
Employer contact person: _____________________________________________________________
Contact person’s address (if different): ___________________________________________________
Phone number: ___________________ FAX: __________________ E-mail: _____________________
Federal employer ID number: _________________
I, __________________________, am an employer or an authorized representative of the employer
named above. The employer cannot comply with the requirement to send child support payments to
the State Disbursement Unit electronically.
This is due to circumstances beyond our control.
Specifically (check all that apply):
We do not have a computer or one that meets the Department's minimum standards (486
processor/66 megahertz, Windows 98 or Macintosh 5.1.6).
We do not have an Internet connection.
We do not send data electronically to the government or any other business.
We need more time to program our computer.
The requirement conflicts with our business procedures.
Meeting the requirement would be a financial hardship for the business.
(Other) ________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
We are asking for the waiver for a period of _________________ (two year maximum).
I certify that the information provided above is true and complete.
Signed __________________________________
Dated______________________
Title or position: __________________________________________
Return this form to:
Child Support Enforcement
Electronic Payments Administrator
P.O. Box 8030
Tallahassee, FL 32314-8030
Please allow six weeks for reply. Please call us toll free at 1-(866)435-2763, if you have any questions
about the waiver.
The rules for electronic payment of child support and waivers are at section 61.1824(6), Florida
Statutes, and Rule 12E-1.032, Florida Administrative Code.
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