Form Cse-1178a Forff - The Modification Documents Packet
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14ARIZONA DEPARTMENT OF ECONOMIC SECURITY
CSE-1178A FORFF (5-17)
PACKET – Page 1 of 2
Division of Child Support Services
INSTRUCTIONS FOR COMPLETING THE MODIFICATION DOCUMENTS
If your financial situation has changed significantly, you may ask for a review of your child support order for a
possible modification. Either parent may request a review for modification of a support order.
A review for a modification may be requested every three (3) years without showing a change of circumstance.
If you request a review for a modification before three years, you must show there has been a substantial and
continuing change of circumstances. Examples that may be considered a substantial and continuing change
of circumstances include the addition of or change in health insurance, losing a job, becoming disabled, or an
increase or decrease in wages. The change in circumstances documentation must show that the amount of
support order would change by at least fifteen percent (15%) or a cash medical order is needed.
The Division of Child Support Services (DCSS) conducts reviews for modifications in accordance with the
Arizona Child Support Guidelines. These guidelines may be found on the link below:
The modification packet must be completed in English. It includes the following documents:
•
Request for Modification Review – (CSE-1170A)
•
Affidavit of Financial Information – (CSE-1171A)
•
Agreement to Accept Service by Mail – (CSE-1167A)
•
Request for Modification Checklist – (CSE-1172A)
The Request for Modification Review (CSE-1170A) is your request to modify your child support order.
Please read the information contained in this document and complete the requested information at the bottom
of the document.
The Affidavit of Financial Information (CSE-1171A) is used to provide your financial information.
Complete and accurate information is required to determine if your case meets the criteria for a modification.
You must provide:
•
your two (2) most recent pay stubs
•
copies of your federal income tax return for the last three (3) years
•
copies of your most recent W-2 and 1099 forms from all sources of income
•
Proof of other children, insurance costs and/or change in circumstances
•
proof of daycare expenses
•
proof of medical/dental premiums
•
copies of birth certificate(s) of child(ren) who reside with you but are not common to the parties
The last page of the Affidavit of Financial Information (CSE-1171A) includes the section Parenting Time/
Visitation Adjustment in which you indicate the established or expected pattern of parenting time with the
children. The Guidelines require that an adjustment to the amount of child support will be made according to the
time the non-custodial parent actually spends with the child(ren). Time that the child(ren) spends in school or in
day care is not considered parenting time. Please read the instructions carefully before completing.
The Agreement to Accept Service by Mail (CSE-1167A) allows DCSS to serve you by mail instead of a process
server formally serving you. Fill in your ATLAS case number, Court Case number and Name in the appropriate
fields. Make sure you enter your current address in this document so that you will receive the paperwork timely.
The CSE-1167A MUST be notarized before sending it in to DCSS. Notary services are provided free of charge at
your local DCSS Office.
The Request for Modification Checklist (CSE-1172A) must be completed. Please check all items that have
changed which affect your child support. Indicate the date your last job ended or the date you became
incarcerated if appropriate.
See reverse for EOE/ADA/LEP/GINA disclosures
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