Application For Child Support Enforcement Services
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4TAT Division of Child Support Enforcement
206 Main Street
P.O. Box 998
New Town, ND 58763
(701) 627-2860 FAX (701) 627-3963
APPLICATION FOR CHILD SUPPORT ENFORCEMENT SERVICES
Filling Out This Application Form:
Please fill out this form the best that you can.
Please print or type all answers.
The children you are requesting services for should have the same mother and father. If any of the
Children have a different mother or a different father, please fill out a separate form.
If you do not know or are not sure of the information, leave the space blank or write “Unsure” or “Do
Not Know” in the space.
The Custodial Parent is the person who has custody of the children listed on the application. The Non-
Custodial Parent is the person who does not have custody of the children.
The more information that you are able to give us will help us do a better job.
You will be required to provide proof of certain information. This is listed on the Verification Checklist
form that we have given to you. If you are unable to provide proof of the information, please talk with
us.
If you have any questions or need assistance in filling out this application, please talk with us. Our staff
is available to assist you in completing this application form.
APPLICATION CHECKLIST
We will need the following verification and documentation in order to proceed with the processing of your
application for Child Support Enforcement Services:
Verification of Social Security Numbers for applicant and children
Copy of the Birth Certificate for your children
Verification of your address (rent receipt, utility bill, correspondence sent to you at this address)
Verification of Tribal Enrollment from the Tribal Enrollment Office
Copies of any court orders (Child Support, Divorce/Dissolution, Temporary Support, Voluntary
Paternity Acknowledgements, etc.) that have already been issued
If Family Violence is claimed, then we will need a copy of the police report, Restraining Order or
Order of Protection issued by a court, or statement from two (2) witnesses attesting to the family
violence.
Copies of any receipts or proof of child support that has already been paid to you
Services Requested:
Establishment of Paternity for the children listed on this application.
Establishment of a child support order for the children listed on this application.
Help in collecting the child support owed to me for the children listed on this application.
Review of my child support order to see if the amount of support ordered may be changed.
Help with locating the non-custodial parent of the children listed on this application.
Help with getting health insurance for the children listed on this application.
Do Not Know
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