APPLICANT IS ►

SELECT ONE ROLE TYPE:

PERSON RECEIVING SUPPORT/CUSTODIAN INFORMATION

If not a United States or US Address, enter Country, Street Name, and Apartment Number and/or Floor Number here. Can also attach a file with your address at the end of the form.

PERSON PAYING SUPPORT/NON-CUSTODIAN/ALLEGED FATHER INFORMATION

If not a United States or US Address, enter Country, Street Name, and Apartment Number and/or Floor Number here. Can also attach a file with your address at the end of the form.

IF YES,

Click on + symbol to add more alleged fathers

CHILDREN TO CUSTODIAL/NON-CUSTODIAL/ALLEGED FATHER
In the United States, a Social Security Number is a nine-digit number issued to citizens, permanent residents, and temporary working residents.

Click on + symbol to add more children

 

If parents are/were married:

 

 

If parents are divorced:

 

TYPE OF CHILD SUPPORT SERVICES YOU WANT
(check the box next to the service(s) you are requesting):
CONSENT AND SIGNATURE
  • I certify that all information provided is true and complete to the best of my knowledge
  • I authorize the Family Support Division to get information contained in my child(ren)’s birth certificate file or record. This may include a copy of an acknowledgment of paternity completed by the parents.
  • I must provide my Social Security number (SSN) and the SSN for each child(ren) per section 466(a)(13) of the Social Security Act and also provide the SSN of the other parent if I know it.
  • By signing this application on paper or electronically, I am giving the Family Support Division (FSD) permission to deliver, or cause to be delivered, phone calls or text messages to me regarding my case from an automated dialing system at my primary number. The FSD does not use an encryption system when sending text messages. Such unencrypted systems are not secure and carry some level of risk that text messages could be read by a third party.
  • By signing, I am affirming that I nevertheless prefer to receive text messages from FSD and understand I do not have to consent to this as part of my application and can opt out of getting these calls or text messages by checking “No” in the “Accept Text Messages” box below.

If domestic violence is not an issue for you and/or your child(ren), you don't need to fill out this section.

 

Have you had problems with your current or past spouse or significant other? Are you afraid that person will hurt you or your children if you receive services from the Family Support Division (FSD)?

If the answer to one of the above questions is “Yes,” FSD may have information that will help you.

If you would like more information about domestic violence services, please check the appropriate box(es) below and return this form with your completed application for services or contact your local FSD office.




I understand that if I do not contact you within seven days, you will enter the address shown on the application. into your system and use it as my contact address. However, FSD will also take action to prevent this address from being released to the other parent.

In the United States, a Social Security Number is a nine-digit number issued to citizens, permanent residents, and temporary working residents.
  1. You will receive a notice of case opening from FSD and information on how to inquire about your case.

  2. Support payments you may receive from the Family Support Payment Center or the State of Missouri will be issued on a prepaid card, providing a safe and convenient way for you to receive payments (please note, this is not a credit card).

  3. If you would like to have support payments deposited directly into your bank account, call 800-859-7999 or visit dss.mo.gov/cse for information on how to get direct deposit.

    For more information about your rights and responsibilities, FSD’s fees and distribution policies or for more information about FSD’s child support services or other FSD services, visit our website at www.dss.mo.gov/cse/index.htm or call the FSD Customer Service Center at 866-313-9960.

Once FSD opens your case, you can choose to withdraw your request for services by sending a written request to FSD, PO Box 6790, Jefferson City, MO 65102–6790.

    Supported file types are accepted: Audio, Video, Image, Text, and Application PDFs.

    Thank You

    Dear {formsubmittinguser},

    Thank you for submitting an Application for Child Support Services. Please allow four to six weeks for the case to be fully opened. It may be necessary for the Family Support Division to request certified copies of court documents to finalize the case opening process.

    Your Application ID is {formuniqueid}

    Sincerely,

    Family Support Division

    Child Support Program