Form Name*

Description

Adobe PDF Fillable

Form*

Application For Support Services Package

Request for child support services.  This package is used for custodial parents to declare and request assistance in child support pursuant cases based on court orders.  Custodial and Non-custodial Parents Only.

Income And Expense Declaration

This form is used for parents to declare income and expenses for proof in support cases. Custodial and Non-custodial Parents.

Employer - Employee Verification Form

Employers Only

This form is used by employers to verify employment and pay benefits to compute child support. 

Health Insurance Statement Verification

Employers Only

This form is used to provide information on employee medical benefits and requirements. 

Forms open in new window. Employers can print out form, sign to validate information and mail to DCSS or simply complete fillable form, save file and email to DCSS. The fillable forms can be saved blank to employer’s computer and filled out from there as above.

Employment Payment Coupon for Wage Withholding

Employers Only

This form is used to identify payment withholding for employees. 

Forms open in new window.  Employers will print out form, sign to validate information and mail to DCSS.

Termination of Employment Notice

Employers Only

This form is used to report termination of employment of NON-CUSTODIAL PARENT for whom you have a requirement to withhold support or enroll the employee's children in a health insurance plan.

Forms open in new window.  Employers will print out form, sign to validate information and mail to DCSS.

For more information and resources on government forms, visit the Judicial Council and the Administrative Office of the Courts website at www.courtinfo.ca.gov/forms/

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