Division of Child Support Forms

Form

Title

Use

09-280b, 09-280b sp(Spanish)

Petition for Modification - Administrative Order

Formal petition to modify an administrative child support order.

09-508, 09-508sp (Spanish)

Waiver of Statute of Limitations Defense

DCS may offer a reduced or deferred repayment plan if the form is signed by the noncustodial parent.  The noncustodial parent waives the right to raise a statute of limitations defense. 

09-520, 09-520sp(Spanish)

Request for Conference Board

Conference boards provide a speedy, informal method of resolving grievances.  Search our FAQ to learn more about enforcement and conference boards.

09-693, 09-693sp(Spanish)

Declaration of Lawful Custody

Used by legal or physical custodians to declare that children are in their lawful custody.  Can help expedite the establishment or enforcement of Child Support.

09-728

Washington State Addendum To Box 2 of Part B - Plan Administrator Response

Medical insurance plan administrators use this form to respond to a National Medical Support Notice.

09-741, 09-741sp(Spanish)

Request For Review Of Child Support Order

Used to request a review and modification to a court order for child support.

09-989

Confidentiality Statement - Tribal Employee

Used by Tribal employees who have access to SEMS to agree to federal and state confidentiality requirements.

14-057, 14-057sp(Spanish)

Child Support Enforcement Referral

Must be used with the Application for Nonassistance Support Enforcement Services (18-078) for case set-up.

14-057b, 14-057b sp(Spanish)

Noncustodial Parent Child Support Enforcement Application

Used with the WSCSS Child Support Schedule Worksheets and the 16-107 Noncustodial Parents Rights and Responsibilities.

14-057d, 14-057d sp(Spanish)

Child Support Referral Continuation

Used as a continuation sheet for the DSHS 14-057 for cases involving more than three children.

14-341, 14-341sp(Spanish)

Application to Convert Payment Services Only (PSO) Case to Full Collection Services Case

Used by in-state custodial and noncustodial parents to apply for case conversion from Payment Services Only (PSO) to full collection services.

16-072, 16-072sp(Spanish)

Nonassistance Support Enforcement Information

Division of Child Support policies and information for nonassistance cases.

16-107, 16-107sp(Spanish)

Noncustodial Parent's Rights and Responsibilities

An overview of the Division of Child Support and child support policies.

17-063, 17-063sp(Spanish)

Authorization to Disclose Personal Information

Either a custodial or non-custodial parent can grant written permission for someone of their choosing to discuss case specific information with DCS. Search our FAQs to learn more about disclosure.

18-078, 18-078sp(Spanish)

Application for Nonassistance Support Enforcement Services

Anyone can request the services of DCS for enforcement of an existing child support order, or establishment of a child support obligation.

18-097, 18-097sp(Spanish)

Statement of Resources and Expenses

A non-custodial parent completes this income and expense statement, usually to negotiate a payment plan.

18-176a, 18-176a sp(Spanish)

Address Disclosure Request

Used by custodial or noncustodial parents (or their attorneys) to request the address of dependent children or to request the home or work address of the other party to the child support order.

18-433, 18-433sp(Spanish)

Declaration of Support Payments

Used by custodial parents to provide a record of child support payments received from the noncustodial parent.

18-463

New Hire Reporting Methods and Instructions

Used to inform employers of the methods to report newly hired and rehired employees.

18-464

Introduction to New Hire Reporting

Used to provide employers information about the New Hire Reporting program.

18-483

Employer Payment Identification Instructions

Used to provide employers with information on how to remit child support payments.  Provides employers with a payment remittance form.  This is a user fillable file.

18-484, 18-484sp(Spanish)

Automatic Payment Authorization and Electronic Funds Transfer Information

Used by noncustodial parents to authorize DCS to deduct support payments from their account by Electronic Funds Transfer (EFT).  Payments can be automatically deducted from a bank account.  Search our FAQs to learn more about payments.

18-551, 18-551sp(Spanish)

School Statement

Used to obtain educational institution graduation and enrollment information to determine eligibility for continued child support.

18-560

Employment Termination Notice

Employers use this form to report termination of employee for whom they had a requirement to withhold child support or enroll the employee's children in a health insurance plan.

18-607, 18-607sp(Spanish)

Child Care Verification

Used to obtain child care costs to enforce or establish a child care obligation.

18-681, 18-681sp(Spanish)

Request for Collection of Uninsured Health Care Expenses

Used to inform the custodial or noncustodial parent that DCS may be able to collect uninsured health care expenses.

18-682, 18-682sp(Spanish)

Detail Sheet - Unreimbursed Health Care Expenses

Used by custodial and noncustodial parents to provide DCS with the details of uninsured health care expenses incurred.

18-683, 18-683sp(Spanish)

Monthly Summary Sheet - Unreimbursed Health Care Expenses for Children

Used by custodial and noncustodial Parents to provide DCS with the details (by month) of unreimbursed health care expenses incurred on behalf of the children.

18-700, 18-700sp(Spanish)

Direct Deposit Authorization

Used by custodial parents to authorize direct deposit to their bank account.

18-701, 18-701sp(Spanish)

Request for Income Information for Purposes of Entering a Child Support Order

Used to ask the Division of Child Support (DCS) for income information about the other party to your child support order.

27-096, 27-096sp(Spanish)

Permission to Share Documents for Reimbursement of Medical Expenses

Used to serve a Notice of Support Owed - Medical Support on the obligated parent.

WPF DRPSCU 01.1550

Financial Declaration

Used as a declaration of income and expenses.

WPF DRPSCU 09-0200, WPF DRPSCU 09.0200sp (Spanish)

Confidential Information Form (INFO)

Used by custodial and noncustodial parents to provide the court confidential information in a modification process.

WPF DRPSCU 09-0210, WPF DRPSCU 09-0210sp (Spanish)

Addendum to Confidential Information Form

Used by custodial and noncustodial parents as an addendum to the Confidential Information Form (INFO).

WSCSS Schedule(Eng),
WSCSS Worksheets(Eng),
WSCSS Worksheets(sp),
WSCSS PAMPHLET(sp)

Washington State Child Support Schedule

The Washington State Child Support Schedule(WSCSS) is developed by the Administrator of the Courts to be used for establishment or modification of a child support obligation.  Search our FAQs to learn more about establishment and modification.