Forms

Please select and print the appropriate form(s). Contact your local child support agency with any additional questions.

Application for Services 

Child Care Verification 
Completed by the child care provider regarding the child (ren) being provided care.

Claim of Exemption 
This form is used regarding bank account levies that were issued for the collection of past due child support. The non-custodial parent or owner of the bank account can file this form with the Local Child Support Agency when the amount of the levy is more than $3500.

Complaint Resolution and State Hearing Forms
These forms are used to initiate the formal complaint process with either Sacramento County DCSS or another county DCSS.

Compromise of Arrearages Program Application 
This form is filled out by the non-custodial parent who meets the Compromise of Arrears Program Requirements and wants to determine if they are eligible to have the amount of past due child support they owe to the government reduced. 

Confidential Paternity Questionnaire
Completed by the applicant in order to provide information regarding the father of the child(ren). 

Declaration of Support Payment History 
Used to provide information regarding any child support payments that were paid directly to the custodial party by the parent that is ordered to pay child support. 

Family Violence Questionnaire
This document must be filled out by both parties on a case to report any instances of domestic violence by either participant. 

Health Insurance Information
Completed by either party to provide details regarding health insurance that is available or being provided for the child (ren).  

Income & Expense Declaration
Completed prior to establishing a court order for child support as well as when reviewing for a modification or change of an existing child support court order.

Income & Expense Instruction Sheet-English
Provides helpful information for English speakers completing the Income & Expense Declaration.

Income & Expense Instruction Sheet-Spanish
Provides helpful information for Spanish speakers completing the Income & Expense Declaration.

Visitation Verification
Used to document the amount of time each child spends with the non-custodial parent.