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Department of Health and Human Services Administration for (U.S. Department of Health & Human Services)

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OMB Control No: 0970-0370
Expiration Date: 02/28/2025
Department of Health and Human Services
Administration for Children and Families
Office of Child Support Enforcement
Employer Services Profile
Description of Service
After completing the registration process and receiving your activation code, you can access the
Portal to:
•
Supply and update information about your organization such as addresses, contact
names,
phone numbers, and email addresses.
•
Report lump sum payments for employees who may owe past-due child support.
•
Report employee terminations.
•
Register as a multistate employer if you have employees in more than one state and choose to
report all new and rehired employees to only one of those states.
Instructions
Fill out all the required fields in this form and email it to the Technical Operations Support. One of our team
members may contact you if additional information is necessary to complete the registration
process.
Note
If you are a multistate employer and want to register only to report new hires to one state or update
information in the Multistate Employer Registry, download and complete the Multistate Employer
Registration form on our website and follow the instructions.
Disclaimer
By completing and supplying the information in this form, you agree to:
1.
Not impersonate any individual, entity, or association; conceal; or supply misleading information
about my identity while transmitting files.
2.
Supply true, accurate, current, and complete information about the entity identified in
this form.
3.
Not use any information obtained because of involvement with Employer Services for
employment decisions.
A third-party provider certifies that it has authorization to update information on OCSE’s Child Support
Portal on behalf of clients.
Page 1 of 6
OMB Control No: 0970-0370
Expiration Date: 02/28/2025
Security
The employer, company, or government agency shall have appropriate procedures in place to promptly report
confirmed or suspected information security or privacy incidents, including, but not limited to, unauthorized
use or disclosure of Personally Identifiable Information (PII) involving confidential child support information
submitted through OCSE to your organization. As soon as reasonably practicable after discovery, but in no case
later than one hour after discovery of the incident, the employer, company, or government agency shall report
confirmed or suspected incidents to OCSE as specified in this paragraph. The requirement for the employer,
company, or government agency to report confirmed or suspected incidents involving PII to OCSE is based on
federal guidance/requirements from the Office of Management and Budget (OMB), Health and Human
Services (HHS), the Federal Information Security Modernization Act of 2014 (FISMA), and the United States
Computer Emergency Readiness Team (US-CERT).
Incidents must be reported via email to OCSE using the security mailbox address:
ocsesecurity@acf.hhs.gov
By selecting
Accept
, you certify that you have read, understood, and agree to the terms of this agreement.
Page 2 of 6
OMB Control No: 0970-0370
Expiration Date: 02/28/2025
Employer Services Profile
Required *
General Information
Enter general information about your organization and participation in Employer Services.
Date: *
(The date you are completing the form using MM/DD/YYYY format.)
FEIN: *
(Primary Federal Employer Identification Number – enter as nine numeric characters with no hyphen after the second
number.)
Organization Type: *
(Select Employer if you manage your own company's employee reporting.
Select Third Party if you are a payroll company or manage multiple employee reporting clients.)
Organization Name: *
Organization Short Name:
(Enter abbreviation for your organization. Maximum 25 characters.)
Address Information
Address Line 1: *
Address Line 2:
Address Line 3:
City: *
State: *
ZIP Code (5 digits): * ZIP Code Ext:
Is this the Payroll/Income Withholding Order address?
Yes
No
Page 3 of 6
OMB Control No: 0970-0370
Expiration Date: 02/28/2025
Required *
Contact Information
Enter business, technical, and alternate contact information. If you have multiple contacts for child supp ort purposes, you can add their
information on the Portal.
Business Contact Information
First Name: *
MI:
Last Name: *
Email: *
(Format: name@somewhere.com)
Select if you want email notifications sent to this address.
Does this email address belong to a shared email box? *
Yes No
Phone Number: *
(Enter numeric characters only. Include
area code. Format: 1231 231111)
Phone Ext:
Fax Number:
(Enter numeric characters only. Include area code. Format 1231231111)
Select other contact types that apply:
Alternate
General Multistate/MSER Technical
Verification of Employment
National Medical Support Notice
Payroll/Income
Withholding
Order
Accounts Payable
Lump Sum
Technical Contact Information
This person is a network or system administrator who can help provide corporate IP address information or batch system
information, if applicable.
First Name:
MI:
Last Name:
Email:
(Format: name@somewhere.com)
Select if you want email notifications sent to this address.
Does this email address belong to a shared email box?
Yes No
Phone Number:
(Enter
numeric
characters
only. Include
area code. Format: 1231231111)
Page 4 of 6
Phone Ext:
OMB Control No: 0970-0370
Expiration Date: 02/28/2025
Fax Number:
(Enter numeric characters only. Include area code. Format: 1 2312311 11)
Select other contact types that apply:
Business
General
Multistate/MSER
Alternate
Ver
ification of Employment
National Medical Support Notice
Payroll/Income Withholding Order
Lump Sum
Accounts Payable
rnate Contact Information
Page 5 of 6
Alt ne rnate Contact Informatio
This is the person child support agencies may contact regarding case-specific questions.
First Name:
MI:
Last Name:
Email:
(Format: name@somewhere.com)
Select if you want email notifications sent to this address.
Does this email address belong to a shared email box?
Yes No
Phone Number:
(Enter numeric characters only. Include
area code. Format: 1231231111)
Phone Ext:
Fax Number:
(Enter numeric characters only. Include area code. Format: 1231231111)
Select
other
contact
types
that
apply:
Business
General
Multistate/MSER
Technical
Veri
fication
of
Employme
nt
National Medical Support
Notice
Payroll/Income
Withholding
Order
Lump
Sum
Accounts Payable
Req
uired *
Communication Preference
You must select a preferred method of communication for your organization: email, fax, or phone.
Communication Preference: *
OMB Control No: 0970-0370
Expiration Date: 02/28/2025
Required *
IP Address Information
The federal Office of Child Support Enforcement (OCSE) requires a public Internet Protocol (IP) address from external partners to
allow secure access to the Child Support Portal. OCSE independently verifies the IP address and organization name with the
American Registry for Internet Numbers (ARIN), a regional internet registry for the United States. For more information, visit the
ARIN website.
Enter the public IP addresses your organization uses to access the internet. In most cases, the IP address is your company's
internet proxy server or the public IP address of the computer used to access OCSE's Child Support Portal. To locate your public IP
address,
search on the internet for "What Is My Public IP Address."
You must verify the addresses with your network administrator.
Public IP Addresses: *
By completing this section, you certify your organization holds exclusive use of the static IP addresses assigned by an Internet
Service Provider vendor. If the static IP address assigned to your organization changes, you must contact the Technical
Operations Support.
Name of Internet Service Provider: *
(Example: Comcast, AT&T, or Verizon. Enter your
company name if you own your IP address and it is
verifiable on the ARIN website.)
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this voluntary
information collection is for OCSE to register and authenticate authorized users of the Employer Services applications on OCSE’s
Child Support Portal. Public reporting estimated burden for this collection of information is 0.08 hours per respondent, including
the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. As
provided by 42 U.S.C. § 653(m)(2), any confidential information collected for this program is accessed only by authorized users.
A federal agency may not conduct or sponsor an information collection without a valid OMB Control Number. No individual or
entity is required to respond to, nor shall an individual or entity be subject to a penalty for failure to comply with a collection of
information subject to the requirements of the Paperwork Reduction Act of 1995, without a current valid OMB Control
Number. If you have any comments on this collection of information, please contact OCSEFedSystems@acf.hhs.gov.
Page 6 of 6
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Completed 27 June 2022

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