JFS
07076
(9/2001)
STARK
COUNTY
CHILD
SUPPORT
ENFORCEMENT
AGENCY
116
CLEVELAND
AVE.
NW
P.O.
BOX
21337
CANTON,
OH
44701-1337
Date
:
Application
#:
APPLICATION FOR
CHILD
SUPPORT
SERVICES
NON-PUBLIC
ASSISTANCE APPLIcANT/REcIPIENT
-IMPORTANT.;
If
you are receiving
OWF
or Medicaid, do not complete this
application, because you
became eligible for child support services when
you
signed the
0WFIMedicai.d
application.
1,.
,
request child support services from
the
STARK
County Child Support Enforcement Agency.
I
understand
and
agree to the following conditions:
A
I
am
a
resident of the county
in
which services
are
requested
and
no
other
Ohio county
has
jurisdiction
over
support:
-
OR
-
I
am
requesting services
from
the
Ohio county of jurisdiction.
B.
~ecipients of child
support
services
shall
cooperate to
the
best of their
ability
with
the
CSEA.
(See
attached rights and responsibility information)
The Child
Support
Enforcement
Agency
can assist you in providing the following
services
:
1.
Location of
Absent
Parents.
+
The agency
can
assist in finding where
an
absent parent
is
currently living,
in what city, town
or
state.
The
applicant
can request "location only
servicesN,
if
the sole need is to find the whereabouts
of
the
absent parent.
2.
Establishment
or
Modification of Child Support
and
Medical Support.
The
CSEA
can
assist you in obtaining
an
order for support if
you
are
separated,
have
been deserted
or
need
to establish paternity (fatherhood).
The
CSEA
can also assist you in
changing
the amount of
support
orders(modification), and to establish
a
medical support order.
3.
Enforcement of Existing
Orders.
+
The
CSEA
can
help you collect
current
and
back
child support
4.
Federal
and
State Income
Tax
Refund Offset Submittals
for
the Collection
of
Child Support Arrearages.
+
The
agency
can
collect back support(arrearages)
by
intercepting an
obligor's federal and state income tax
refunds
on
some
cases.
JFS 07076(Rev. 9/2001)
(Formerly
DHS
7076)
