Page 1 of 2 CHILD SUPPORT GRIEVANCE FORM
CSF 01 8643 web (Rev. 11/18/20)
Child Support Grievance Form
If you have a dispute with a child support office, please try to resolve the problem with staff, a leadworker or
supervisors in that office before you file a grievance (formal complaint). Each local office should have a
complaint process for you to use. The child support office cannot discriminate against you for filing a complaint
or grievance.
If you believe you were treated unfairly or your support case was not handled appropriately and you are unable
to resolve your complaint through your local office, report your complaint on this form. Send the completed
form to: Constituent Services, Oregon Child Support Program, 1162 Court Street NE, Salem, OR 97301.
Your name: Daytime Phone:
Case Name (if different) Child Support Case Number:
Address:
(Street)
(City) (State) (Zip Code)
PLEASE READ THIS PART BEFORE FILING A GRIEVANCE:
The Oregon Child Support Program must follow the requirements of federal and state laws when deciding
and taking actions. We realize that sometimes people do not agree with these actions or decisions.
However, if your complaint is about an action the law says we must do or can do, we cannot continue with
your grievance using this formal process. We will keep working with you to resolve the issue(s). Some
examples of issues we cannot address using this formal process include child support order amounts,
income withholding as required by law, and actions taken by other agencies or states. For more specific
information, see OAR 137-055-1600.
Oregon Child Support office you want to report:
D
escribe your complaint here. Be sure to sign and date the form on the next page.
NOTE: This form is compatible with Acrobat Reader v8 or higher. If the 'Send' button doesn't
work (by opening an email message), select 'Save As' to save the completed form locally and
then attach it to an email message addressed to: Constituent.Desk@doj.state.or.us
