0 évaluation0% ont trouvé ce document utile (0 vote)
22 vues1 page
State of Georgia local Office Stamp Department of Human services Division of child support services applicant INST!CTIONS please provide detailed information to help us assist in processing #our application$ if #ou receive TAN() edicaid services' please call the DCSS Contact Center for further assistance.!ocial!ecurity cards for all children listed in the application, if availa"le; roof of physical custody of a minor child or dependent child;!ignatures on all pages and notari1
State of Georgia local Office Stamp Department of Human services Division of child support services applicant INST!CTIONS please provide detailed information to help us assist in processing #our application$ if #ou receive TAN() edicaid services' please call the DCSS Contact Center for further assistance.!ocial!ecurity cards for all children listed in the application, if availa"le; roof of physical custody of a minor child or dependent child;!ignatures on all pages and notari1
State of Georgia local Office Stamp Department of Human services Division of child support services applicant INST!CTIONS please provide detailed information to help us assist in processing #our application$ if #ou receive TAN() edicaid services' please call the DCSS Contact Center for further assistance.!ocial!ecurity cards for all children listed in the application, if availa"le; roof of physical custody of a minor child or dependent child;!ignatures on all pages and notari1
Division of Child Support Services APPLICANT INST!CTIONS Than" #ou for appl#ing for child support services$ To offer Same Da# Services %SDS&' please provide detailed information to help us assist in processing #our application$ If #ou receive TAN()*edicaid services' please call the DCSS Contact Center for further assistance %num+er listed +elo,&$ Applicant must provide at least one form of identification' for e-ample. Valid drivers license; Any other international government, federal government, state government and local government-issued picture/photo ID including a Green Car or Visa; Valid assport; !ocial !ecurity card; if the applicant does not have one, they may present an ID card issued "y the Georgia Department of Driver !ervices# Applicants *!ST provide. Current income information $i#e# chec% stu"s, &-'s, or (a) !tatements for past * years +ith ,-..s if self employed and a completed financial affidavit/; 0irth certificates and !ocial !ecurity cards for all children listed in the application, if availa"le; !ignatures on all pages and notari1e forms +here re2uired; roof of physical custody of a minor child or dependent child; Verification of school enrollment, status, grade level and anticipated graduation date if the child$ren/ is ,3 and is still a full-time high school student and the court order addresses child support "eyond the age of ,3, if applica"le; A photocopy of any support orders that e)ist $4inal Divorce Decree, !eparation or !ettlement Agreement, Child !upport 5rder entered "y any state or foreign country, 6odification of !upport 5rder, Contempt 5rder, 7uvenile Court 5rder and/or (emporary 5rder/# /-ception. A certified copy of the order is re2uired if the order must "e registered for enforcement in another state or foreign 8urisdiction, "efore DC!! can process a 9I4!A action; :eceipts/verification of medical, vision, dental, life insurance, deducti"les and co-pays, if applica"le; ;)traordinary educational e)pense information for tuition, room < "oard, fees, "oo%s, if applica"le; and Child rearing e)penses for music/art lessons, travel, "and, clu"s, and athletics, if applica"le# Note: Please call the DCSS Contact Center toll-free at 1-877-423-4746 if: =ou spea% another language other than ;nglish in your home and need assistance, =ou have a disa"ility and need assistance or accommodations to visit our office; or =ou are deaf or hearing impaired and need the assistance# If you are a ((= $te)t telephone/ user you may contact our office through the Georgia :elay !ervice at >-,-, Note: If possible, please a!e copies of iportant inforation an" #o$r entire application before %isitin& o$r office to retain for #o$r recor"s' ,'/?/'-,'