Child Support Agency

Application for Child Support Services (Form 03EN001E)

Application for Child Support Services (Form 03EN001E)

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Rescission of Denial of Paternity (Form 03PA213E)

Rescission of Denial of Paternity (Form 03PA213E)

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CC-031 Verbal Notice of Eligibility (Eng/Span)

CC-031 Verbal Notice of Eligibility (Eng/Span)

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CC-200-A-FF Certified Family Child Care Provider Application (Addendum)

CC-200-A-FF Certified Family Child Care Provider Application (Addendum)

 

INSTRUCTIONS: ARIZONA CERTIFIED FAMILY CHILD CARE PROVIDER APPLICATION (ADDENDUM) (Form CC-200-A-FF)

 

 

When applying for a position as an Arizona certified family child care provider, an application must be submitted using a form CC-200-FF. If there is not sufficient space on this form to document all household members or adult and minor children who live out of your home, use a supplemental form CC-200-A-FF to document them. This form can be obtained from the website maintained by the Arizona Department of Economic Security.

 

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 1: At the top of the page, enter your last name, first name and middle initial.

 

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 2: The first table provided is for documentation of household members including your spouse. In the first column, enter the last name, first name and middle name of all household members.

 

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 3: In the second column, enter the birth date of all household members.

 

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 4: In the third column, enter the Social Security number of all household members.

 

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 5: In the fourth column, write the relationship of this household member to you.

 

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 6: In the fifth column, indicate with a check mark whether or not each household member is 18 years or older.

 

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 7: The next table provided is for documentation of adult and minor children who do not live in your home. Include your spouse's children and step-children. In the first column, enter the last name, first name and middle name of all such adult and minor children.

 

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 8: In the second column, give the birthdate of all minor and adult children.

 

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 9: In the third column, give the Social Security number of all minor and adult children.

 

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 10: In the fourth column, give the relationship of all minor and adult children. In the last column, indicate with a check mark whether they are 18 or older.

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CCA-1163AS Affidávit de Exendión de Vacunación – Para Miembros del Hogar de 13 años de edad y Menores

CCA-1163AS Affidávit de Exendión de Vacunación - Para Miembros del Hogar de 13 años de edad y Menores

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ACY-1290AS Carta Sobre el Fallo del Registor Central para Empleadores

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CS-016-FF Certified Public Expenditures Statement

CS-016-FF Certified Public Expenditures Statement

 

INSTRUCTIONS: ARIZONA CERTIFIED PUBLIC EXPENDITURES STATEMENT (Form CS-016-FF)

 

 

When spending public expenditures as part of the operations involved in child support enforcement, Arizona public officials use a form CS-016-FF to certify these expenses. This document can be obtained from the website maintained by the Arizona Department of Economic Security. This form should be filed on a monthly basis.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 1: Enter the county name and the month being reported at the top right-hand corner.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 2: Indicate with a check mark whether the expenditures being documented were incurred by a county attorney, clerk of Superior Court, sheriff or family law commissioner.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 3: Enter the name of the person preparing this return, the date and phone number.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 4: On line 1, enter the expenditures for public services.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 5: On line 2, enter expenditures for employee-related expenses.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 6: On line 3, enter expenditures for professional and outside services and specify.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 7: On line 4, enter travel and per diem expenditures.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 8: On line 5, enter expenditures related to your workspace including rent and utilities.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 9: On line 6, enter equipment costs including maintenance.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 10: On line 7, enter expenditures for materials and supplies.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 11: On line 8, document operating expenses.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 12: On line 9, enter indirect costs.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 13: On line 10, enter the total of your expenditure fees.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 14: Lines 11 and 12 should only be completed by the Child Support Enforcement office.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 15: Enter total credits allowed on line 13.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 16: Complete the rest of the lines as instructed.

 

Arizona Certified Public Expenditures Statement CS-016-FF Step 17: Sign and date the bottom of the page, as well as providing your title.

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CSE-1158A Non-Custodial Parent Request for Review of Arrears

CSE-1158A Non-Custodial Parent Request for Review of Arrears

 

INSTRUCTIONS: ARIZONA NON-CUSTODIAL PARENT REQUEST FOR REVIEW OF ARREARS (Form CSE-1158A)

 

 

To request that a review be conducted of a request for unpaid child support dues in Arizona, the non-custodial parent should file a form CSE-11158A. This document can be obtained from the website maintained by the Arizona Department of Economic Security.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 1: On the first blank line, enter your name.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 2: On the second blank line, enter your phone number.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 3: On the third blank line, enter your street address.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 4: On the fourth blank line, enter your city.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 5: On the fifth blank line, enter your state.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 6: On the sixth blank line, enter your zip code.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 7: On the seventh blank line, enter your Atlas case number.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 8: On the eighth blank line, enter the date.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 9: The next section concerns your reason for requesting this review. Check the box next to the first statement if direct payments were made to the custodial parent. Include copies of cancelled check or an Affidavit of Receipt of Direct Payments.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 10: Check the box next to the second statement if the children have been emancipated, adopted or are deceased.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 11: Check the box next to the third statement if you do not owe any past-due support. Proof must be attached.

 

Arizona Non-Custodial Parent Request For Review Of Arrears CSE-1158A Step 12: Check the box next to the fourth statement if your court order was changed but your DCSE records do not show the changes. Check the box next to the fifth statement if a legal change in custody was made. Check the sixth box if the DCSE does not have a complete payment history. For other, check the last box and explain.

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Administrative Hearing Request

Administrative Hearing Request

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Motion to Intervene

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