Child Support Payment Form

1. In the Case # field, enter the case number.

2. The Amount field is automatically populated with the value entered in the Payment Amount field.

3. In the Absent Parent SS# field, enter the Social Security Number of the absent parent. 

4. In the Medical Support Provided field, select the check box to indicate that medical support is provided.  If no medical support is provided, make sure the check box is cleared.

5. In the Absent Parent Last Name field, enter the last name of the absent parent.

6. In the Absent Parent First Name field, enter the first name of the absent parent.

7. In the FIPS Code field, enter the Federal Information Process Standard Code.

Notes:

• Data entered on this form will be saved along with data from the main form if the transaction is saved as a preformat.

• The fields on this form are automatically populated if the transaction was created from a preformat.

• Automatically populated fields may be overwritten.