PORTAGE COUNTY CHILD SUPPORT SERVICES 817 WHITING AVENUE, STEVENS POINT WI 54481 715-346-1588 1-866-920-2525 TDD 1-800-123-1234 FAX – 715-343-6263 _______________________________________________________________________________________________ Dear Applicant: The Portage County Child Support Agency can help you:     establish paternity, if necessary; locate the noncustodial parent to establish or enforce a child support order; obtain a court order for child support and health insurance to be provided by the noncustodial parent; and collect court-ordered child support and health insurance payments on behalf of your child(ren). Please note: child support agencies do not handle child custody, physical placement or visitation issues. The child support attorney who appears at a child support hearing represents the State of Wisconsin, not individual parents. Child Support services provided by this attorney do not create an attorneyclient relationship. You may apply at any time, now or in the future. We are enclosing an application form and additional materials that explain all available child support services and fees. We will open a child support case when we receive your application. An interview will be scheduled, if necessary. Please indicate what service you are requesting on page 8 and provide a copy of your current order/judgment. Additional comments should be written on the back of the application form. Please contact us if you have any questions. Please also provide a copy of the health insurance coverage for the minor child(ren). YOUR APPLICATION WILL NOT BE PROCESSED UNLESS WE RECEIVE A COPY OF YOUR MARITAL SETTLEMENT AGREEMENT, DIVORCE JUDGMENT AND/OR PATERNITY JUDGMENT AND PAGE 8 COMPLETED INDICATING THE REASON FOR REQUESTING OUR SERVICES. This agency is an equal-opportunity employer and service provider. If you have a disability and need information in an alternative format, or need it translated to another language, please contact us at the telephone number or address listed at the top of this letter. Portage County Child Support Agency Enclosure(s) PORTAGE COUNTY CHILD SUPPORT SERVICES 817 WHITING AVENUE, STEVENS POINT WI 54481 715-346-1588 1-866-920-2525 TDD 1-800-123-1234 FAX – 715-343-6263 _______________________________________________________________________________________________ Dear Applicant: Statement of Understanding Please read the statements below, then sign and return this form and the application form to the address above. I understand that a child support action will be started for my child, and that my cooperation with the child support agency is necessary. I understand that I must cooperate by: * appearing promptly as directed for court and other appointments, * informing the child support agency of any changes in my address and phone number, and * answering all questions truthfully and as completely as possible. If I am receiving public assistance and fail to cooperate, I understand that the child support agency will notify the economic support agency. I understand that unless I have established good cause for not cooperating, I and/or my family will be ineligible for public assistance. If I am not receiving public assistance and fail to cooperate, I understand that the child support agency will close my case and stop efforts to collect support for my child(ren). I understand that the child support attorney who appears at a child support hearing represents the State of Wisconsin, not individual parents. Child support services provided by this attorney do not create an attorney-client relationship. I understand that the interests of the State of Wisconsin, the child(ren) for whom support is sought, and the parents are not necessarily the same and may be in conflict. In addition, I understand that any information received as a result of a child support investigation or proceeding may be used by the State of Wisconsin in related investigations or proceedings. I understand that the child support agency staff cannot become involved in disputes over child custody, physical placement or visitation, and cannot offer me legal advice. I understand that if I want legal advice, I should consult a private attorney. I hereby acknowledge that I have read and understand this information. Signature Date This agency is an equal-opportunity employer and service provider. If you have a disability and need information in an alternative format, or need it translated to another language, please contact us at the phone number or address listed at the top of this letter. APPLICATION FOR CHILD SUPPORT SERVICES (Existing Portage County court case only) If you are involved in a family court action in Portage County, you may apply for services from the Portage_ County Child Support Agency (CSA). Our agency can help you:  Collect your child support order through income withholding.  Enforce the payment of unpaid support through tax refund intercept, account seizure and other administrative processes.  Modify your support order. You can get more information about the child support program at www.childsupport.wisconsin.gov. There is no fee to apply for child support services. If you are interested, please complete and return the form below to: Portage County Child Support Agency 1516 Church Street Stevens Point WI 54481 Please note the following regarding Child Support services:  Child support agencies do not handle child custody, physical placement (visitation) issues, or enforce maintenance-only (alimony) orders.  A Child Support attorney who appears at your hearing represents the State of Wisconsin, not you. Applying for services does not create an attorney-client relationship with the Child Support attorneys.  If you have a percentage–expressed child support order (for example, an order of 17% of gross income, instead of a fixed dollar amount such as $300 per month), and you apply for child support services, the agency is required by state law to ask the court to change your order to a fixed dollar amount.  If the agency collects support arrears through tax refund intercept and the refund is recalled, you will have to return the payment. If a tax intercept collection is at least $10, a fee of 10%, up to $25, will be deducted from the collection. Application for Child Support Services Yes, I ________________________ request Child Support services from Portage County CSA. (Please print your name clearly) Court Case Number _________________________ Birth date: __________________ My address: ___________________________________________________________________________ (Street) (City) (State) (Zip) Telephone: Home _____________________ Work ____________________ Cell ___________________ Other Parent: ___________________________________________________ ________________ ________________ Full name: First Middle Last Birth Date Telephone Address: ______________________________________________________________________________ (Street) (City) (State) (Zip) I have received information that describes IV-D services available, individual rights and responsibilities, and fees/costs. Signature: ______________________________________________ 12/2009 Date: ______________________ Office use: KIDS case #: ________________