• NON-CUSTODIAL PARENT APPLICATION FOR IV-D SERVICES

  • Please complete and sign the application. There is no cost to apply for services.

  • Important Safety Information (Please Print All Information)

  • If you have concerns regarding family violence, there are some protections available in the child support process. The following questions will provide relevant information to determine the actions necessary for your case. You may wish to visit www.texasattorneygeneral.gov/child-support to find out about the protections available in the child support process.

  • Have your or your child(ren) experienced the following by the other parent?

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  • If you are under the age of 18 years and are not married or emancipated, please list your parent or guardian's name and contact information.

  • Name of parent/guardian: Phone number:

  • The person who has custody of the child(ren) is:

  • Date of Marriage Ceremony: Pick a Date   County:    St:    

  • If you are divorced or have a court order (divorce order, paternity order, custody order, protective order, etc.) of any kind regarding child(ren) please attach a copy of the order to this form.

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  • If you are unable to provide a copy you must provide the following

  • Date:Pick a Date   Cause/ Case Number:    County:   State:  Court:          

  • List the child(ren) and dates of birth for who this person is, or may be, responsible:

  • First Name: Last Name DOB:  Pick a Date   .

  • First Name: Last Name DOB:  Pick a Date   .

  • First Name: Last Name DOB:  Pick a Date   .

  • First Name: Last Name DOB:  Pick a Date   .

  • First Name: Last Name DOB:  Pick a Date   .

  • First Name: Last Name DOB:  Pick a Date   .

  • If this application relates to more than six children, provide the names and dates of birth on a separate page for any additional children.

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  • Texas Government Code Chapter 559 gives you the right to review and request correction of information on this form.

    I request all appropriate IV-D services of the Office of the Attorney General, Child Support Division. The information in this application is true and complete. I have either read the attached information, or had it read to me. My signature is my agreement to the above statement and to the other statements included in this application packet.
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