Non Custodial Parent IV-D Application

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?
Physical abuse
Emotional abuse
Threats
Harassment
Serious harm or Injury
Will opening a child support case pose a family violence risk for you and/or your child(ren) with the other parent?

Yes No
Will opening a child support case pose a family violence risk for you and/or your child(ren) with someone other than the parent of your child(ren)?

Yes No
If you selected YES, please provide the name of the other person and describe the relationship between you/or your child(ren)
Do you have a protective order, police report, or supporting document?

Yes No
If possible attach a copy of any documentation.

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Cancel of
In certain circumstances, a court can order that information related to your place of residence or contact information be excluded from the court order. Would requiring you to provide residence or contact information to the other parent or another party cause you or your child(ren) harassment, abuse, serious harms, or injury?

Yes No
My Name:

First Name Last Name
Date of birth:
SSN:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email: *
example@example.com
My relationship to children(ren):
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: name Phone number: phone number
Check this box if you are under 18 years of age and you do not have a parent or guardian who can serve as your adult representative.
Check this box if you are under 18 years of age and you are married, you have joined the military, or the court has declared you emancipated.
The person who has custody of the child(ren) is:
Name:

First Name Last Name
Date of birth:
SSN:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Relationship to the child(ren):

Father Mother Other
What is the current relationship between the mother and the biological father of the child(ren)

Never married Divorced Married
Date of Marriage Ceremony: Date County: blank St: state
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.
File Upload

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Cancel of
If you are unable to provide a copy you must provide the following
Date:Date Cause/ Case Number: blank County:state State:state Court: court
List the child(ren) and dates of birth for who this person is, or may be, responsible:
First Name: name Last Name blank DOB: Date .
First Name: name Last Name blank DOB: Date .
First Name: name Last Name blank DOB: Date .
First Name: name Last Name blank DOB: Date .
First Name: name Last Name blank DOB: Date .
First Name: name Last Name blank DOB: 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.
File Upload

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Cancel of
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.
Signature *

Clear
Date

Month Day Year
Date
Should be Empty:

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)

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

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.

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

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.

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

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

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

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