STATE OF WASHINGTON
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DIVISION OF CHILD SUPPORT (DCS)
Application to Convert Payment Services Only (PSO) Case
to Full Collection Services
The Division of Child Support (DCS) opened a Payment Services Only (PSO) case for your child support order. DCS
cannot open a Full Collection Services case unless one of the parties applies for Full Collection Services. A valid
application for services must contain the signature of the party applying for services. DCS opened the case as PSO for
one or more of the following reasons:
1. No one signed the application line on the last page of the Order of Child Support.
2. A party's attorney signed the application line on the last page of the Order of Child Support on behalf of that party.
3. Neither party submitted an application for services.
If you want DCS to provide Full Collection Services for your child support case, you must sign and mail this completed
form to the DCS address listed below. Except for your signature, print all responses. Use blue or black ink.
Application
I understand and agree to the terms stated in the Nonassistance Support Enforcement Information, DSHS 16-072,
(for custodial parents) or the Noncustodial Parent's Rights and Responsibilities, DSHS 16-107, (for noncustodial
parents) if enclosed. I want DCS to provide Full Collection Services for my child support case.
MY FULL NAME
CASE NUMBER
MY TELEPHONE NUMBER (INCLUDE AREA CODE)
OTHER PARENT’S FULL NAME
MY PO BOX NUMBER OR STREET NUMBER
OTHER PARENT’S DATE OF BIRTH
MY CITY, STATE, AND ZIP CODE
SIGNATURE
DATE
DIVISION OF CHILD SUPPORT
PO BOX 9162
OLYMPIA WA 98507-9162
No person because of race, color, national origin, creed, religion, sex, age, or disability, shall be discriminated against in
employment, services, or any aspect of the program's activities. This form is available in alternative formats upon request.
APPLICATION TO CONVERT PAYMENT SERVICES ONLY (PSO) CASE TO
FULL COLLECTION SERVICES CASE
DSHS 14-341 (REV. 12/2012)
STATE OF WASHINGTON
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DIVISION OF CHILD SUPPORT (DCS)
Application to Convert Payment Services Only (PSO) Case
to Full Collection Services
The Division of Child Support (DCS) opened a Payment Services Only (PSO) case for your child support order. DCS
cannot open a Full Collection Services case unless one of the parties applies for Full Collection Services. A valid
application for services must contain the signature of the party applying for services. DCS opened the case as PSO for
one or more of the following reasons:
1. No one signed the application line on the last page of the Order of Child Support.
2. A party's attorney signed the application line on the last page of the Order of Child Support on behalf of that party.
3. Neither party submitted an application for services.
If you want DCS to provide Full Collection Services for your child support case, you must sign and mail this completed
form to the DCS address listed below. Except for your signature, print all responses. Use blue or black ink.
Application
I understand and agree to the terms stated in the Nonassistance Support Enforcement Information, DSHS 16-072,
(for custodial parents) or the Noncustodial Parent's Rights and Responsibilities, DSHS 16-107, (for noncustodial
parents) if enclosed. I want DCS to provide Full Collection Services for my child support case.
MY FULL NAME
CASE NUMBER
MY TELEPHONE NUMBER (INCLUDE AREA CODE)
OTHER PARENT’S FULL NAME
MY PO BOX NUMBER OR STREET NUMBER
OTHER PARENT’S DATE OF BIRTH
MY CITY, STATE, AND ZIP CODE
SIGNATURE
DATE
DIVISION OF CHILD SUPPORT
PO BOX 9162
OLYMPIA WA 98507-9162
No person because of race, color, national origin, creed, religion, sex, age, or disability, shall be discriminated against in
employment, services, or any aspect of the program's activities. This form is available in alternative formats upon request.
APPLICATION TO CONVERT PAYMENT SERVICES ONLY (PSO) CASE TO
FULL COLLECTION SERVICES CASE
DSHS 14-341 (REV. 12/2012)
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