Form CSF03 0574 "Application for Child Support Services" - Oregon

What Is Form CSF03 0574?

This is a legal form that was released by the Oregon Department of Justice - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2022;
  • The latest edition provided by the Oregon Department of Justice;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CSF03 0574 by clicking the link below or browse more documents and templates provided by the Oregon Department of Justice.

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Download Form CSF03 0574 "Application for Child Support Services" - Oregon

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FOR OFFICE USE ONLY
Date application requested:
Application for Services
_____________________
Date application mailed to
__________
requestor:
To apply for services from the Oregon Child Support Program, complete, sign, and date this application, or apply
online at OregonChildSupport.gov. Within two days of receiving your application, we will review it to determine if
you qualify for services. If you do, we will set up your case and contact you if more information is needed.
The attachment provides important information about the Oregon Child Support Program.
If you do not apply online, you can take this application to your local child support office or mail it to:
Oregon Child Support Program
PO Box 14680
Salem OR 97309
If you have questions, contact us at 800-850-0228.
Applicant’s Name
General Information
Complete these sections
Are you applying for all child support services?
Yes
No
1, 5, 6, 7, 8, 9
Are you applying for paternity establishment services with no child support order?
Yes
No
2, 5, 6, 9
Are you applying for support services as a Child Attending School?
Yes
No
3, 5, 8, 9
Are you applying for limited spousal support services only?
Yes
No
4, 5, 9
If yes, please include proof of public assistance with your application
and employment information for the paying party.
Have you been making or receiving payments through an escrow agent?
Yes
No
If yes, by your signature on this application, you authorize the escrow company listed below to release copies of support
payment information to the Oregon Child Support Program.
Name of escrow company
Address
Phone #
1. Child Support Orders
Has parentage been legally established for all children?
Yes
No
Is there a pending child support legal action in any state?
Yes
No
If yes, Court Case #
County
State
Is there an existing child support order?
Yes
No
If yes, Court Case #
County
State
Do you want the existing order reviewed for a modification?
Yes
No
Are there arrears owed under the existing order?
Yes
No
If yes, do you want these arrears collected?
Yes
No
Is there spousal support also ordered?
Yes
No
If yes, we will collect both child support and spousal support.
Have you ever had a child support case in another state?
Yes
No
If yes, which state?
Are there any other support, custody, divorce, or juvenile court orders for your children, you, or the other parent?
Yes
No
If yes, Court Case #
County
State
Page 1 of 5 - APPLICATION FOR CHILD SUPPORT SERVICES
CSF 03 0574 – web (Rev. 01/01/22)
FOR OFFICE USE ONLY
Date application requested:
Application for Services
_____________________
Date application mailed to
__________
requestor:
To apply for services from the Oregon Child Support Program, complete, sign, and date this application, or apply
online at OregonChildSupport.gov. Within two days of receiving your application, we will review it to determine if
you qualify for services. If you do, we will set up your case and contact you if more information is needed.
The attachment provides important information about the Oregon Child Support Program.
If you do not apply online, you can take this application to your local child support office or mail it to:
Oregon Child Support Program
PO Box 14680
Salem OR 97309
If you have questions, contact us at 800-850-0228.
Applicant’s Name
General Information
Complete these sections
Are you applying for all child support services?
Yes
No
1, 5, 6, 7, 8, 9
Are you applying for paternity establishment services with no child support order?
Yes
No
2, 5, 6, 9
Are you applying for support services as a Child Attending School?
Yes
No
3, 5, 8, 9
Are you applying for limited spousal support services only?
Yes
No
4, 5, 9
If yes, please include proof of public assistance with your application
and employment information for the paying party.
Have you been making or receiving payments through an escrow agent?
Yes
No
If yes, by your signature on this application, you authorize the escrow company listed below to release copies of support
payment information to the Oregon Child Support Program.
Name of escrow company
Address
Phone #
1. Child Support Orders
Has parentage been legally established for all children?
Yes
No
Is there a pending child support legal action in any state?
Yes
No
If yes, Court Case #
County
State
Is there an existing child support order?
Yes
No
If yes, Court Case #
County
State
Do you want the existing order reviewed for a modification?
Yes
No
Are there arrears owed under the existing order?
Yes
No
If yes, do you want these arrears collected?
Yes
No
Is there spousal support also ordered?
Yes
No
If yes, we will collect both child support and spousal support.
Have you ever had a child support case in another state?
Yes
No
If yes, which state?
Are there any other support, custody, divorce, or juvenile court orders for your children, you, or the other parent?
Yes
No
If yes, Court Case #
County
State
Page 1 of 5 - APPLICATION FOR CHILD SUPPORT SERVICES
CSF 03 0574 – web (Rev. 01/01/22)
2. Paternity Establishment for a Child – No Child Support Order Requested
If your child does not have two legally established parents and you want to establish paternity of
the father, are you and the other parent willing to sign a Voluntary Acknowledgment of Paternity to
Yes
No
have the father’s name added to the birth record?
If a Voluntary Acknowledgment of Paternity cannot be completed, do you want the Oregon Child
Yes
No
Support Program to start a legal action to establish paternity?
If you decide during this action that you want a child support order, you must notify the office handling your
case to request a child support order be established.
3. Child Attending School (adult children between ages 18 and 21 attending school)
Is there a pending child support legal action in any state?
Yes
No
If yes, Court Case #
County
State
Is there an existing child support order?
Yes
No
If yes, Court Case #
County
State
Do you want the existing order reviewed for modification?
Yes
No
Are you married, on active military duty, or legally emancipated by a court order?
Yes
No
Have you ever received public assistance in any state?
Yes
No
4. Spousal Support Orders (without child support)
If you provide proof you receive any form of public assistance, the Oregon Child Support Program will provide income
withholding and maintain a record of the dollar amounts received and disbursed. We provide no other services.
Spousal support order information: Court Case #
County
State
Are you receiving any public assistance at this time?
Yes
No
If yes, what type of public assistance are you receiving? Attach proof.
(Public assistance includes services provided to needy persons by the Oregon Department of Human Services or
Oregon Health Authority)
All Applicants Must Complete Section 5
5. Applicant Information
Male
Female
Non-binary
Custodial parent
Full Name
Non-custodial parent
Address
Caretaker or guardian
Child attending school
Person receiving spousal support
We will use your address to send documents to you in the future. It may also appear in legal papers given to the other party, and in
court records. If you do not want your address to be given to the other party, or appear in court records, contact us.
Mobile:
Home:
Message:
Text?
Yes
No
Email:
Social Security Number:
Date of Birth:
Employer Name and Address:
Other Party 1 Information (parent or caretaker)
Male
Female
Non-binary
Full Name
Custodial parent
Address
Non-custodial parent
Caretaker or guardian
Mobile:
Home:
Message:
Text?
Yes
No
Email:
Social Security Number
Date of Birth:
Employer Name and Address:
Page 2 of 5 - APPLICATION FOR CHILD SUPPORT SERVICES
CSF 03 0574 – web (Rev. 01/01/22)
Other Party 2 Information (if any)
Male
Female
Non-binary
Full Name
Custodial parent
Address
Non-custodial parent
Caretaker or guardian
Mobile:
Home:
Message:
Text?
Yes
No
Email:
Social Security Number:
Date of Birth:
Employer Name and Address:
Preferred Language
If you do not speak English, what language do you speak?
Do you need an interpreter?
Yes
No
If you do not read English, what language do you read?
If any other party does not speak English, what language do they speak?
Do they need an interpreter?
Yes
No
If the other party does not read English, what language do they read?
English
Need another language? Contact us.
Avez-vous besoin d’une autre langue? Communiquez avec nous.
French
German
Sie benötigen eine andere Sprache? Kontaktieren Sie uns.
Предпочитаете другой язык? Свяжитесь с нами.
Russian
Somali
Ma u baahan tahay luqad kale? Na la soo xiriir.
Spanish
¿Necesita otro idioma? Contáctenos.
Quý vị có cần dùng ngôn ngữ khác không? Hãy liên lạc với chúng tôi.
Vietnamese
6. Children Information
Place of Birth
Social Security
(use additional sheets if necessary)
Full name
Gender
Birth Date
County/State
Number
 Male  Female
 Non-binary
/
/
 Male  Female
 Non-binary
/
/
 Male  Female
 Non-binary
/
/
 Male  Female
 Non-binary
/
/
7. Health Insurance
Is health insurance available for the children?
Yes
No
If yes, who is the policy holder?  Non-custodial parent  Custodial parent  Other
Insurance company
Policy number
Address
Phone number
8. Public Assistance
Has the custodial parent or the children ever received cash public assistance in any state?
Yes
No
If yes, who received the assistance?
State(s):
Dates:
9.
I certify that the above information is true and correct to the best of my knowledge.
Date:
Signature:
Page 3 of 5 - APPLICATION FOR CHILD SUPPORT SERVICES
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Information about the Oregon Child Support Program
The Oregon Child Support Program provides child support services through the Oregon Department of Justice
(DOJ) Division of Child Support and some county district attorney offices. The DOJ Division of Child Support
handles the majority of cases, including nearly all cases where a party has received public assistance. In
counties where district attorney offices provide child support services, they handle most of the cases that do
not involve public assistance. Visit OregonChildSupport.gov for a list of offices.
Services we provide
The Oregon Child Support Program cannot act as a lawyer for any party. We do not provide services or make
decisions regarding parenting time and custody as these matters are decided in the court system. You should
talk to a lawyer if you have any legal questions about your case. Low-cost legal services may be available. For
more information, visit our website at OregonChildSupport.gov.
The program provides services to establish paternity, as well as to establish and modify child support orders.
We enforce orders to collect child support payments and obtain medical support. We will also enforce spousal
support included with a child support order.
We provide applicants with all appropriate services. An applicant cannot choose or limit which services will be
provided except for two limited-services options: (1) establishment of legal paternity with no child support order
and (2) spousal support if you are receiving public assistance. If circumstances change and you want full child
support services, you must submit a new application.
Your rights and responsibilities
The Oregon Child Support Program complies with applicable federal and state civil rights laws and
does not discriminate based on race, color, national origin, disability, religion, sex, gender identity,
sexual orientation, or age.
You are responsible for keeping us informed of your current address. If we cannot contact you, we may
close your case. Your case may also be closed if you do not provide necessary information, sign legal
documents, or cooperate when asked.
We will protect your personal information by following all state and federals laws and court
requirements. If you do not want your address to be given to the other party or to appear in court
records, contact your case manager.
You are required to provide your Social Security number to the Oregon Child Support Program. This is
mandatory under federal law [42 USC §405(c)(2)(C) and 42 USC §666(a)(13)]. We will use your Social
Security number as one of the identifiers to find you and your records for purposes of establishing
paternity and establishing, modifying, and enforcing support obligations. When you call us or are
completing forms, you may be asked for your case number or other identifying information so we can
correctly identify your case.
All parties have equal status in child support cases. Any party can ask questions, raise issues, or
request changes, with or without assistance from a lawyer.
The Oregon Child Support Program will serve parties with copies of notices and legal actions as
necessary. The papers will be served by regular mail, priority mail, certified mail, or in person. These
papers will let you know what is happening with your case. Accepting the papers does not mean you
agree with what is in them and does not take away your legal right to dispute any actions or decisions.
When receiving child support services, you have the right to ask the program to review your child
support order using the current guidelines to determine if the amount should be increased or lowered.
Safety concerns
The Oregon Child Support Program works hard to prevent the release of personal information about a party to
the other party or to the public. We can take extra precautions if you think your or your child’s health or safety
is in danger. To learn how you can address safety risks in the child support process, go to our website at
OregonChildSupport.gov/safety. If you have a safety issue and do not have access to the internet,
.
contact Customer Service at 800-850-0228 or visit any child support office
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CSF 03 0574 – web (Rev. 01/01/22)
Information about establishing paternity
We will not pursue establishment of paternity if:
Adoption of the child is final
Parentage has already been legally established for the child
The director of the Oregon Child Support Program determines that establishing paternity is not in the
best interests of the child.
If either parent claims another person is the father, you and the child may be required to take a parentage test
to provide evidence of paternity
If you apply to establish paternity without a child support order, any information provided can be used in a
future action to establish a support order.
How we disburse child support payments
When a parent or child attending school is receiving services from the Oregon Child Support Program, all child
support payments must go through us. We receive and record the payment, and send it to the party who is
owed support.
If the children are not in foster care or receiving public assistance, we send the payment electronically to the
person owed support. If there are qualified children attending school, they will receive their portion of the
payment and the parent or caretaker will receive the remaining portion. If the children are in foster care, we
send the payments for those children to the Child Welfare program at the Oregon Department of Human
Services. If the children are receiving Temporary Assistance to Needy Families (TANF), we may send some of
the money to the family and keep the rest of the payment. This is called a pass-through. General information
about how we disburse payments is found in Oregon Administrative Rule (OAR) 137-055-6021. More
information about the pass-through is in OAR 137-055-6010.
Fees for services
A one-time fee of $1 for processing your application will be deducted from the first collection. The Oregon Child
Support Program also charges fees for other services.
If we collect past-due support from the paying parent’s federal or state tax refund, a collection fee will be
deducted from the amount distributed to the person receiving support. The IRS adjusts the federal fee every
year. Effective November 1, 2021, the IRS fee is $21.67 per collection from federal tax refunds. The Oregon
Department of Revenue charges 3.5 percent of the amount collected from state tax refunds.
Annual fee
Federal law requires an annual fee on child support cases if the family receiving support has never received
TANF benefits. The annual fee of $35 is withheld from child support payments after the family receives $550
during the federal fiscal year. The federal fiscal year runs from October 1 to September 30. No annual fee is
charged if less than $550 is collected.
Grievance process
Our goal is to give you fair, professional, courteous, and accurate service. If you believe you did not receive
high-quality service from one of our offices, contact a supervisor at that office. If you are unable to resolve the
issue with the supervisor, you may contact Constituent Services at 503-947-4337. You can also submit a
grievance form at any time. The form is available at any Oregon Child Support Program office and on our
website at OregonChildSupport.gov.
If your complaint is about a decision or action required by federal or state law, we may not be able to resolve
the issue. We will explain the reason for our decision.
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