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FOR OFFICE USE ONLY
Oregon Child Support
Date application requested: ____________________
Date application mailed to requestor:
Program
Application for Child Support Services
DO NOT COMPLETE THIS APPLICATION IF YOU ARE APPLYING FOR ONLY SPOUSAL SUPPORT SERVICES
If you wish to apply for child support services, please complete, sign and date this application. After we
receive your completed application, we will set up your case on our computer system within two days. After
that, the child support office may send you a questionnaire asking for information needed to handle your case.
Please read the attachment to this application form carefully. It explains information about the Child
Support Program that you need to know.
You can hand-deliver or mail the completed application to your local child support agency, or mail it to:
Child Support Program, 4600 25th Ave NE, Suite 180, Salem Oregon 97301
Applicant’s Name (Please print) ___________________________________________________________
Has paternity been established?
[ ] Yes [ ] No
Is there an existing support order? [ ] Yes [ ] No
If yes: Court Case #
County
State
Do you want the order reviewed for a modification? [ ] Yes [ ] No
Are there arrears owed under the support order? [ ] Yes [ ] No
If there are arrears owed under the support order, do you want collection of these arrears? [ ] Yes [ ] No
Are there any other support, custody, divorce or juvenile court orders about your child(ren) or about you and
the other parent?
[ ] Yes [ ] No
If yes, Court Case #
County
State
Is there a pending legal action in any state for child support?
[ ] Yes [ ] No
If yes, Court Case #
County