Forms

Application for IV-D Services JFS 07076 and Rights and Responsibilities JFS 07012

This application may be used to apply for Title IV-D child support services and describes your rights and your responsibilities as part of the child support services you receive.

Report Changes Form

This form may be used to report any changes to the Wayne CSEA, including a change in address, phone number, employment, etc.

3rd Party Authorization

The Wayne County CSEA follows strict guidelines concerning the confidentiality of case information. However, you may request that the CSEA allow another individual to assist you with your child support case. You may use this form to designate another person to receive information or to discuss your


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child support case with us.

Request to Terminate Support

You may use this form to notify the Wayne CSEA that a circumstance has occurred that may result in the termination of the support obligation. Upon receipt of this notification, the Wayne CSEA will conduct an investigation to determine whether the support obligation should terminate

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or continue. The CSEA will issue a written recommendation notifying the parties of the CSEA’s findings and recommendations.

Seek Work List

If the obligor is currently unemployed, he/she may be ordered to seek work and to provide proof that he/she has applied for employment with a minimum of 10 employers per month.

Abatement Request

Some visitation/parenting time orders in Wayne County may include a visitation/parenting time abatement for extended periods of visitation/parenting time. If your order includes this, you may use this form to notify the Wayne CSEA that the parenting time occurred and to request that the credit be

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applied.

Release of Injured Spouse Claim Affidavit

When an obligor and his/her current spouse file a joint federal tax return, the entire tax refund may be seized by the child support program if the obligor owes over $500 in arrears(back due support), and otherwise qualifies for the tax offset program. The current spouse may file an IRS form 8379 Injured

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Spouse Allocation to request that his/her portion of the tax refund be returned. Please refer to www.irs.gov or see your tax preparer for tax advice and information. If the current spouse is not going to file an injured spouse claim, the current spouse can request that the CSEA release the money to the child support case before the 6 month hold expires. You may also refer to Ohio Office of Child Support’s tax offset information at http://jfs.ohio.gov/Ocs/pdf/InjSpsFAQs.pdf for more information.

Request for Case Information JFS 4001

If you are requesting information from your child support case about the other party or child, you may use this form. This form may also be used by attorneys or other authorized requestors to request information about a case. In accordance with Ohio Administrative Code rule

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5101:12-1-20 and its supplemental rules, case information may only be disclosed to an authorized requestor for an authorized purpose. The Wayne CSEA will notify you within 30 days whether it can release the information to you.

Request to Negotiate

Recently, the State of Ohio, issued a policy allowing for the waiver and compromise of some arrears owed to the State of Ohio. If you would like to talk to the Wayne CSEA about whether or not your case qualifies, you may use this form.  More Info – Waiver and Compromise Fact Sheet

Request for an Administrative Review of the Child Support Order, JFS 01849

Either parent or guardian can ask the CSEA to review and adjust (modify) a support order every 36 months or sooner if there is a qualifying change in circumstances.

The Ohio e-QuickPay® Prepaid Debit Card or Direct Deposit Enrollment/Authorization Form

Fill out this form to enroll in either the direct deposit or the e-QuickPay® option, attach your voided check or deposit slip if you are choosing direct deposit, seal it and drop it in the mail. You may obtain the form by contacting the CSEA or call 1-888-965-2676.