Child Support - Forms

Most child support forms are available in several languages. Find the form you want and choose the language you need.

You can find other DHS documents and forms online at DHS eDocs.

You will need the free Adobe Acrobat Reader to view, print, and save some of these publications that are in the Portable Document Format (PDF).

Some child support publications are printed and available to order. See the DHS Order fulfillment website for bulk orders of preprinted DHS documents.

Authorization for Release of Child Support Information to a Third Party - Parents use this form to give permission to DHS and the county child support office to discuss private information about their child support case with a third person, entity, or agency not otherwise entitled to the information.
(DHS-5510) (PDF)

Automatic Withdrawal for Your Child Support Payments -
Obligors with an open child support case who are not court-ordered to pay by income withholding use this form to authorize automatic recurring withdrawal from their checking or savings account as a payment option.
DHS-4117 (English) (PDF)

Direct Deposit for Child Support - This form explains the benefits of directly depositing child support to checking and savings accounts and includes a Direct Deposit Authorization form.
DHS-3371 (English) (PDF)

DHS-3371 (Lus Hmoob) (PDF)

DHS-3371 (Soomaali) (PDF)

DHS-3371 (Español) (PDF)

Explanation of Child Support (IV-D) and Income Withholding-Only (Non-IV-D) Services in Minnesota - This form explains child support services available to applicants and the difference between full IV-D services and non-IV-D income withholding-only services.
DHS-2973 (English) (PDF)

DHS-2973 (Lus Hmoob) (PDF)

DHS-2973 (Soomaali) (PDF)

DHS-2973 (Español) (PDF)

Financial Statement - Parents may use this form to request that the county child support office review their court order to determine if it should be changed (modified). Parties can also respond to a request for review using this form.
DHS-6523. (English) (PDF)

Full Child Support (IV-D) Services Application - A person who is not receiving public assistance and wants to apply for county child support enforcement services uses this form. It includes an application, describes the services available, and explains the applicant's responsibilities.
DHS-1958 (English) (PDF)

DHS-1958 (Lus Hmoob) (PDF)

DHS-1958 (Soomaal) (PDF)

DHS-1958 (Español) (PDF)

Income Withholding for Spousal Support – A person who receives support uses this form to initiate court-ordered income withholding (IW) for spousal support not involving child support.
DHS-5785 (English) (PDF)

Income Withholding-Only (Non-IV-D) Services Application - A person uses this form to apply for non-IV-D Services. The county child support office will use this information to process non-IV-D automatic income withholding.
DHS-3164 (English) (PDF)

DHS-3164 (Lus Hmoob) (PDF)

DHS-3164 (Soomaali) (PDF)

DHS-3164 (Español) (PDF)

Minnesota Husband's Non-paternity Statement Revocation Form - This is a legal form to cancel a previously signed Husband's Non-paternity Statement (DHS-3159c).
DHS-3159e (English) (PDF)

DHS-3159e (Lus Hmoob) (PDF)

DHS-3159e (Soomaali) (PDF)

DHS-3159e (Español) (PDF)

Minnesota Voluntary Recognition of Parentage - Parents who are not married to each other use this legal form to voluntarily establish paternity for a child born to them. When both parents agree that the man is the biological father, they sign this form to make him the legal father.
DHS-3159 (English) (PDF)

DHS-3159 (Lus Hmoob) (PDF)

DHS-3159 (Soomaali) (PDF)

DHS-3159 (Español) (PDF)

Minnesota Voluntary Recognition of Parentage Revocation Form - This legal form cancels a voluntary paternity establishment created by a previously-signed and filed Recognition of Parentage form.
DHS-3159b (English) (PDF)

DHS-3159b (Lus Hmoob) (PDF)

DHs-3159b (Soomaali) (PDF)

DHS-3159b (Español) (PDF)

Minnesota Voluntary Recognition of Parentage Husband's Non-paternity Statement - Husbands may sign this form when they are not the biological father of their wife's child. This form must be filed in conjunction with a Minnesota Voluntary Recognition of Parentage Form which has been signed and filed by the mother and biological father of the child in order to remove a husband’s legal name from the child’s birth certificate and ends his legal relationship to the child.
DHS-3159c (English) (PDF)

DHS-3159c (Lus Hmoob) (PDF)

DHS-3159c (Soomaali) (PDF)

DHS-3159c (Español) (PDF)

Referral to Support and Collections - MinnesotaCare and Medical Assistance recipients use this form for referral to the local child support agency to establish paternity or initiate child support enforcement services.
DHS-3163b (English) (PDF)

DHS-3163b (Lus Hmoob) (PDF)

DHS-3163b (Soomaali) (PDF)

DHS-3163b (Español) (PDF)

Request for Exception to Direct Deposit - The state child support office sends support payments by direct deposit. People who receive child support use this form to request an exception to direct deposit.
DHS-4583 (English) (PDF)

Request to Close Support Case - People who applied for child support services use this form to ask the child support worker to close their case.
DHS-4060 (English) (PDF)

Stored Value Card - People who receive child support use this form to sign up to have child support payments loaded to a prepaid U.S. Bank ReliaCard® Visa.
DHS-4533 (English) (PDF)

Unreimbursed and/or Uninsured Medical Dental Expenses Packet - Either parent can use this packet to begin collection of unreimbursed and/or uninsured medical or dental expenses from the other parent. The packet contains information, notices, and instructions.
DHS-4931 (English) (PDF)

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