| Authorization for Release of Child Support Information to a Third Party (DHS-5510) This form gives permission to DHS and the county child support office to discuss private information concerning your child support case with a third person, entity or agency who would not otherwise be entitled to the information. |
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| Automatic Withdrawal for Your Child Support Payments (DHS-4117) This form authorizes and explains automatic recurring withdrawal as an option for obligors who have an open child support case but are not court-ordered to pay by income withholding. |
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| Direct Deposit for Child Support (DHS-3371) This form explains the benefits of directly depositing child support to checking and savings accounts and includes a Direct Deposit Authorization form. |
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| Explanation of Child Support (IV-D) and Income Withholding-Only (Non-IV-D) Services in Minnesota (DHS-2973) This form is used to explain child support services available to applicants. The form explains the difference between IV-D and Non-IV-D services. |
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| Financial Affidavit for Child Support (no longer in print) The affidavit is used to disclose all sources of income when determining support for joint children. Minnesota Courts system maintains the affidavit, and it can be found on the Minnesota Judicial Branch's website under the category of "Other." The financial affidavit is located under the sub-category of "Family Forms." |
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| Full Child Support (IV-D) Services Application (DHS-1958) This form is used by an applicant who is not receiving public assistance and wants to apply for county child support enforcement services. The form includes an application, describes the services available, and explains the applicant's responsibilities. |
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| Income Withholding for Spousal Support (DHS-5785) This form is used by the obligee to initiate court-ordered income withholding (IW) for spousal support not involving child support. |
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| Income Withholding-Only (Non-IV-D) Services Application (DHS-3164) This form is used to apply for Non-IV-D Services. The county child support enforcement agency will use this information to process Non-IV-D automatic income withholding. |
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| Minnesota Husband's Non-paternity Statement Revocation Form (DHS-3159e) This is a legal form to cancel a previously signed Husband's Non-paternity Statement. |
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| Minnesota Voluntary Recognition of Parentage (DHS-3159) This is a legal form to voluntarily establish paternity for a child born to parents who aren't married to each other. |
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| Minnesota Voluntary Recognition of Parentage Revocation Form (DHS-3159b) This is a legal form to cancel voluntary paternity establishment created by a previously- signed and filed Recognition of Parentage form. |
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| Minnesota Voluntary Recognition of Parentage Husband's Non-paternity Statement (DHS-3159c) This is a form a husband can sign when he is not the father of his wife's child. Signing this form ends the legal relationship between a presumed father and child when a Voluntary Recognition of Parentage Form is also signed and filed. |
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| Referral to Support and Collections (DHS-3163b) This form is used by MinnesotaCare and Medical Assistance recipients for referral to the local child support agency to establish paternity or child support enforcement services. |
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| Request for Exception to Direct Deposit (DHS-4583) The State of Minnesota, Child Support Enforcement Division now sends support payments by direct deposit. This form is used to request an exception to direct deposit. |
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| Request to Close Support Case (DHS-4060) This form is used by people who applied for child support services to request to close their case. |
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| Stored Value Card (DHS-4533) This form is used to sign up to have child support payments loaded to a prepaid U.S. Bank ReliaCard®Visa. |
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| Unreimbursed and/or Uninsured Medical Dental Expenses Packet (DHS-4931) This packet is for the collection of unreimbursed and/or uninsured medical or dental expenses from the requesting party to the non-requesting (liable) party. The packet contains the information, notice, and instructions for the requesting party, and the notice of intent to collect the unreimbursed and/or uninsured medical expenses and the affidavit that will be completed by the requesting party and sent to the non-requesting (liable) party. |
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