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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF CHILD SUPPORT SERVICES TERMINATION OF BENEFITS / EMPLOYMENT NOTICE DCSS 0114 (09/20/2015) EMPLOYER: DATE: EMPLOYEE: COUNTY: SSN:.

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How to fill out the Dcss 0114 online

The Dcss 0114 form is essential for reporting the termination of employment or benefits for employees with support withholding obligations. This guide provides a clear, step-by-step approach to assist you in completing the form accurately and efficiently online.

Follow the steps to complete the Dcss 0114 form

  1. Press the ‘Get Form’ button to access the Dcss 0114 form and open it in your chosen editor.
  2. In the 'Employer' field, enter the name of the employer reporting the termination.
  3. Complete the 'Employee' field with the name of the employee.
  4. Fill in the 'SSN' field with the employee's Social Security Number.
  5. Enter the 'Participant Number' assigned to the employee.
  6. Indicate the 'Termination of' status by selecting either Employment, Health Benefits, or Both.
  7. Specify the 'Reason for Termination' and indicate if it is a Temporary Lapse or Permanent Termination, along with relevant dates.
  8. Complete the sections for 'Last Known Home Address' and 'Telephone Number' of the employee.
  9. Review the certification statement, providing your 'Signature', 'Printed Name', 'Title', and 'Date' to confirm accuracy.

Complete your documents online today for a smooth filing experience.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232