
Clear FormDHS3163BENG1019Referral to support and collections Purpose of formFOR OFFICE USE ONLYThe child support agency will use the information you give to help collect support.CASE NUMBERHow to.
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How to fill out the MN DHS-3163B online
The MN DHS-3163B form is a critical document used in the child support process. This guide will provide a detailed, step-by-step approach to filling it out online, ensuring that you understand each section and field required.
Follow the steps to successfully complete the form online.
- Click ‘Get Form’ button to obtain the form and open it for editing.
- Begin with your personal information in Section 1. Fill in your last name, first name, middle name, and maiden or other names as applicable. Ensure to include your complete address, date of birth, phone number, and social security number.
- Indicate your relationship to the children listed. Choose from mother, father, or other, and specify if necessary. Also, note if you require medical assistance services.
- In Section 2, provide details on the other parent or alleged father. Input the name, date of birth, gender, and address. If applicable, include the date of death and any additional names used.
- Complete Section 3 for each child living with you. Provide their names, date of birth, social security numbers, and relationships to the other parent using the provided codes.
- In Section 4, fill in the employment details for yourself and the other parent, including employer names, job titles, and salary information.
- Proceed to Section 5 to provide information about any child support payments the other parent may be required to make. Indicate the type of court order if applicable and report any payment history.
- For Section 6, answer questions regarding the other parent's medical support responsibility and fill in any relevant insurance details.
- In Section 7, provide identifying data about the other parent, such as race, current marital status, and details about relatives if known.
- Complete all additional required context in Sections 8 and 9, which include your relationship status and any additional information about the other parent.
- Finally, review the authorization, understanding, and declaration section. Sign and date the form to confirm that the information is accurate.
- Once all sections are completed, you can save your changes, download the form, print it, or share it as necessary.
Complete your MN DHS-3163B document online for efficient processing.
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