Forms

We often send forms to you as part of your case. If you need another copy and it is a form that is listed below, you may print it from this list. If the form is one that you need to complete and return to our office, you may download, save and complete the fillable form on your computer. To return the form to our office, you can either print the form and mail it to our office, or you may attach it to an email and email the form to [email protected]. If you have questions about which form you need to complete, please contact us at 801-536-8500.

Financial Forms

XFWA Affidavit of Unauthorized Paper Debit

XEFA Electronic Payment Enrollment Form

Complete this form to sign up for electronic payments.

CFIN Post-Order Financial Statement

This form gives us a record of the finances of the paying parent. We use the information on this form to set how much that parent should pay for past-due child support.

CPIO-PRE Financial Statement for Order Establishment

CRVU Financial Statement for Review and Adjustment

This form gives us information about each parent’s finances. We use that information to look at the current child support payment amount and potentially change it to fit the parents’ current incomes.

CLAA Lost Warrant Declaration and Agreement

Complete this form if a check has been lost and it has been at least 10 working days since it was mailed.

Request Forms

UHRS Hearing Request: NAA - Child Support

URRC Hearing Request: NAA - Determination of Controlling Order and/or Reconcilliation of Arrears

UHRW Hearing Request: NAA - Failure to Withhold and/or Remit

UHRP Hearing Request: NAA - Parentage and Child Support

UHSR Request for Administrative Hearing: Retained Support

URGT Request for Genetic Testing: NAA - Parentage and Child Support

CIC-UHRC Request for Hearing - Notice of Agency Action

R30A Request for Information on Possible Divorce Action

OMRV Request for Review and Adjustment of Child Support Obligation

Use this form to officially ask us to start the process of reviewing your income and your child support amount. Depending on what we find, we may adjust the child support amount. To understand how the process works, we recommend first reading OM50, “Review and Adjust: Pre-review Packet.”

XZCB Request for Termination of Child Support Services

URDO Written Request for Recission of Order to Suspend Driver License

URRM Written Request for Review National Medical Support Notice

Complete this form if you do not think that you can or should carry medical insurance for your child. We will use it to review the National Medical Support Notice that we sent to your employer.

URAC Written Request for Review of Child Support Obligation Based on Physical Custody Change

URAA Written Request for Review of Past-Due Support Amount

Complete this form if you do not agree with the past-due amount that ORS shows that you owe. Be sure to include all evidence or documentation to support your claim.

URDL Written Request for Review: Driver License Suspension

URAL Written Request for Review: Notice of Lien Levy

URRN Written Request for Review: ORS/CSS Non-Cooperation Determination

URRB Written Request for Review: Payment Schedule

URTR Written Request for Review: Thrift Savings Plan - Income Withholding Order for State Agencies

WHRB Written Response Contesting Income Withholding

Applicant Information

XAPP Application for Child Support Services

XAPP Solicitud para los Servicios de Manutención de Menores

Complete this form to provide ORS with the information needed to open a child support services case. This form can also be completed online.

CIC-L01C CIC - Applicant/Recipient Information Request

L01A CSS- Applicant/Recipient Information Request

Parentage (Paternity) Forms

PAAX Parentage: Declaration of Affiliation

This is a legal affidavit that names a potential father of a child.

PAAR Parentage: Declaration of Affiliation, Relative

This form lists the alleged father and is used by one of the alleged parents to declare paternity, or by a relative or legal guardian to testify to the relationship of the alleged parents.

PQUE Parentage Questionnaire

PQUE Cuestionario de Paternidad

This form names a child’s potential father and gives us the information we need to pursue paternity establishment.

Insurance Credit Forms

I75A R Insurance Credit Request

If you pay insurance premiums for your child and your order was set in Utah, you might be able to get a credit for your child’s part of those insurance premiums. Complete this form and we will see if you qualify for this credit.

I75A V Insurance Credit Verification

If you are currently receiving an insurance credit, ORS must verify insurance information annually. Complete this form and return it to ORS before January 2nd to maintain your insurance credit

Other Forms

OM50 Review and Adjust: Pre-review Packet

This packet explains how child support amounts can be reviewed based on current income and potentially adjusted to a new amount. The packet contains a sample child support worksheet. It also includes income tables to help you calculate the potential changes. The packet also contains the form you need to officially request that we start the review and adjustment process.

QIGT General Testimony

XARR Stipulated Arrears Agreement

Complete this form to tell us that both parents agree on the balance of past-due support and that we can add that balance to the case for collection.