Form 03EN017E - Oklahoma Department of Human Services

OKLAHOMA DEPARTMENT OF HUMAN SERVICES
Oklahoma Child Support Services
P.O. Box 53552
Oklahoma City, Oklahoma 73152
Customer Assistance: 1-800-522-2922
www.okdhs.org
Motion to Modify Child Support in District Court Instructions and Forms
GENERALLY:
You MUST have an Oklahoma chi ld support order fr om the Di strict Court in the county
where you will f ile the Moti on to Modify. If y ou do not hav e an Oklahoma child support
order these forms will not work.
If you use these materials, you will be proceeding pro se, that is, you will be representing
yourself in court. Oklahoma Child Support Services (OCSS) cannot provide legal advice
to you. If you need help, please seek the advice of a private attorney.
You will be responsible for paying the filing fee to the Court. You will also pay fees
for service of process. These fees are subject to change. You may contact the
Court Clerk of the court where you will be filing the papers to find out what the
current court costs are, and your local sheriff or private process server to find out
how much it will cost to have the papers served. If you decide to serve these
papers by certified mail, contact the U.S. Postal Service for the total cost.
BEFORE YOU BEGIN THE PROCESS, you will need:
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a copy of your last District Court order for child support;
an address or contact information for the other people in the case;
your Family Group Number (FGN) if you have an open case with OCSS;
the address of the OCSS office where y our case is assigned or the OCSS offic e
assigned to the count y where you file your Motion to Mo dify. If you are not sure
which office your case is assigned to, you can call customer service at
1-800-522-2922 for that information. A list of OCSS offices by county is available
at the OK DHS website at http://www.okdhs.org or by phone at the customer
service number; and
the following forms (included with these instructions):
• Motion to Modify Child Support
• Order for Hearing on Motion to Modify Child Support
• Notice of Child Support Proceeding
• Affidavit of Service by Certified Mail
• Order Modifying Child Support
Print neatly and use a pen with blue or black ink.
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Step one: Complete the Motion to Modify Child Support
The first thing y ou will do is complete the Motion to Modi fy Child Support form. T his
document asks the Court to change the amount of child support ordered in your case.
Look at y our last c hild support orde r. You w ill need information from the
order to complete the forms.
Fill in the name of the county where your child support order was filed in the
blank at the top of the form. Example: In the District Court of ____ County.
Print the names in your case in t he blanks at the top left of the first page of
the Motion. The names should read the sa me as they appear on your child
support order.
Fill in t he blank mar ked Dist Ct. Case No with the court case number,
usually found at the upper right hand side of your Order.
Fill in the bl ank marked OAH Case No with your OAH Case Number. You
will only have an OAH Case Number if
you have an existing case with
OCSS and your case has been on an Administrative Docket. If the number
is not on t he order that you are tr ying to change, it will be on court papers
that you have received from OCSS. Example: 04-3215-72.
Fill in the blank marked OK IV-D FGN with your Family Group Number. You
will only have an OK IV-D FGN if you have an existing ca se with OCSS. If
the number is not on the order that yo u are trying to chan ge, it will be on
papers that you have received from OCSS. Example: 123456001.
Fill in the blanks for obligor and custodial person. Obligor is the person who
is ordered to pay child support. Custodial person is the person who gets the
child support.
Print your name in the blan k contained in th e statement, I, _______
respectfully show the Court:
In paragraph 1, check mother or fa ther, whichever pers on was ordered to
pay support. Print the amount of child support in the first blank and the date
of the last order in t he second blank. Then fi ll in the name(s) of all children
and their birthdates included in the last child support order.
In paragraph 2, you must t ell the court why y ou want your child support
changed. Check the box nex t to the reason you wa nt the child support
changed. You can check more than one box.
Print your name in the blank in the sentence that begins WHEREFORE.
Sign your name on the signature line.
Print your name on the line underneath your signature line.
On the next three lines, print your address and phone number.
On the lines below Verification you will need to put in the date and place
(city and state) where you signed the form and then sign the Verification.
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Step two: Complete the Order for Hearing
The Order for Hearing included in your packet is the form you use to get your court date.
Complete the top of the form just as you did the top of your Motion to Modify
Child Support - filling in the blanks with names, case numbers, etc.
Print your name in t he first blank of the first paragraph of t he Order. (The
Court sets the Motion to Modify Child Support filed by: ______ for hearing.)
Do not fill in the blanks for the Judge's name and the date for the hearing.
Print the name of the county in which you are filing your motion in the blank
in the first paragraph just before the words County Courthouse.
Write the address of the courthouse on t he lines pr ovided just after th e
first paragraph.
Do not write on the line for the date and t he Judge's signature. The Judge
will sign and date the form when a court date is set.
On the lines provided aft
and address.
er the wor ds Prepared by: print y our name
Step three: Complete the Notice of Child Support Proceeding
The Notice of Child Support Proceeding included in your packet is the form you use to tell
OCSS that you are filing the Motion to Modify.
Complete the top of the form just as you did the top of your Motion to Modify
Child Support - filling in the blanks with names, case numbers, etc.
Sign and print your name on the lines for Signature and Printed name.
In the Certificate of Service portion, enter t he date y ou will deliv er the
papers by mail or by hand to O CSS. You must deliv er this form after the
papers are filed, s o the da te should be on or afte r the dat e you will fil e
the forms.
Write the address of your local OCSS office in the lines after at the following
address:
Check the box that describes how you will deliver the papers to OCSS.
Step four: File the Motion to Modify and Notice of Child Support
Proceeding
Take your completed Motion and Notice of Child Support Proceeding to the
Court Clerk's office of t he District Court. Rememb er, this will be the Court
that issued the or der that you ar e trying to chan ge. You must bring the
original and four copies of the motion with you to the Court
Clerk's office.
You will have to pay the filing fee when you file y our Motion. Call ah ead or
visit the Court Clerk's offi ce and ask what th e fee will be and h ow they will
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accept payment - some offices may not accept personal checks. This is
only a filing fee and not a service fee.
Give your Motion and Notice to t he clerk. Tell the clerk that you need to file
the Motion and Notice. The clerk will file stamp your original and copies, the
original will be kept by the c lerk for t he court file. The file stam ped copies
will be given back to you.
Step Five: Get a court date and file your Order for Hearing
The Order for Hearing is the form the court uses to give you a hearing date
for your M otion. When you f ile your Motion, show the clerk y our Order f or
Hearing and ask the Court Cler k how to get a hearing date. The wa y you
get a court date is different in different courthouses:
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the clerk may be able to give you a court date; OR
the clerk may tell you to go to t he Judge's office to get a hearing
date. You may need to leave the Order for Hearing with a copy of the
Motion to Modify with the Judge for several days. You may also want
to leave an extra copy of the Mo tion to Modify with the Judge as
some judges require this.
Either way, the completed Order for Hearing will show the date and time for
your hearing and will be signed by the Judge.
When the Order for Hearing is completed, you will need to make four copies
and have the clerk file it the s ame way as the Motion was filed. You should
not have to pay another filing fee to file the Order for Hearing.
You have filed your Motion with the Court and you have a hearing date. You will
keep the extra copies for your records and for the other people in the case.
Step six: Service of Your Motion and Order for Hearing
Before the Judge can hear your Motion, you must have proof that the other people in the
case and OCSS hav e received a copy of t he Motion and the Or der for Hearing. This is
called service.
Service on the other people in the case:
You can serve the papers on the other people in the case in a number of ways:
Option 1: send the papers by certified mail, restricted deliver y, return receipt
requested (this is the least expensive method);
Option 2: pay a private process server to deliver the papers; or
Option 3: pay the county sheriff's office to deliver the papers.
Each method of service is described below:
Option 1: Service by Certified Mail
Insert one file-stamped copy of the Motion and one file-stamped copy of the
Order for Hearing into an envelope and take it to your local post office.
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Tell the m ail clerk t hat you need t o send the letter by cert ified mail,
restricted delivery, return receipt requested. You MUST restrict delivery to
the person you want to serve.
The clerk will direct you to the materials you need to fill out.
Pay the postage and mail the packet.
Wait to receive the green card (return receipt) in your mail. If you do not get the card
within one week of your court date, you will have to try one of the other methods of
service. You may al so receive the entire packet back in the mail if the other party does
not claim the mail. If the mail is unclaimed, you will have to serve the party by one of the
other methods.
When you get the green card back signed by the person to whom it was ad dressed, you
must complete the Affidavit of Service by Certified Mail.
Complete the top of the Affidavit of Service by Certified Mail just as you did
the top of your M otion to Modif y Child Support - filling in the blanks with
names, case numbers, etc.
Fill in the date you mailed the papers.
Fill in the name of the person to whom you sent the papers.
Fill in the address where you mailed the papers.
Make a copy of the front and back of the green card for yourself.
Staple the green card to the s econd page of the Affidavit of Service. Make
sure the person's signature is showing.
On the day of the hearing, take the Affidavit of Service by Certified Mail and
one copy to the Court Clerk for filing. Bring the file-sta mped copy to your
hearing.
Option 2: Service by Private Process Server
Choose the proc ess server you w ould like to use by look ing in th e yellow
pages of your telephone book or on the Internet. Call ahead to find out what
the fee will be. Ask the proc ess server you choose to tell you how they will
serve the other people in the c ase and what papers they will f ile with t he
court to prove that they delivered the papers to the people in the case.
Write down inform ation that t he process server may need to serve your
papers such as: their addresses, their physical description (provide a recent
photograph if you have one), what k ind of car they drive, and wh ere
they work.
Deliver the following to the process server:
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one copy each of your Motion and Order for Hearing;
the information about how to find the people you need to serve; and
the service fee.
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The process server should file a Return of Service with the c ourt. A Return
of Service is a paper that will tell the Court that the other people in the case
were served with the Motion and Order. The pr ocess server should also
give you a copy of the Return of Service for your records.
You MUST have a copy of the Return of Service with you on your
court date.
Option 3: Service by County Sheriff
Contact the County Sheriff's office in y our county to find out how to hi re them to serve
your papers. This process is different in different counties. Usually, you will need to follow
these steps:
Write down information that the Sheriff may need to serve your papers such
as: their addresses, their physical description (provide a recent photograph
if you hav e one), what kind of car they drive, and wher e they work. Make
sure to include on the note that you want the Return of Service mailed
to you in the envelope provided.
Prepare a self-addressed, stamped envelope (addressed to you). The
Return of Service will be mailed to you in this envelope.
Take the following items to the County Sheriff's Office in the county in which
your hearing will be held:
1. one copy each of your Motion and Order for Hearing.
2. the information about how to find the people you need to serve;
3. a money order or personal check for the service fee (you should call
ahead to find out how much the fee is); and
4. the self-addressed, stamped envelope you prepared for the Ret urn
of Service.
Tell the Sheriff y ou want personal service and you would like the Return of
Service mailed to you in the envelope provided.
If the Sheriff does not file the Return of Ser vice, file the Return of Service
and one c opy with the court clerk on the day of y our hearing. Bring the
copy of the Return of Service to the hearing.
Service to OCSS
You must serve the Motion to Modify Child Support, Notice of Child Support Pr oceeding,
and Order for Hearing on the local child support office.
You can s erve the papers on OC SS by mail or in person. Ma il or bring t he papers to
your assigned OCSS office. If you are not su re which office your case is assigned to,
you can call customer servic e at 1-800-522-2922 to get the in formation. If you do not
have an open OCSS case, deliver the copies to the OCSS office assigned to the county
where you file your Motion to Modify. A list of OCSS offices by county is available at the
OKDHS website at http://okdhs.org or by phone at the customer service number.
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Step seven: The hearing
On your court date bring the following with you:
Your copy of the Motion.
Your copy of the Order for Hearing.
A copy of the last Order for Child Support that you are modifying.
The Order Modifying Child S upport that is included in this packet . Fill in
the blanks on the top half of the first page, just as you did on your Motion.
The remaining blank s will be filled in after the judge issues a ruling at
the hearing.
If you served your papers by certified mail, bring the file-stamped Affidavit of
Service by Certified Mail to show the judge that you have service.
If you ser ved your papers by private process server or by s heriff, bring a
file-stamped copy of the Return of Service with you.
All proof of income: current pay che ck stubs, any evidence of disability,
copies of W-2 and 1099 forms, and inc
ome tax returns for the last
three years.
Proof of healt h insurance coverage and costs
for the child(r en) or
information about other medical coverage available for the child(ren) (such
as Indian Health Services, Military (DEERS) or Soonercare).
Proof of any child care costs.
At the hearing:
Be early and dress appropriately for a courtroom setting.
DO NOT bring your children.
Be prepared to wait. Your case may not be heard at the exact time listed on
your Notice of Hearing.
Be prepared for the judge to set another court date for the other people in
the case to get attorneys if they choose.
You may not get a final order on the first court date.
If the case is continued, be sure to appear at all court dates, or your Motion
to Modify could be dismissed.
Agreed modification:
If you, t he other people in the c ase, and OCSS (if there is an open chil d
support case) hav e agreed what the income for eac h parent is, you wil l
need to c alculate the ch ild support guidelines t o see what the new child
support amount wil l be. Y ou can calcul ate the child support guidelin es on
the Internet at http://www.okdhs.org and look under the Forms Section.
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When you know what the new child support amount will be, tell the judge
about your agreement when you are asked to present your case. The judge
will review your agreement and decide if it is within the law and appropriate.
No agreement:
If you and the other person do not ag ree on the ne w child support amo unt,
the judge may set the case for a hearing or trial.
Be prepared to tell the judge why your child support should be modified.
After the case is decided, you will need to prepare the Order Modifying Child
Support. You, the other people in t he case, and OCSS (if ther e is an ope n
child support case) must sign the order before it is given to the judge.
If OCSS is involved in yo ur case and present at th e hearing, the OCS S
attorney will help you prepare the order and the child support guidelines form.
If OCSS is not involved, you may need to show your order to the court and
ask for t he court's help in c ompleting the order and t he child support
guidelines form.
If the other parent does not appear:
Make sure you have your Affidavit of Service proving that you served the
other person with notice of the hearing date.
If you can prov e service, you can ask the judge for a def ault order. Make
sure you have inf ormation to give the judge about the inc ome of bot h
parents. For example, you can bring:
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a paycheck stub or tax return for the other parent; or
•
the average income for a person in the same type of job as the othe r
parent. Some of this inform ation is available on the Internet:
http://tinyurl.com/qwdwds.
or you can offer to testify as to t
he other person's job history, training,
education, and past earnings.
When the judge grants y our Motion to Modify by default, you should
prepare the Order Modifying Child Support and the child sup port guidelines
form. Sign them both and give them to the judge.
If the judge denies your Motion to Modify:
After the judge hears your evidence, your Motion to Modify may be denied.
If your Motion to Modi fy is denied, yo u will st ill need to prepar e the Order
Modifying Child Support. You will check the box in par agraph two showing
the Motion to Modif y is denied. Yo u do not need t o fill in t he other
paragraphs of the order.
You do not need to attach a child support guidelines form.
Sign the order and give it to the judge.
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After the order is prepared:
The Judge will sign the order and child support guidelines form and return it
to you for filing.
In the Certificate of Service portion, check the bo x describing how you will
deliver the order to the ot her people in the case an d to OCSS. Write in the
date you will deliver t he order to the other people. Sign the bottom of the
Certificate of Service on the signature line.
Unless the Moti on to Modi fy is deni ed, you will need to attach the chil d
support guidelines f orm to the or der and make four c opies of th e papers.
File them at the Court Clerk's office the same way you filed your Motion.
Keep at least one c opy of the order and c hild support guidelines form for
your records.
You MUST mail though regular mail or hand-deliver copies of the order and
the attached child s upport guidelines form to the other people in the c ase
and OCSS. If OCSS does not r eceive a copy of the order, it cou ld create
problems with your child support case.
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IN THE DISTRICT COURT OF
STATE OF OKLAHOMA
)
)
)
)
)
)
)
)
)
COUNTY
Dist. Ct. Case No.
OAH Case No:
OK IV-D FGN:
Obligor:
Custodial Person:
MOTION TO MODIFY CHILD SUPPORT
I,
respectfully show the Court:
Your name
1. The
mother or
to pay $
father of t he minor child(ren) in the abov e case was ordered
per month for child support on
Date of order
for the child(ren)
listed below:
Child's name
Date of birth
2. Since that or der was ent ered there has been a s ubstantial and material change in
circumstances as follows: (Check boxes that apply to your situation.)
A child for whom the order was entered has tur ned 18 an d is no lon ger
regularly enrolled and attending high school.
The father's income has changed.
The mother's income has changed.
The living arrangements of the child(ren) have changed.
The child care expenses have changed.
There has been a c hange in health in surance or it was not a ddressed in a
previous order.
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Other:
WHEREFORE
requests this Court modify the
(Your name)
child support order.
Respectfully submitted,
Signature
Printed name
Address
Address
Phone
Verification
By signing below, I state under penalty of perjury under the laws of Oklahoma that I have
read this Motion to Modify Child Support and I am fam iliar with its contents and the facts
as set forth are true and correct.
Date:
Place:
Your signature
City, state
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IN THE DISTRICT COURT OF
STATE OF OKLAHOMA
)
)
)
)
)
)
)
)
)
COUNTY
Dist. Ct. Case No.
OAH Case No:
OK IV-D FGN:
Obligor:
Custodial Person:
ORDER FOR HEARING ON MOTION TO MODIFY CHILD SUPPORT
The Court sets the Motion to Modify Child Support filed by:
for hearing before Judge
20
at
at:
o'clock
.m. at the
(Your name)
on
,
County Courthouse
(Address)
.
All parties are ordered to br ing: current pay check stubs, an y evidence of a di sability,
copies of W-2 and 1099 forms, and income tax returns for the last t hree years, health
insurance costs for children, and proof of any child care costs.
Dated:
Prepared by:
JUDGE OF THE DISTRICT COURT
Printed name
Address
Address
Phone
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IN THE DISTRICT COURT OF
COUNTY
STATE OF OKLAHOMA
)
)
)
)
)
)
)
)
)
Dist. Ct. Case No.
OAH Case No:
OK IV-D FGN:
Obligor:
Custodial Person:
NOTICE OF CHILD SUPPORT PROCEEDING
This is to notify Oklahoma Child Support Services (OCSS) that a Motion to Modify
Child Support has been filed in the abov e case. OCSS ma y be a necessary party in this
case pursuant to 43 O.S. Section 112.
_____________________________________
Signature
_____________________________________
Printed name
CERTIFICATE OF DELIVERY
This is to certif y that a tr ue and c orrect copy of the abov e Notice of Ch ild Support
Proceeding was delivered to OCSS on
at the following address:
by:
First class mail to OCSS; or
Hand-delivery.
_____________________________
(Signature)
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IN THE DISTRICT COURT OF
COUNTY
STATE OF OKLAHOMA
)
Dist. Ct. Case No.
)
)
OAH Case No:
)
)
OK IV-D FGN:
)
)
Obligor:
)
)
Custodial Person:
AFFIDAVIT OF SERVICE BY CERTIFIED MAIL
I certify that on
, I mailed a copy of the Motion t o
Modify and Order for Hearing in the above case to
at the following address:
by certified mail, return receipt requested, restricted delivery, and:
delivery was made to the addressee who signed the return receipt card; or
delivery was refus ed by the address ee as ind icated on the ret urn receipt
card. The documents were then sent t o the addressee by regular mail, fir st
class, postage fully prepaid on
.
The return receipt card is attached as Exhibit A.
_____________________________________
Signature
_____________________________________
Printed name of person mailing documents
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Affidavit of Service by Certified Mail -- Exhibit A
Attach original return receipt card here.
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IN THE DISTRICT COURT OF
STATE OF OKLAHOMA
COUNTY
) Dist. Ct. Case No.
)
) OAH Case No:
)
) OK IV-D FGN:
)
) Obligor:
)
) Custodial Person:
(Insert Case style above as it is on your original Order.)
ORDER MODIFYING CHILD SUPPORT
On
, 20
, this matter came on for h earing on
the Motion to Modify Child Support filed by
[43 O.S. Section 118]. The
Oklahoma Department of
per
Human Services (OKDHS),
Oklahoma Child Support Services, appears through its attorney.
The obligor (noncustodial parent) appears:
in person, pro se;
In person, with counsel
not;
not, being in default;
not, having previously signed this order; or
not, represented by counsel
;
.
The custodial person appears:
in person, pro se;
in person, with counsel
not;
not, having previously signed this order; or
not, represented by counsel
;
.
Other persons appear:
The Court, being inf ormed by evidence presented and h earing from the parties,
find that this Court has juris diction over the parties and the subjec t matter of this act ion.
The Court, therefore, FINDS, ORDERS, AND DECREES AS FOLLOWS:
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1.
CHILDREN. The
mother or
father of the m inor child(ren) in the abov e
case was ordered to pay $
per month for child support on
for the child(ren) listed below:
Date of order
Child's name
2.
Date of birth
MODIFICATION.
The moving part y has failed to show a mater ial change of c ircumstances that
would justify a m odification of the child support amount. Therefore, the Motion t o
Modify is denied.
Since the order was ent ered there has been a subst antial and material change in
circumstances as follows:
a child for whom the or der was ent ered has turned 1 8 and is no lon ger
regularly enrolled and attending high school;
the father's income has changed;
the mother's income has changed;
the living arrangements of the child(ren) have changed;
the child care expenses have changed;
there has been a c hange in health insurance or it was not addressed in a
previous order; or
other:
.
3.
CURRENT CHILD SUPPORT:
has
a duty to provide support for the minor child(ren) who is/are the subject of this action and
shall pay child support in the following amounts in accordance with the attached support
computation sheet. Payment shall begin
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and
continue on the same day of each month thereafter, until the child(ren) reach(es) the age
of eighteen years. Provided, that if the last minor child residing with the custodian reaches
the age of eight een years and is still att ending high sc hool, child support shall c ontinue
until the age of twenty years, so long as t he child is regular ly enrolled in and attending
high school, including other means of high sc hool education or an alternative high school
education program.
Child Support Obligation Subtotal (line 26a)
$
Cash Medical Support if ordered (line 26b)
$
Ongoing Medical Support if ordered (line 26c)
$
Total obligation to be paid by obligor (line 27)
$
The child support obli gation is set in ac
cordance with the child support
guidelines without deviation and a c opy of the child support computation sheet
is attached hereto.
The Court deviates f rom the c hild support guidelines as t hey result in an
amount that is inequitable, unreasonable under the circumstances, and/or not
in the best interests of the child(ren), and in support of the deviation the Court
finds the following:
OR
Child Support is not being set at this time due to the following reason(s):
the biological parents are residing together supporting the children;
OCSS has been unable to locate the custodial person; or
other:
The Court shall reconsider t he issue of current child support and any arr ears which may
be owed to the custodian upon proper application by any party.
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4.
MEDICAL SUPPORT ORDER.
A.
Medical Support definitions.
Reasonable in cost means dependent coverage does not exceed 5% of the party's
gross income.
Reasonable in cost for Father is an amount not to exceed $
per month.
Reasonable in cost for Mother is an amount not to exceed $
per
month.
Accessible means t here are available prov iders appropriate to meet
the
child(ren)'s individual health care needs within 60 m iles one-way from the primary
residence of the child(ren).
B.
Medical Support Orders. (Choose all that apply from Options 1, 2, or 3)
Option 1:
Accessible employer-sponsored or other group medical insur ance is
available at a reasonabl e cost and is ordered.
Mother
Father has
dependent health ins urance in effect or available through an employersponsored or other group plan and shall provide the insurance until further
order of the court.
The employer-sponsored or ot her group medical insurance pr emium
exceeds the 5% reasonable cos t standard. However, the court orders
coverage in excess of the standard based on the agreement of the parties
or the child(ren)'s best interests.
Mother
Father shall provide the
insurance until further order of the court.
Option
2:
Father, or
Alternative
health
coverage
ordered.
Mother,
Other, spec ify name an d relationship to child(r en):
has
alternative
health
coverage for the child(ren) in effect or available as described b elow and is
ordered to maintain the cover age as lo ng as the c hild(ren) continue(s) to
be eligible:
a.
Indian Health Services. Child(ren) is/are eligible or belie ved to
be eligible for Indian H ealth Services. The par ents shall cooperate fu lly to
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enroll the child(ren) in t he tribe and provide a co py of the c ard or othe r
documentation to the child support office. Tribal affiliation:
.
If the child(ren) is/are determined eligible for Indian Health Services, other
health care coverage for the child(ren)
b.
is required
is not required
Department of Defense (DOD). Child(ren) are be lieved to b e
eligible for or enrolled in the DOD managed health care program. The name
of the DOD sponsor is
. The parents shall cooperate fully in
enrolling the child(ren) in the Def ense Enrollment Eligibility Reporting
System (DEERS) and prov ide a c opy of the identification card for the
child(ren) to the child support office. Whenever coverage through DEERS
ceases to be avail able, health insurance shall be pr ovided by
Mother or
Father thr ough an ac cessible employer-sponsored or other gro up plan
at a cost not to exceed $
c.
per month.
Child(ren) is/are covered under health coverage provided
, current spouse of
by
Mother or
Father. In t he event that heal th coverage is no lo nger being
provided by the step-parent,
Mother or
Father shall provide
accessible health coverage at a cost not to exceed $
, if such
coverage is accessible.
d.
Other alternative coverage.
shall provide h ealth coverage
for the minor child(ren) in this case through the following coverage type:
.
Option 3: Cash medical. The court finds that currently:
there is no information regarding available insurance coverage;
there is no insurance coverage available; OR
the available coverage:
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is not reasonable in cost; OR
is not accessible to the minor child(ren).
a.
The court orders
support in the amount of $
Mother or
Father to pay cas h medical
per month. The c ash medical support is
included in the child support amount ordered above.
b.
All cash medical support shall be pa id through the Oklahoma
Centralized Support Registry as outlined below. The cash medical amount
should be disc ontinued when health insurance becomes available at a
reasonable cost and the child is enrolled in the insurance plan unless it was
ordered due to family vi olence issues. The party providing insurance must
provide proof to the c ourt, OCSS, and the other part y that the child(re n)
is/are covered by the insurance plan. The cash medical shall be terminated
by notice sent to the parties by regular mail.
c.
If the child( ren) is/are not c overed by d ependent health insurance,
alternative health coverage, or a gov ernment medical assistance program,
the custodial person is ordered to apply immediately on behalf of the child
for government medical assistance (such as Soonerc are or similar
program) unless t he court finds ot herwise. The custodial person must
provide proof of application for services to the other parent within 30 days of
this order.
AND (Choose one or more)
Mother shall obt ain accessible health insurance coverage for the minor
child(ren) whenever such insurance is available through an employer or
other group plan, at a cost not to exceed $
per month, (must
not exceed 5% of the party's current gross income).
Father shall obtain a ccessible health insur ance coverage for the minor
child(ren) whenever such insurance is available through an em ployer or
other group plan, at a cost not to exceed $
per
month (must not exceed 5% of the party's current gross income).
The obligor is not required to obtai n health insurance coverage for the
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minor children because family
violence issues exist and release of
information for purposes of enrollm
ent in insurance coverage would
endanger a party or child(ren) ; or obligor is partici pating in a g overnment
sponsored medical assistanc e program; or it is in the best interests of
the child(ren).
C.
Additional Medical Support Orders.
(1) Non-covered expenses. Mother shall pay
shall pay
per cent and F ather
per c ent of t he reasonable and necessary medical, dental,
orthodontic, optometric, psychological, or any other physi cal or mental health
expenses for the minor chi ld(ren) not covered by insu rance or ot her thirdparty coverage. The parent who incur s the expe nse shall be r eimbursed by
the other parent within thirty (30) days of receipt of documentation of the noncovered portion of the expense.
(2) Exchange of Information. The pers on ordered to prov ide health
insurance shall provide t he custodial person and OCSS wit h proof of
enrollment, insurance cards, policy information, policy number, and any other
documents necessary for the c hild(ren) to use the ins urance. The custodial
person and non-c ustodial parent s hall be requi red to exchange any
information necessary to secure dependent health insurance enrollment.
The parents must furnis h each other and O
CSS with timely written
documentation of any chan ge in health insurance within 30 days of the dat e
of the change. Upon timely not ification of the c hange, the ot her parent is
responsible for hi s/her percentage share of the ch anged cost of t he health
insurance. Failure to provide timely notice may result in a denial of the right to
receive credit or reimbursement for the expense or increased premium.
(3) Fixed Ongoing Medical Costs (check only if applicable). The current
monthly child support amount includes obligor's portion of f ixed ongoing
medical costs for the following expenses:
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in the amount of $
(Child Support Computation line 1 6b).
The payment of fix ed ongoing medic al costs shall be ter
minated on
, and t hereafter the current monthly child support
obligation shall be $
(4) Other:
5.
unless otherwise modified by the court.
________________________________________
CHILD CARE. (select one)
The obligor's share of child car e expenses is included in the ch ild support
amount ordered in paragraph 3 above. The custodial person shall provide timely
documentation to the Obligor of said expenses.
Child care is not currently being expen ded, but s hould such expenses occur,
the obligor is ordered to pay
percent of monthly employment or
education-related child care expenses of
said child(ren), as additional child
support, commencing on the same day and to be paid in the same manner, a s any
current child support set out
in paragraph 3 above. The
custodial person shall
provide timely documentation to the obligor of said expenses.
6.
METHOD OF PAYMENT. Child support and judgm ent payments shall be
made payable to the Oklahom a Department of Human Services (OKDHS) and mailed
to: Oklahoma Centralized Support Registry,
P.O. Box 268849, Oklahoma City, OK
73126-8849, with the child support case number:
,
on the face of the
payment. Payments may also be paid electronically through the State of Oklahoma Web
Pay System.
Payments shall continue to be made in this
manner for so long as Oklahoma child
support services are provided for the benefit of the mi nor child(ren) by OKDHS. Upon
termination of such s ervices, OKDHS shall provide written notice to the person owing
the child s upport. Any delinquent child support payments due at the time and st
ill
subject to an assignment made in favor of OKDHS shall continue until the assignment
has been release d by OKDHS. PAYMENT S MADE IN ANY MANNER OTHER THAN
AS SPECIFIED IN THIS ORDER SHAL L BE CONSIDERED GIFTS AND SHAL L NOT
BE CREDITED TO THE AMOUNT OWED.
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7. INCOME ASSIGNMENT. An immediate income assignment is ordered pursuant
to 12 O.S. Section 1171.3(G)(1 ). A portion of the obli gor's monthly or other per iodic
income shall be as signed to the cust odial person or appropriate agency in an am ount
sufficient to ens ure payment of the monthly support obligat ion, including any arrearage
and judgment payments. The assignment is effective immediately; provided however, that
the obligor remains responsible for making payments directly to OKDHS in any
month when an income assignment is not in effect or does not pay the full amount
due under this order.
8. ADDRESS OF RECORD FOR SERVICE OF PROCESS AND
ADDRESS AND EMPLOYMENT CHANGES. 43 O.S. Section 112 requires all
parties and custodial persons to inform the Central Case Registry of the current address
of record for service of process in support, visitation, and custody actions. The following
applies to the obligor and any custodial person subject to this order. Any changes
(names and address es) in y our address of record, your
employer, and your health
insurance must be provided in writing to the Central Case Registry within 30 days of the
change at the following address:
Central Case Registry
P. O. Box 248843
Oklahoma City, Oklahoma 73124-8843
Your last address of record may be disclosed to a party or custodial person upon request
in accordance with OKDHS rules. OKDHS does not release home addresses if prohibited
by a court order granted for t he protection of a par ent or custodial person, or if th e case
has a family violence indic ator. The address of record does not have to be t he address
where you live. You may be served in child support actions filed after this date by regul ar
mail to the last address of record provided to the Central Case Registry. If your physical
address and addres s of record are differen
enforcement office of any changes in your
t, you must notify the child support
physical address. F uture notices shall b e
sent to the last address of record provided to the Central Case Registry.
The following is the current address of record for service of process for the obligor:
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The following is the current
address of r ecord for service of proc ess for t he
custodial person:
____________________________________________________
9. PRIOR ORDERS AND CHILD SUPPORT ARREARS. All provisions in
prior orders entered in this case not s pecifically modified herein remain in full force and
effect. The issue of child suppor t owed by either par ent for a p eriod prior to this order is
reserved for future determination.
10. INTEREST ON PAST-DUE CHILD SUPPORT. Unpaid child su pport
payments accruing under an Oklahoma order draw interest at the rate of ten per cent per
year from t he date they bec ome delinquent, and the inter est shall be c ollected in th e
same manner as the paym ents upon which the interest accrues. Orders issued by other
states may have a different interest rate for unpaid child support.
11.
OBLIGOR'S EMPLOYMENT INFORMATION.
Employer's name:
Address:
Phone number:
12. ENFORCEMENT. The OKDHS Oklahoma Child Support Serv ices Division may
enforce this order in any court with jur isdiction to enforce child support orders, i ncluding
administrative court. T he obligor underst ands that until (1) all past-d ue child support is
paid in full, and (2) the obligor is current on all support obligations, multiple enforcement
remedies may be us ed. These remedies include, but are not limited to, interception of
state and federal tax refunds, and pursuant to 56 O. S. Section 240.23 of the Oklahoma
Statutes, intercepting or seiz ing periodic or lump-sum payments from: (1) a state or lo cal
agency, including unemploym ent compensation, workers' compensation, and ot her
benefits; and (2) judgments, settlements, and lotteries; attaching and seizing assets of the
obligor held in financial instit
utions; attaching public and privat e retirement funds;
imposing liens in acc ordance with 43 O.S.
Section 135; and in creasing the mont hly
payment on child support, for purposes of securing past-due support, in an amount not to
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exceed five per cent of the t otal child s upport order. Such increa se may not be made
more than once every 12 months.
13. ADDITIONAL ORDERS.
JUDGE OF THE DISTRICT COURT
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APPROVED AS TO FORM AND CONTENT:
Obligor signature
Custodial Person signature
Printed name
Printed name
Address
Address
Address
Address
Phone
Phone
Attorney for Obligor
Attorney for Custodial Person
OBA#
OBA#
Address
Address
Address
Address
Phone
Phone
Attorney for OCSS
OBA#
Address
Address
Phone
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CERTIFICATE OF SERVICE
This is to certify that copies of the foregoing Order Modifying Child Support were
served as follows:
In person on
, 20
to:
Obligor
Attorney for the obligor
Custodial person
Attorney for the custodial person
State's Attorney for OCSS
Other
By regular mail on
, 20
to:
Obligor at address of record
Attorney for the obligor at the address listed on page 27
Custodial person at address of record
Attorney for the custodial person at the address listed on page 27
State's Attorney for OCSS
Other
at
Signature of person certifying copies were served in person or mailed
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