This page collects information on a parent or parents who are not present in the home with the child.
This page is displayed because you have indicated one or more children under the age of 18 on the application do not have a parent or parents living at home. If this is not correct, use the Previous button to go back and change the relationships entered on the previous page. If both parents are not present in the home, the mother’s information is collected first, then the father’s information.
Some items have an asterisk (*) next to them, indicating they are mandatory. You must fill in these items before you can continue to the next page.
Parent Details
Type the first name and last name in the text boxes. Be sure to use the full, legal name. Do not use nicknames. The First Name text box allows a maximum of 12 characters, and the Last Name text box allows a maximum of 19 characters. If the name does not fit in the boxes, type as much as you can.
Type the City and State of birth, along with the parent’s date of birth.
Type the Social Security Number in the text boxes using only numbers. Enter the first three digits in the first text box, the next two digits in the second text box, and the remaining four digits in the third text box.
Alias Information
This section only appears if you selected No to the question about the parent being deceased. Type in details in the text boxes if the absent parent has any alias information.
Ethnicity and Race
This section only appears if you selected No to the question about the parent being deceased. This section is optional. Select one of the options that describes the absent parent.
Parent Address
This section only appears if you selected No to the question about the parent being deceased. Address Line 1 and Address Line 2 fields should only contain letters, numbers and ‘-‘, ‘#’, and ‘/’. City should only contain letters. Zip Code should contain only numbers.
Parent Mailing Address
This section only appears if you selected No to the question about the parent being deceased. Enter information in the text boxes if the mailing address is different than the address the parent lives at.
Parent Employment Information
This section only appears if you selected No to the question about the parent being deceased. For employer, enter the company, business, or person the individual works for. If you do not know the exact name or address of the employer, provide as much information as possible.
Cooperation With Child Support Enforcement
This section only appears if you selected No to the question about the parent being deceased. Select either Yes or No to the questions “Would you like to claim good cause?” If you select Yes, select a reason from the drop down menu.
Add Another Parent
Select Yes or No to if you would like to add another parent. If you have Child Support Enforcement services, you may add up to a total of 2 fathers and 1 mother for each child less than 18 years old. If you do not have Child Support Enforcement Services, you may add several mothers and fathers.
Click the Print button to print this page for your reference.
Click the Next button to save and continue with the online Redetermination/Change Report/Simplified Report.
Click the Previous button to view the previous page.
Click the Save & Exit button to exit the online Redetermination/Change Report/Simplified Report and save your progress on your Redetermination/Change Report/Simplified Report. The Redetermination/Change Report/Simplified Report is saved as Incomplete.