Required Forms

EAS 82-510, CCR 50101, 50157, 50185

The same forms are used in both child and medical support enforcement; therefore, the following forms and completion instructions pertain to the CalWORKs and Medi-Cal programs. Refer to the topic Forms in Foster Care Handbook Chapter 9 Child/Medical Support Referrals for FC information.

CW 2.1 N&A "Notice and Agreement for Child, Spousal and Medical Support"

The EW must provide the client with the "Notice and Agreement for Child, Spousal and Medical Support" (CW 2.1 N&A) and image the signed copy.

CW 2.1Q "Support Questionnaire"

The EW must provide the client with the "Support Questionnaire" (CW 2.1Q) and image the signed copy. The information provided by the applicant about the absent parent must also be entered into CalSAWS on the Absent Parents page.

The minimum information to be provided on the CW 2.1Q for each absent parent is:

Name,
Date and place of birth,
SSN,
Last known address,
Income and employment information, including union and health insurance,
Relationship and marital status of absent parent,
Status of any support court order,
Friends or relatives of absent parent,
Name, SSN, birth date, and birthplace of absent parent's children.

The EW must review the form, ensuring that the boxes are complete. If the requested information is not known, “unknown” or “not available” must be entered. In order to expedite processing at DCSS, information concerning court-ordered child/medical/spousal support must be listed on the CW 2.1Q when available. A CW 2.1Q is required for EACH absent/unmarried parent (unless death verification is on file or the client claims Good Cause on the CW 2.1 N&A).

EWs must ensure that:

Only children for whom aid is being requested or paid, and who are citizens or legal non-citizens are listed on the CW 2.1Q. Undocumented children are not included in support enforcement activities.
The CW 2.1Q is thoroughly completed, especially the sections that pertain to voluntary or court-ordered support payments.

Both the CW 2.1 N&A and CW 2.1Q can be completed by phone, however, the telephonic signature process must be completed.

A referral to FRED must also be completed when, during the child support referral process for an applicant, it is determined that:

The father of the child(ren) for whom aid is requested is “unknown.”
The whereabouts of the absent parent is unknown.
The applicant has not cooperated with DCSS anytime in the past.
The absent parent’s children were conceived while the family was receiving CalWORKs or Medi-Cal.

Refer to the Possible Criteria for FRED/General On-Going Fraud Referral section of DEBS BP Handbook Chapter 13 Fraud for more information.

CW 51 "Good Cause Claim and Determination Transmittal"

The "Good Cause Claim and Determination Transmittal" (CW 51) must be completed when the client indicates the desire to claim good cause for not cooperating with the child/medical support procedures. Refer to Job Aid: Child Support Good Cause Claim for system entries.

CW 371 "Referral to Local Child Support Agency (LCSA)"

The "Referral to Local Child Support Agency (LCSA)" (CW 371) only needs to be printed and imaged when pertinent or explanatory information, specific to the case, requires documentation in the Journal Detail page such as:

Any direct support payments or payments being received by the client from DCSS.
If the client is non-English-speaking. DCSS special-language staff is extremely limited, so if the client does not understand or converse in English, the CW 371 must indicate the client's primary language.
Health insurance coverage available from the absent parent for the spouse or children.
Any Social Security, Railroad Retirement, or Veteran's Benefits received by the absent parent.

Image the completed CW 371.

CS 196 "Child Support Enforcement Program Notice"

The "Child Support Enforcement Program Notice" (CS 196) provides information on what the client should expect from DCSS.

CS 909 "Declaration of Paternity"

The "Declaration of Paternity" (CS 909) is used to legally establish the paternity of a child when the mother and father are NOT married to each other.

SCD 1603 "Social Services Agency (SSA)/Local Child Support Agency (LCSA) Communication Form"

The "Social Services Agency (SSA)/Local Child Support Agency (LCSA) Communication Form" (SCD 1603) is used to communicate information between the EW and DCSS’s CSOs that was not included on the CW 371.

Either agency may use this form to provide information.
When EWs complete the form, it is important that the Child Support case number be entered on the form.
- The Child Support case number can be found on the Absent Parents page listed as the "Participant ID #/CSE #.”
The form should be sent via county pony service to the DCSS at 880 Ridder Park Drive, San Jose, CA 95131.