Parent/Custodian signs here Print name Date (lawyer cannot sign for party) Warnings! If you don’t follow this support order… If you receive child support… DOL or other licensing agencies may deny, suspend, You may have to: or refuse to renew your licenses, including your driver’s license and business or professional Document how that support and any cash received licenses, and for the children’s health care was Dept. of Fish and Wildlife may suspend or refuse to Repay the other parent for any day care or special your fishing and hunting licenses and you may expenses included in the support if you didn’t not be able to get permits. (RCW 74.20A.320) actually have those expenses. (RCW 26.19.080) Health Insurance Warnings! Both parents must keep the Support Registry informed whether or not they have access to health insurance for the children at a reasonable cost, and provide the policy information for any such insurance. * * * If you are ordered to provide children’s health insurance… You have 20 days from the date of this order to send: can no longer get or continue coverage as ordered in section through your job or union. If your 21 proof that the children are covered by insurance, or insurance coverage for the children ends, you must proof that insurance is not available as ordered. notify the other parent and the Support Registry. Send your proof to the other parent or to the Support Registry (if your payments go there). If an insurer you payment for a medical provider’s service: If you do not provide proof of insurance: you must send it to the medical provider if the The other parent or the support agency may contact provider has not been paid; or your employer or union, without notifying you, to ask you must send the payment to whoever paid the for direct enforcement of this order (RCW provider if someone else paid the provider; or 26.18.170), and you may keep the payment if you paid the provider. The other parent may: If the children have public health care coverage, the Ask the Division of Support (DCS) for help, state can make you pay for the cost of the monthly Ask the court for a contempt order, or premium. File a Petition in Always inform the Support Registry and other parent if Don’t cancel your children’s health insurance without your access to health insurance changes or ends. the court’s approval, unless your job ends and you
Parent/Custodian signs here Print name Date (lawyer cannot sign for party) Warnings! If you don’t follow this support order… DOL or other licensing agencies may deny, suspend, or refuse to renew your licenses, including your driver’s license and business or professional licenses, and Dept. of Fish and Wildlife may suspend or refuse to your fishing and hunting licenses and you may not be able to get permits. (RCW 74.20A.320) If you receive child support… You may have to: Document how that support and any cash received for the children’s health care was Repay the other parent for any day care or special expenses included in the support if you didn’t actually have those expenses. (RCW 26.19.080) Health Insurance Warnings! Both parents must keep the Support Registry informed whether or not they have access to health insurance for the children at a reasonable cost, and provide the policy information for any such insurance. * * * If you are ordered to provide children’s health insurance… You have 20 days from the date of this order to send: proof that the children are covered by insurance, or proof that insurance is not available as ordered. Send your proof to the other parent or to the Support Registry (if your payments go there). If you do not provide proof of insurance: The other parent or the support agency may contact your employer or union, without notifying you, to ask for direct enforcement of this order (RCW 26.18.170), and The other parent may: Ask the Division of Support (DCS) for help, Ask the court for a contempt order, or File a Petition in Don’t cancel your children’s health insurance without the court’s approval, unless your job ends and you can no longer get or continue coverage as ordered in section 21 through your job or union. If your insurance coverage for the children ends, you must notify the other parent and the Support Registry. If an insurer you payment for a medical provider’s service: you must send it to the medical provider if the provider has not been paid; or you must send the payment to whoever paid the provider if someone else paid the provider; or you may keep the payment if you paid the provider. If the children have public health care coverage, the state can make you pay for the cost of the monthly premium. Always inform the Support Registry and other parent if your access to health insurance changes or ends.
DRPSCU%2001-500%20(C13)%202013-03-22%20Child%20Support%20Order%20-%20Draft%20for%20Testing.docx