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The DCSS 0569 form is an important document used in California's child support system. This form serves as a Declaration of Support Payment History, allowing individuals to outline the amounts of support that were ordered by the court and the amounts actually paid each month. It is essential for establishing a clear record of support payments, which can impact any discussions regarding past due amounts. The form includes sections where users can indicate both the ordered and paid support amounts for each month, along with any necessary adjustments for changes in the support order. There is also a section dedicated to detailing any incarceration or institutionalization history relevant to the other parent, which may affect the financial obligations related to support. Understanding how to accurately complete this form can help in resolving potential disputes over payment history. Importantly, the information provided may be shared with the other party involved in the case, and both parties may need to present proof of payments if there is any disagreement. If assistance is required while filling out this form, resources are available through the local court’s Family Law Facilitator Office.

Dcss 0569 Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF CHILD SUPPORT SERVICES

DECLARATION OF SUPPORT PAYMENT HISTORY

DCSS 0569 (06/17/2018)

INSTRUCTIONS FOR COMPLETING THE DECLARATION

OF SUPPORT PAYMENT HISTORY

On the back of this page is the Declaration of the Support Payment History for your case. Please provide the amount of support that was ordered by the court and the amount that was paid for each month. These figures will help determine the amount of the past due support owed, if any.

Within the boxes on the bottom half of the page, please complete the:

"Amount Ordered" column for each year

Fill in the amount of support that was ordered by the court each month since your order began. If there has been a change in your order, make sure each month reflects the correct amount of support due.

"Amount Paid" column for each year

Fill in the dollar amount of support paid in that month. If more than one payment was made in a given month, put the total dollar amount of support paid. Put the dollar amount next to the month in which the payment was actually paid, and not the month the payments were intended to cover. If needed, you may attach more sheets.

Within the boxes on the bottom half on the page, only if it applies to your case, please complete the:

“Incarceration/Institutionalization History"

Fill in the details of any time periods during which the other parent of your child was involuntarily confined in a state prison, county jail, juvenile facility, mental health facility, or other facility. If needed, you may attach additional sheets.

Please complete a separate page(s) for child support, spousal support, family support, medical support, unreimbursed medical expenses, and other types of support not listed. DO NOT combine child support and spousal support unless your court order combines the two support payments into a "family" support order.

Be aware that this Declaration is not confidential and may be given to the other parent or party in your case for review. If there is a disagreement regarding the payment history, the parties may be required to present proof of payments, for example, cancelled checks, or receipts.

If you have questions and/or need assistance with child support forms, you can get free help from your local court's Family Law Facilitator Office. Information for the Family Law Facilitator can be found at the California Courts website at http://www.courts.ca.gov/selfhelp-facilitators.htm.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF CHILD SUPPORT SERVICES

DECLARATION OF SUPPORT PAYMENT HISTORY

DCSS 0569 (06/17/2018)

Person completing this form (name):

 

 

 

I am the:

 

 

 

 

 

Support Payment History for (check one):

Child

Spousal

Family

Unreimbursed medical expenses

Medical

Other (specify):

 

 

Custodial Party Noncustodial Parent

 

YEAR

 

 

YEAR

 

 

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMOUNT

 

AMOUNT

AMOUNT

AMOUNT

AMOUNT

AMOUNT

 

ORDERED

 

PAID

ORDERED

 

PAID

ORDERED

 

PAID

January

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

February

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

March

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

April

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

May

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

June

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

July

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

August

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

September

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

October

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

November

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

December

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Incarceration/Institutionalization History

BEGIN DATE

(MM/DD/YYYY)

RELEASE DATE (MM/DD/YYYY)

FACILITY/INSTITUTION NAME AND LOCATION

OTHER DETAILS, SUCH AS CHARGING

OFFENSE(S), CONVICTION(S),

VICTIM NAME(S), COURT WHERE

SENTENCED, ETC.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I am aware that this may be provided to the other parent for their verification and that either party may be required to provide documentation.

Signature:

 

Date:

 

CSE Case Number:

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Form Characteristics

Fact Name Description
Purpose The DCSS 0569 form is used to document the payment history of child support, spousal support, family support, and other types of financial support as ordered by the court.
Governing Law This form operates under California Family Code Section 4000 et seq. which governs child support obligations.
Confidentiality Information submitted on the DCSS 0569 form is not confidential and may be shared with the other parent or related parties for verification purposes.
Payment Documentation
Assistance Individuals can seek assistance with completing the DCSS 0569 form from the local court's Family Law Facilitator Office, with information accessible on the California Courts website.

Guidelines on Utilizing Dcss 0569

Completing the DCSS 0569 form accurately is crucial for establishing a clear record of support payment history. This form requires specific information about court-ordered support payments and amounts paid. Once finished, it may play a role in resolving any disputes over support obligations. Follow these steps for accurate completion of the form.

  1. Identify yourself: Write your name at the top of the form where it asks for the person completing the form.
  2. Specify your role: Indicate whether you are the custodial party or the noncustodial parent by checking the appropriate box.
  3. Select the type of support: Check the box next to the relevant support option: child, spousal, family, unreimbursed medical expenses, medical, or other (provide details if necessary).
  4. Fill in the payment information: For each year, fill out the "Amount Ordered" column with the monthly support amounts established by the court.
  5. Record payments received: In the "Amount Paid" column, enter the total amount paid for each month. If multiple payments were made, only include the total for the month in which the payment was actually deposited.
  6. Add incarceration details if necessary: If applicable, record any periods during which the other parent was incarcerated in the designated section. Include the begin and release dates and any pertinent facility information.
  7. Sign and date the form: At the end of the form, sign your name and note the date of completion. This confirms the information you provided is true and correct.
  8. Include the CSE Case Number: Don’t forget to add your Child Support Enforcement (CSE) Case Number where indicated.

After completing the form, review all entries for accuracy. Should you need to provide supporting documents, gather evidence such as receipts or canceled checks for verification. If questions arise during this process, assistance is readily available from local court facilitators.

What You Should Know About This Form

What is the DCSS 0569 form?

The DCSS 0569 form is a Declaration of Support Payment History provided by the California Department of Child Support Services. It is used to document how much child support or other types of support has been ordered by the court and how much has actually been paid over time. This form helps determine any past due support that may be owed.

Who needs to complete the DCSS 0569 form?

Either the custodial party or the noncustodial parent involved in a child support case should complete this form. It is essential for anyone responsible for paying or receiving support to maintain accurate records of payments made over the years.

How do I fill out the DCSS 0569 form?

Begin by entering the amount of support ordered by the court in the appropriate year and month. Next, record the amount of support actually paid for each month. If there were changes in the support order, ensure those adjustments are reflected accurately. There are sections to provide additional details if needed, such as any incarceration history of the other parent.

What do I do if I missed a payment for a month?

If a payment was missed, you should indicate a zero in the "Amount Paid" column for that month. It is important to keep an accurate record since this could affect the total amount owed in support payments. Make sure to maintain documentation to support your claims regarding missed or late payments.

Can I combine different types of support on the form?

Do not combine child support and spousal support unless your court order specifically combines them into a "family" support order. If you have different types of support like medical support or unreimbursed medical expenses, complete separate sections for each of these types to guarantee clarity.

Is the information on the DCSS 0569 form confidential?

No, the information provided on the DCSS 0569 form is not confidential. It may be shared with the other parent or party involved in your case for their review. Both parties may need to prove the payment history with supporting documents if there are disagreements.

What should I do if there are discrepancies in payment records?

If a disagreement arises about the payment history, both parties may be required to present proof. This could include canceled checks or receipts showing the payments made. Keeping accurate records will help resolve such issues more easily.

Where can I get help with filling out the DCSS 0569 form?

If you need assistance with the DCSS 0569 form or any child support-related forms, free help is available from your local court's Family Law Facilitator Office. You can find more information and locate your nearest office through the California Courts website.

Common mistakes

Filling out the DCSS 0569 form can be a crucial step in addressing child support matters. However, many individuals encounter issues that lead to errors. One common mistake is neglecting to provide the correct amounts for both the ordered support and the payments made. Accurate figures are essential, as they determine the amount of past due support.

Another frequent error is failing to update the amounts due when there have been changes to the support order. It’s important to reflect any adjustments in your monthly entries, ensuring that each month's figures are accurate and current.

People often misplace the payment dates as well. Payments should be recorded based on when they were actually made, not when they were intended to cover. This can lead to discrepancies that complicate the support calculation.

Combining different types of support payments is also a mistake many make. Child support and spousal support should not be merged unless your court order specifies this. Failure to separate these payments may result in confusion and inaccuracies.

Some individuals forget to provide necessary documentation about the other parent’s incarceration or institutionalization. If applicable, include details about any time periods they were confined, as this information can be crucial for establishing the support situation.

Moreover, people sometimes overlook the need for additional sheets when the space on the form is insufficient. If you have more information than can fit, don’t hesitate to attach extra pages to ensure that your entire payment history is clearly represented.

Accuracy in the signatures and dates is equally important. Missing a signature or providing the wrong date can lead to unnecessary delays in processing the form. Always double-check your entries before submission.

Lastly, not seeking help can be a significant error. If there are any questions or uncertainties while filling out the form, it’s wise to contact a local Family Law Facilitator for assistance. They can guide you through the process and help mitigate any mistakes.

By being aware of these common pitfalls and taking the time to review your submissions carefully, you can avoid unnecessary complications and ensure that your declaration is processed smoothly.

Documents used along the form

The DCSS 0569 form is a vital tool in the California child support process, helping to track and clarify payment histories. Along with this form, several other documents are commonly used to support child support cases. Each document serves a specific purpose, contributing to a thorough understanding of obligations and payments. Below is a list of these documents.

  • Uniform Reciprocal Enforcement of Support Act (URESA) Forms: These forms assist in the enforcement of child support orders across state lines. They play a crucial role when one parent resides in a different state, ensuring support payments are still pursued effectively.
  • Child Support Order: This legal document outlines the specific terms of the child support obligations, including payment amounts, frequency, and duration. It is the foundation for any related support payments and modifications.
  • Financial Disclosure Forms: Both parties may be required to provide detailed information about their finances. This includes income, expenses, and assets, which can impact the court’s assessment of child support needs.
  • Income Withholding Order: This document directs an employer to deduct child support payments directly from an employee's paycheck. It helps ensure timely and consistent payment to the custodial parent.
  • Payment Records: Documentation such as receipts and bank statements that show payments made or received are essential. They provide proof of compliance with court-ordered support amounts and timelines.
  • Modification Request Forms: If there are significant changes in circumstances, such as job loss or changes in custody, these forms allow parties to request modifications to the existing support order.
  • Declaration of Financial Difficulties: This form documents any economic hardships one parent may be experiencing. If filed, it may impact the court's decision on support payments or modifications.
  • Proof of Incarceration/Institutionalization: If a parent is incarcerated, these documents verify the parent’s status and detail the period of incarceration. They can be relevant when determining payment capabilities.
  • Tax Returns: Providing copies of tax returns can show annual income, which can affect support calculations. It is often necessary to review these for inaccuracies or changes in situations.
  • Documentation of Expenses: To justify claims for additional support (such as medical expenses or educational costs), receipts and invoices may need to be gathered and submitted.

These documents together with the DCSS 0569 form create a comprehensive picture of the support situation. Each plays a unique role in ensuring that both parties remain informed and that the obligations set forth by the court are met. Understanding these documents can facilitate smoother experiences in managing child support cases.

Similar forms

  • Child Support Guidelines Worksheet: This document is used during child support calculations to determine the appropriate amount of support based on the parent’s incomes and expenses. Like the DCSS 0569, it requires detailed financial information and must be completed for accurate support determination.

  • Support Order: A formal judicial document that outlines the amount of child or spousal support one party must pay to another. It shares similarities with the DCSS 0569 in that both address the amounts ordered and paid over time, serving as critical references in support enforcement.

  • Payment History Report: This document provides a comprehensive record of all support payments made. Like the DCSS 0569, it ensures that both parties have an accurate understanding of payment trends, helping to confirm whether support obligations are being met.

  • Income and Expense Declaration: Often required in family law matters, this form captures a party's income, expenses, and overall financial situation. It parallels the DCSS 0569 by gathering necessary financial details that affect support calculations and obligations.

Dos and Don'ts

When filling out the DCSS 0569 form, attention to detail is crucial. Here are six key recommendations to guide you through the process:

  • Do accurately fill in the "Amount Ordered" and "Amount Paid" columns for each month.
  • Do ensure that the figures reflect the actual support ordered and paid, including any changes over time.
  • Do provide separate pages for different types of support if applicable. Don't combine child and spousal support unless specified by the court.
  • Don't forget to include documentation of payments, such as receipts or canceled checks, if there's any dispute.
  • Don't confuse the month of payment with the month for which the payment was meant. Record payments in the month they were received.
  • Don't assume confidentiality. Be aware that this declaration is not confidential and may be shared with the other party.

Misconceptions

Here are six common misconceptions about the DCSS 0569 form:

  • 1. The form is confidential. Many people believe that the information submitted with the DCSS 0569 is private. In reality, this declaration may be shared with the other parent involved in the case.
  • 2. It can be used to make changes to support orders. Some think that filling out this form allows them to adjust their support payments. However, it primarily documents payment history and does not change any existing court orders.
  • 3. Only one support type can be included. There is a belief that only one type of support, such as child support, can be reported on this form. It's important to note that separate pages are required for different types of support.
  • 4. You don't need proof of payment. Some individuals assume they can just list the amounts without providing evidence. If there's a disagreement about the payment history, proof such as receipts or canceled checks may be necessary.
  • 5. Missed payments are not important. There’s a misconception that overdue or missed payments don’t need to be documented. In fact, all payments, including those that were late, are essential for an accurate history.
  • 6. The form is only for custodial parents. Many believe that only custodial parents need to fill out this form. However, non-custodial parents also need to complete it when reporting their payment history.

Key takeaways

When filling out the DCSS 0569 form, there are several important points to keep in mind:

  • Accurate Information: Ensure you provide the correct amounts for both the ordered support and the payments made each month. This information is essential for determining any past due support owed.
  • Monthly Breakdown: Complete the "Amount Ordered" column with the support ordered each month since your order began. If there has been any change in the support amount, reflect that change for each applicable month.
  • Documentation: Maintain records of your payments. If there is a dispute about the payment history, you may need proof like cancelled checks or receipts to support your claims.
  • Incarceration Details: If applicable, include information about any periods of incarceration for the other parent. This could affect support obligations.
  • Confidentiality Caution: This Declaration is not confidential. It can be shared with the other parent, so consider this when completing the form.

Following these guidelines will help ensure the DCSS 0569 form is filled out correctly and effectively contributes to your case.