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Non custodial parent form ncp 1

Masshealth absent parent form 2013-2026

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The document is an Absent Parent/Non-Custodial Parent Form from the Commonwealth of Massachusetts, intended for custodial parents applying for state health plans like MassHealth. It requires the custodial parent to provide information about non-custodial parents of their children to assist in collecting medical support. The form outlines the responsibilities of the custodial parent, including cooperation with MassHealth and the Child Support Enforcement Division, and details exceptions where information may not be required. It emphasizes that while benefits will not be denied for non-cooperation, eligibility may be affected.

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Click ‘Get Form’ to open the masshealth absent parent form 2013 in the editor.
Begin by entering the name of each child for whom you are providing non-custodial parent information. Ensure that you fill out all required fields, including first, middle, and last names.
For each child, check any applicable boxes regarding their situation (e.g., adoption status or if cooperation is not in their best interest). If any apply, you do not need to provide non-custodial parent information for that child.
Fill in the non-custodial parent's details such as name, relationship to the child, gender, social security number, and contact information. If unknown, select 'I do not know' where applicable.
Complete sections regarding health insurance coverage and any court orders related to health insurance obligations. Be thorough to ensure compliance with MassHealth requirements.
Finally, sign and date the form at the bottom. This certifies that all provided information is accurate to the best of your knowledge.

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