Wage and insurance verification - Child Support Services 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Employee/Case Participant Identification section. Enter the participant's name, Social Security Number, date of birth, address, and phone number.
3. In the Employee Work Status section, check all applicable boxes regarding employment status. If currently employed, indicate whether part-time or full-time and provide relevant dates.
4. Complete the Employee Earnings section by entering pay frequency, hourly rate if applicable, and earnings for the past 12 months. Attach payroll records if necessary.
5. Fill out the Health Insurance Information section. Indicate availability of health insurance for both employee and dependents, along with associated costs.
6. Provide dependent information and policy details for medical, dental, vision, or other insurances as required.
7. Finally, complete the Certification of Record by typing your name in the signature line to validate your submission.

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