DHS-3163B-ENG (Referral to Support and Collections) This form is used by MinnesotaCare, Medical Assi 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information in Section 1. Include your last name, first name, middle name, and other relevant details such as your address and social security number.
3. In Section 2, provide information about the other parent or alleged father. If applicable, indicate if they are deceased and include their details.
4. Section 3 requires you to list children living with you. Fill in each child's name, gender, date of birth, and their relationship to the other parent using the provided codes.
5. Complete Sections 4 and 5 with employment information for both you and the other parent, including employer details and any child support payment history.
6. In Section 6, indicate whether there is a court order for medical support from the other parent. Provide necessary insurance details if applicable.
7. Finally, review all sections for accuracy before signing at the end of the form. Ensure that all required fields are completed.

Start editing your DHS-3163B-ENG form online for free today!