Noncustodial Parent Form Mass 2026

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4.3 out of 5

42 votes

The Noncustodial Parent Form from the Commonwealth of Massachusetts is required for custodial parents applying for state health plans like MassHealth. It collects information about noncustodial parents to facilitate medical support for children. The form must be completed by the custodial parent, who agrees to cooperate with the Child Support Enforcement Division unless there are valid reasons not to. Failure to complete the form may affect eligibility for benefits, although children's MassHealth coverage will not be denied.

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Click ‘Get Form’ to open the Noncustodial Parent Form Mass in the editor.
Begin by providing your personal information as the custodial parent. Ensure that all details are accurate to avoid any delays in processing.
For each child listed, fill out their name and indicate if there are any good cause reasons that apply. This section is crucial for determining whether you need to provide noncustodial parent information.
If applicable, enter the noncustodial parent's details including their name, relationship to the child, and contact information. If you do not know certain details, select 'I do not know' where appropriate.
Review all entered information carefully. Make sure everything is complete before signing at the end of the form.
Once completed, save your form and choose to either fax or mail it to the Health Insurance Processing Center as instructed.

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See more Noncustodial Parent Form Mass versions

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Versions	Form popularity	Fillable & printable
2022	4.3 Satisfied (42 Votes)
2021	4.9 Satisfied (31 Votes)
2015	4.3 Satisfied (122 Votes)
2013	4 Satisfied (32 Votes)
2013	4.3 Satisfied (132 Votes)

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