Application For Child Support Services (Title IV-D)

The form is written in English only. If you require the form to be written in Spanish, download and fill out the application, print and mail it to our office. 

Esta forma es escrita en inglés solamente. Si necesita que la forma sea en Espa​ñol, bajar y llenar la solicitud, imprimir y enviarla por correo a nuestra oficina.  

So that we can provide the best and quickest services possible, please:

• Complete the online form below. Once you begin the process of filling out the application, you cannot save the document and go back later to finish.  If you  close the document before selecting the submit button, all information you entered will be lost.
• Any information that you do not know, please enter “don't know” in the blank.
• Read the Child Support Program Fact Sheet. It explains the services we provide.

Please make sure you have the following information available before completing this application:

• Applicant's Information (including Social Security Number)
• Other Parent's Information (if known, Address, Date of Birth, Social Security Number, Employer, etc)
• Child's Information (including Date of Birth, Social Security Number)
• Other Important Information (If you were married-Date of Divorce, State/County & Docket Number)

For every Non-Custodial Parent (NCP), you must fill out a separate application.

If you are NOT the biological or legal parent of the child, complete the application available at www.childsupport.illinois.gov

or call 1-800-447-4278 for a different application.

 Application for Child Support Services (Title IV-D)

Your County Use this on-line application only if your county is listed in the selection box. Adams Alexander Bond Boone Brown Bureau Calhoun Carroll Cass Champaign Christian Clark Clay Clinton Coles Cook Crawford Cumberland DeKalb DeWitt Douglas DuPage Edgar Edwards Effingham Fayette Ford Franklin Fulton Gallatin Greene Grundy Hamilton Hancock Hardin Henderson Henry Iroquois Jackson Jasper Jefferson Jersey Jo Daviess Johnson Kane Kankakee Kendall Knox Lake LaSalle Lawrence Lee Livingston Logan Macon Macoupin Madison Marion Marshall Mason Massac McDonough McHenry McLean Menard Mercer Monroe Montgomery Morgan Moultrie Ogle Peoria Perry Piatt Pike Pope Pulaski Putnam Randolph Richland Rock Island Saline Sangamon Schuyler Scott Shelby St. Clair Stark Stephenson Tazewell Union Vermilion Wabash Warren Washington Wayne White Whiteside Will Williamson Winnebago Woodford Application Date Your Last Name Your First Name Your Middle Initial Your Street Address Your City Your State Your Zip Code + Four (if known) Your Relationship to Child Mother Father Your Date of Birth Your Age Your Sex Male Female Your Social Security Number Your Race White, not of Hispanic origin BK Black, not of Hispanic origin American Indian or Alaskan Native Other Unknown Hispanic Asian or Pacific Islander Your Home Phone # Your Work Phone # / Extension Your Cell Phone # Your E-mail Address What time of day is most convenient to talk to you? At what phone number? Other Parent Last Name Other Parent First Name Other Parent Middle Initial Other Parent Street Address Other Parent City Other Parent State Other Parent Zip Code + Four (if known) Relationship to Child Mother Father Date of Birth Age Other Parent Social Security Number Parent Race White, not of Hispanic Origin BK Black, not of Hispanic Origin American Indian or Alaskan Native Other Unknown Hispanic Asian or Pacific Islander Other Parent Home Telephone # Other Parent Work Telephone #/Extension Other Parent Cell Telephone # Other Parent E-mail Address Name of Employer or Income Source Employer Street Address Employer City Employer State Employer Zip Code + Four (if known) Is the other parent in the military? No Yes Which branch of service? Make and Model of Car License Plate # Other Parent's Relatives: (Mother) Other Parent's Relatives: (Father) Does the other parent have additional children with someone else? If you know the other children's names, list them here. Child's Last Name Child's First Name Child's Middle Initial Child's Sex Male Female Child's Date of Birth (mm/dd/yyyy) Child's Place of Birth (City/State) Child's Social Security Number Child's Race White, not of Hispanic Origin BK Black, not of Hispanic Origin American Indian or Alaskan Native Other Unknown Hispanic Asian or Pacific Islander Child2 Last Name Child2 First Name Child2 Middle Initial Child2 Sex Male Female Child2 Date of Birth (mm/dd/yyyy) Child2 Place of Birth (City/State) Child2 Social Security Number Child2 Race White, not of Hispanic origin BK Black, not of Hispanic origin American Indian or Alaskan Native Other Unknown Hispanic Asian or Pacific Islander Child3 Last Name Child3 First Name Child3 Middle Initial Child3 Sex Male Female Child3 Date of Birth (mm/dd/yyyy) Child3 Place of Birth (City/State) Child3 Social Security Number Child3 Race White, not of Hispanic origin BK Black, not of Hispanic origin American Indian or Alaskan Native Other Unknown Hispanic Asian or Pacific Islander Child4 Last Name Child4 First Name Child4 Middle Initial Child4 Sex Male Female Child4 Date of Birth (mm/dd/yyyy) Child4 Place of Birth (City/State) Child4 Social Security Number Child4 Race White, not of Hispanic origin BK Black, not of Hispanic origin American Indian or Alaskan Native Other Unknown Hispanic Asian or Pacific Islander Child5 Last Name Child5 First Name Child5 Middle Initial Child5 Sex Male Female Child5 Date of Birth (mm/dd/yyyy) Child5 Place of Birth (City/State) Child5 Social Security Number Child5 Race White, not of Hispanic origin BK Black, not of Hispanic origin American Indian or Alaskan Native Other Unknown Hispanic Asian or Pacific Islander If you have more than 5 children, please provide the same information in the box below. Do you have a child support order? Yes No Are/were you married to the other parent of the child? (If yes, you must enter a date below.) Yes No If yes, marriage date? Are you and the other parent of the child divorced? Yes No If yes, divorce date? State of Divorce Order County of Divorce Order If you were not married and have a child support order, please fill in the following information. Date of Child Support Order Order or Docket # City of Support Order County of Support Order State of Support Order Do you want your case marked with a Family Violence Indicator? Yes No What is your language preference? English Spanish Polish Attachments Leave Blank

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