IN THE DISTRICT COURT OF COUNTY
STATE OF OKLAHOMA
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brackets for blank form] ) Dist. Ct. Case No.
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) OAH Case No:
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) OK IV-D FGN:
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) Obligor:
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) Custodial Person:
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ORDER MODIFYING CHILD SUPPORT
On , 20 , this matter came on for hearing on
the Motion to Modify Child Support filed by per
Your name
[43 O.S. § 118]. The Oklahoma Department of Human Services (OKDHS), Child
Support Enforcement, appears through its attorney.
The Obligor (noncustodial parent) appears:
In person, pro se.
in person, with counsel
not.
not, being in default.
not, having previously signed this order.
not, represented by counsel
The Custodial Person appears:
in person, pro se.
in person, with counsel
not.
not, having previously signed this order.
not, represented by counsel
Other persons appear:
OKDHS issued 3-15-2007 03EN014E Page 1 of 9
The Court, being informed by evidence presented and hearing from the parties,
find that this Court has jurisdiction over the parties and the subject matter of this action.
The Court, therefore, FINDS, ORDERS AND DECREES AS FOLLOWS:
1. CHILDREN. The mother or father of the minor child(ren) in the above case
was ordered to pay $ per month for child support on
for the child(ren) listed below:
Date of order
Child's name Date of birth
2. MODIFICATION. Since that order was entered there has been a substantial and
material change in circumstances as follows:
A child for whom the order was entered has turned 18 and is no longer
regularly enrolled and attending high school.
The father's income has changed.
The mother's income has changed.
The living arrangements of the child(ren) have changed.
The child care expenses have changed.
There has been a change in health insurance or it was not addressed in a
previous order.
Other:
3. CHILD SUPPORT. Because of these material changes in circumstances, the
Motion to Modify Child Support is granted. The mother or father is the Obligor
and is ordered to pay for the support of the above-named minor child(ren) the sum of
$ per month beginning on , 20 ,
a nd on the same day of each month thereafter until further order of this Court or until the
Page 2 of 9 03EN014E OKDHS issued 3-15-2007
minor child(ren) reaches the age of 18 years, or until the age of 20 years, provided the
child(ren) is regularly enrolled in and attending high school.
4. CHILD SUPPORT COMPUTATION FORM. The child support is calculated
according to the Oklahoma child support guidelines as follows: (select one)
The child support obligation is set in accordance with the child support
guidelines without deviation and a copy of the child support computation sheet
is attached hereto.
The Court deviates from the amount of support in accordance with the child
support guidelines as it results in an amount that is inequitable, unreasonable
under the circumstances, and/or not in the best interests of the child(ren), and
in support of the deviation the Court finds the following:
Pursuant to 10 O.S. § 7003-8.8(B)(3)(c), deviation is determined
necessary in order for the parent to meet the obligations of a
court - imposed individual treatment and service plan.
Other:
5. MEDICAL SUPPORT. OKDHS inquired into the availability of health care
insurance and: (select one)
Medical support through group plan. Mother Father shall obtain
health insurance coverage for the minor child(ren) immediately or
whenever such insurance is available through an employer or other group plan.
Alternative medical support. Neither parent is required to provide health
insurance coverage through an employer-sponsored or other group plan at this
time because medical support is being provided through the following
alternative coverage:
Indian Health Services. The child(ren) is eligible or believed to be eligible
for Indian Health Services. The parents shall cooperate fully in taking the
necessary action through the appropriate tribe to enroll the child(ren). The
tribal member parent shall provide a copy of the card or other documentation
to the child support enforcement office to verify the child(ren) is enrolled and
OKDHS issued 3-15-2007 03EN014E Page 3 of 9
eligible for Indian Health Services. If the child(ren) is determined by the tribe
not to be eligible for Indian Health Services, Mother Father shall
obtain health insurance coverage for the minor child(ren) whenever such
insurance is available through an employer or other group plan.
Department of Defense. The child(ren) is believed to be eligible for or
enrolled in the Department of Defense managed health care program,
TRICARE. The name of the Department of Defense sponsor (military
service member or Department of Defense employee) is . The parents
shall cooperate fully in enrolling the child(ren) in the Defense Enrollment
Eligibility Reporting System (DEERS). The parent(s) shall provide a copy of
the identification card for the child(ren) to the child support enforcement
office to verify the child(ren) is enrolled in DEERS. In the event the child(ren)
is not receiving TRICARE coverage through DEERS,
Mother or Father shall provide health insurance coverage for the
minor child(ren) whenever such insurance is available through an
employer or other group plan.
Other alternative coverage. Mother Father shall provide health
care coverage for the minor child(ren) in this case as follows:
The parent providing the health care coverage shall provide proof of
coverage to the child support enforcement office and shall keep the
coverage in effect until further order of the Court. In the event that the parent
ordered to provide alternative health care coverage is no longer providing it,
Mother Father shall provide health insurance coverage for the minor
child(ren) whenever such insurance is available through an employer or
other group plan.
Other:
Uncovered expenses. Mother shall pay per cent and Father shall pay
per cent of the reasonable and necessary medical, dental, orthodontic,
Page 4 of 9 03EN014E OKDHS issued 3-15-2007
optometric, psychological, or any other physical or mental health expenses for
the minor child(ren) not covered by insurance or other health care plan. If
reimbursement is required, the Custodial Person who incurs the expense shall
be reimbursed by the Obligor within 30 days of receipt of documentation of the
expense.
6. CHILD CARE. (select one)
The Obligor's share of child care expenses is included in the child support
amount ordered in paragraph 3 above. The Custodial Person shall provide
timely documentation to the Obligor of said expenses.
Child care is not currently being expended, but should such expenses occur,
the Obligor is ordered to pay per cent of monthly employment or
education - related child care expenses of said child(ren), as additional child
support, commencing on the same day and to be paid in the same manner, as
any current child support set out in paragraph 3 above. The Custodial Person
shall provide timely documentation to the Obligor of said expenses.
7. METHOD OF PAYMENT. All child support payments shall be made by employer's
check, cashier's check, money order, or government check, payable to Oklahoma
Department of Human Services, identified with the above FGN number on the face of
the payment (or Social Security number if no FGN available) and mailed to:
Oklahoma Centralized Support Registry
P. O. Box 268849
Oklahoma City , OK 73126-8849
PAYMENTS MADE IN ANY MANNER OTHER THAN AS SPECIFIED IN THIS COURT
ORDER SHALL BE CONSIDERED GIFTS AND SHALL NOT BE CREDITED TO THE
AMOUNT OWED.
8 . INCOME ASSIGNMENT. An immediate income assignment is ordered pursuant to
12 O.S. § 1171.3(G)(1). A portion of the Obligor's monthly or other periodic income shall
be assigned to the Custodial Person or appropriate in an amount sufficient to ensure
payment of the monthly support obligation, including any arrearage and judgment
payments. The assignment is effective immediately; provided however, that the Obligor
remains responsible for making payments directly to OKDHS in any month when
OKDHS issued 3-15-2007 03EN014E Page 5 of 9
an income assignment is not in effect or does not pay the full amount due under
this order.
9. ADDRESS OF RECORD FOR SERVICE OF PROCESS AND ADDRESS AND
EMPLOYMENT CHANGES. Title 43 O.S. § 112A requires all parties and Custodial
Persons to inform the Central Case Registry of the current address of record for service
of process in support, visitation, and custody actions. The following applies to the Obligor
and any Custodial Person subject to this order. Any changes (names and addresses) in
your address of record, your employer, and your health insurance must be provided in
writing to the Central Case Registry within 30 days of the change at the following address:
Central Case Registry
P. O. Box 528805
Oklahoma City, Oklahoma 73152-8805
Your last address of record may be disclosed to a party or Custodial Person upon
request in accordance with OKDHS rules. OKDHS does not release home addresses if
prohibited by a court order granted for the protection of a parent or Custodial Person, or
if the case has a family violence indicator. The address of record does not have to be
the address where you live. You may be served in child support actions filed after this
date by regular mail to the last address of record provided to the Central Case Registry.
If your physical address and address of record are different, you must notify the child
support enforcement office of any changes in your physical address. Future notices will
be sent to the last address of record provided to the Central Case Registry.
The following is the current address of record for service of process for the
Obligor:
The following is the current address of record for service of process for the
Custodial Person (if applicable):
____________________________________________________
10. PRIOR ORDERS AND CHILD SUPPORT ARREARS. All provisions in prior orders
entered in this case not specifically modified herein remain in full force and effect. The
Page 6 of 9 03EN014E OKDHS issued 3-15-2007
issue of child support owed by either parent for a period prior to this order is reserved
for future determination.
11. INTEREST ON PAST-DUE CHILD SUPPORT. Unpaid child support payments
accruing under an Oklahoma order draw interest at the rate of ten per cent per year
from the date they become delinquent, and the interest shall be collected in the same
manner as the payments upon which the interest accrues. Orders issued by other states
may have a different interest rate for unpaid child support.
12. OBLIGOR'S EMPLOYMENT INFORMATION.
Employer's name:
Address:
Phone number:
13. ENFORCEMENT. The OKDHS Child Support Enforcement Division may enforce
this order in any court with jurisdiction to enforce child support orders, including
administrative court. The Obligor understands that until (1) all past-due child support is
paid in full, and (2) the Obligor is current on all support obligations, multiple enforcement
remedies may be used. These remedies include, but are not limited to, interception of
state and federal tax refunds, and pursuant to 56 O.S. § 240.23, intercepting or seizing
periodic or lump-sum payments from: (1) a state or local agency, including unemployment
compensation, workers' compensation, and other benefits, and (2) judgments,
settlements, and lotteries; attaching and seizing assets of the obligor held in financial
institutions; attaching public and private retirement funds; imposing liens in accordance
with 43 O.S. § 135; and increasing the monthly payment on child support, for purposes of
securing past-due support, in an amount not to exceed five per cent of the total child
support order. Such increase may not be made more than once every 12 months.
14. ADDITIONAL ORDERS.
JUDGE OF THE DISTRICT COURT
OKDHS issued 3-15-2007 03EN014E Page 7 of 9
APPROVED AS TO FORM AND CONTENT:
Printed name Printed name
Address Address
Address Address
Phone Phone
Attorney for Attorney for
OBA# OBA#
Address Address
Address Address
Phone Phone
State's attorney , CSE, OKDHS
OBA#
Address
Address
Phone
Page 8 of 9 03EN014E OKDHS issued 3-15-2007
CERTIFICATE OF SERVICE
This is to certify that copies of the foregoing Order Modifying Child Support were
served as follows:
In person on , 20 to:
Obligor
Attorney for the Obligor
Custodial Person
Attorney for the Custodial Person
State's Attorney, CSE, OKDHS
Other
By regular mail on , 20 to:
Obligor at Address of Record
Attorney for the Obligor at the address listed above
District Attorney
Attorney for the Custodial Person at the address listed above
State's Attorney, CSE, OKDHS
Other
at
Signature of person certifying copies were served in person or mailed
OKDHS issued 3-15-2007 03EN014E Page 9 of 9
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