DSHS 18-334 (REV. 06/2022)
Your Options for Child Support Collection while Receiving
Temporary Assistance for Needy Families (TANF)
When you receive TANF for the children in your care, you must help the Department of Social and Health
Service (DSHS), Division of Child Support (DCS), collect child support unless it is not safe for you or the
children. Community Services Division (CSD) determines eligibility for TANF and refers to DCS to provide
full support enforcement services when you or the child(ren) receive TANF. These services may include
DCS enforcing another parent’s obligation to provide health insurance and contributing their share of
uninsured medical expenses for the child(ren).
What do I have to do to help DCS collect child support?
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Name the parent(s) of the child(ren).
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Give us information to help find the parent(s).
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Help to prove who the parent(s) of the child(ren) are.
Why is it beneficial to establish paternity and collect child support?
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Because child support can help you achieve financial stability.
•
Because it gives the child(ren) a family medical history by knowing who their parent is.
•
Because it gives the child a legal right to inheritance, social security, veterans benefits and
other government entitlements.
What happens if I don’t cooperate with DCS?
If you’re receiving benefits for yourself and don’t help DCS collect child support, your portion of the cash
grant may be reduced by 25%. DCS will pursue child support collection without your cooperation.
When is it OK to not cooperate with DCS?
You don’t have to help collect your child support if your CSD worker determines you have good cause not
to help. Good Cause reasons are:
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You fear you or the child(ren) in your care will be harmed physically or emotionally.
•
Your child was born due to rape or incest.
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You have started adoption proceedings, or you are in counseling (for up to three months) with
a child placement agency about adoption.
What should I give my CSD worker to show I have Good Cause not to help?
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Your signed statement outlining your fears and concerns (including this form), or
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Any records including medical, police, statements from family or friends about your safety
claim, if available.
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You have 20 days to provide this verification but you can ask for more time if needed.
Can I still have child support collected and not cooperate with DCS?
Yes, because there are two different levels that you can choose; Level A or Level B.
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Level A: You will not be asked to cooperate with DCS. Child support will not be collected.
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Level B: You will not be asked to cooperate with DCS but child support will be collected and
your address remains protected.
What should I do if it is no longer safe for DCS to collect child support?
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Contact CSD and your DCS child support officer immediately. Tell them both about your new
situation.
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Request Good Cause by completing this form.
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If you currently have Good Cause Level B, consider switching to Level A.
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Ask for a referral to the onsite or community based family violence advocate.
What if I disagree with the CSD Good Cause decision?
You have the right to ask for an Administrative Hearing about the Good Cause decision. An
Administrative Hearing is a review of the Good Cause decision. See the “Administrative Hearing Process”
on the last page for more administrative hearing information.
If you have any questions about helping with child support collections, ask before you sign this form.
Check only one of the statements below.
I believe it is safe for me and my children for DCS to collect child support. I understand that I must
help DCS collect child support and if I don’t my cash grant will be reduced by 25%.
I have a good reason not to help. Please describe your reason outlining your fears and concerns on
the next page.
DSHS 18-334 (REV. 06/2022)
Every families’ situation is different. Please check all boxes below that describe the reason(s) it might not
be safe to pursue child support.
The child(ren) are subject of legal adoption proceedings.
The child(ren) were born as a result of incest or rape.
I have a restraining order or police reports filed for the non-custodial parent.
The non-custodial parent has harmed or threatened to harm me or the child(ren).
The non-custodial parent has a history of violent behavior.
The non-custodial parent will try to gain custody of the child(ren) if child support is pursued, and
would not provide a safe environment for the child(ren).
I am concerned that the stability of the child(ren) would be disrupted.
If child support is pursued, the non-custodial parent would likely become hostile and cause emotional
trauma for the child(ren).
The non-custodial parent has mental health or substance abuse issues which have caused harm to
me or the child(ren).
Other, please describe your fears and concerns below:
I declare the above statement to be true.
CLIENT NAME (PRINTED)
CLIENT ID NUMBER
CLIENT’S SIGNATURE
DATE
I have given a copy of this form to the client.
WORKER’S SIGNATURE
DATE
NON-CUSTODIAL PARENT NAME
CLIENT ID NUMBER
CHILD NAME
CLIENT ID NUMBER
CHILD NAME
CLIENT ID NUMBER
CHILD NAME
Administrative Hearing Process
1. For a review of your case, call CSD at 1-877-501-2233.
2. To request an Administrative hearing contact CSD or write to The Office of Administrative Hearings,
PO Box 42489, Olympia, WA 98504-2489 within 90 days. DCS will not start working your case until
the hearing decision is final.
A lawyer or other person you choose can represent you at the hearing, or you can represent
yourself.
Can I receive legal advice or representation?
You can call the statewide legal services line at 1-888-201-1014.