ACF DHHS GOV PROGRAMS CSE FORMS OMB 0970 0222 PDF

ACF DHHS GOV PROGRAMS CSE FORMS OMB 0970 0222 PDF

CSE Agency Case Identifier: See NMSN Instructions: programs/css/resource/national- medical-support-notice-form currently valid OMB control number. OMB control number: Expiration Date: 06/30/ Document Tracking Identifier: Employer web site: See NMSN Instructions: www. /cse/forms/ unless it displays a currently. NOTE: For purposes of this form, the Custodial Parent may also be the employee when Agency within 40 business days after the date of the Notice, or sooner if reasonable). Case #.

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This document serves as legal notice that the employee identified on this National Medical Support Notice is obligated by a court or administrative child support order to provide health care coverage for the child ren identified on this Notice. This National Medical Support Notice replaces any Medical Support Notice that the Issuing Agency has previously served with respect to the employee and the children listed on this Notice.

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The document has two parts:. Skip to main content. Office of Child Support Enforcement. Main navigation Search form Search.

National Medical Support Notice Form & Instructions | Office of Child Support Enforcement | ACF

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National Medical Support Notice Form & Instructions

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