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The DCSS 0569 form, officially known as the Declaration of Support Payment History, plays a crucial role in California's child support system. It serves as a detailed record for parents to document the amount of support ordered by the court and the payments made over time. Each entry on the form, from monthly figures to annual totals, can influence the determination of any past due support owed. Complete the “Amount Ordered” and “Amount Paid” columns accurately for each month, ensuring changes in support amounts are reflected correctly. Moreover, the form requires individuals to detail any periods of incarceration or institutionalization that may affect support. It's essential to understand that this declaration is not a confidential document and can be shared with the other parent for review. Discrepancies in the payment history may lead to a need for proof, which could include receipts or canceled checks. For those needing assistance in navigating this process, resources are available through local Family Law Facilitator Offices. Remember, accurate and thorough completion of this form is vital for resolving child support matters effectively.

Dcss 0569 Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF CHILD SUPPORT SERVICES

DECLARATION OF SUPPORT PAYMENT HISTORY

DCSS 0569 (06/17/2018)

INSTRUCTIONS FOR COMPLETING THE DECLARATION

OF SUPPORT PAYMENT HISTORY

On the back of this page is the Declaration of the Support Payment History for your case. Please provide the amount of support that was ordered by the court and the amount that was paid for each month. These figures will help determine the amount of the past due support owed, if any.

Within the boxes on the bottom half of the page, please complete the:

"Amount Ordered" column for each year

Fill in the amount of support that was ordered by the court each month since your order began. If there has been a change in your order, make sure each month reflects the correct amount of support due.

"Amount Paid" column for each year

Fill in the dollar amount of support paid in that month. If more than one payment was made in a given month, put the total dollar amount of support paid. Put the dollar amount next to the month in which the payment was actually paid, and not the month the payments were intended to cover. If needed, you may attach more sheets.

Within the boxes on the bottom half on the page, only if it applies to your case, please complete the:

“Incarceration/Institutionalization History"

Fill in the details of any time periods during which the other parent of your child was involuntarily confined in a state prison, county jail, juvenile facility, mental health facility, or other facility. If needed, you may attach additional sheets.

Please complete a separate page(s) for child support, spousal support, family support, medical support, unreimbursed medical expenses, and other types of support not listed. DO NOT combine child support and spousal support unless your court order combines the two support payments into a "family" support order.

Be aware that this Declaration is not confidential and may be given to the other parent or party in your case for review. If there is a disagreement regarding the payment history, the parties may be required to present proof of payments, for example, cancelled checks, or receipts.

If you have questions and/or need assistance with child support forms, you can get free help from your local court's Family Law Facilitator Office. Information for the Family Law Facilitator can be found at the California Courts website at http://www.courts.ca.gov/selfhelp-facilitators.htm.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

DEPARTMENT OF CHILD SUPPORT SERVICES

DECLARATION OF SUPPORT PAYMENT HISTORY

DCSS 0569 (06/17/2018)

Person completing this form (name):

 

 

 

I am the:

 

 

 

 

 

Support Payment History for (check one):

Child

Spousal

Family

Unreimbursed medical expenses

Medical

Other (specify):

 

 

Custodial Party Noncustodial Parent

 

YEAR

 

 

YEAR

 

 

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMOUNT

 

AMOUNT

AMOUNT

AMOUNT

AMOUNT

AMOUNT

 

ORDERED

 

PAID

ORDERED

 

PAID

ORDERED

 

PAID

January

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

February

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

March

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

April

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

May

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

June

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

July

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

August

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

September

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

October

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

November

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

December

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Incarceration/Institutionalization History

BEGIN DATE

(MM/DD/YYYY)

RELEASE DATE (MM/DD/YYYY)

FACILITY/INSTITUTION NAME AND LOCATION

OTHER DETAILS, SUCH AS CHARGING

OFFENSE(S), CONVICTION(S),

VICTIM NAME(S), COURT WHERE

SENTENCED, ETC.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I am aware that this may be provided to the other parent for their verification and that either party may be required to provide documentation.

Signature:

 

Date:

 

CSE Case Number:

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File Breakdown

Fact Name Description
Form Purpose The DCSS 0569 form is used to document support payments made and received for court-ordered child support, spousal support, family support, and other support types.
State Requirement This form is specific to the State of California and is governed by California Family Code Section 4050 et seq., which outlines child support obligations.
Payment History Users are required to fill in details about amounts ordered versus amounts paid for each month since the support order began. This historical data is critical for assessing any past due support owed.
Incarceration Record If applicable, the form allows for reporting periods of involuntary confinement of the noncustodial parent, which might affect support payments.
Confidentiality The information on this form is not confidential and may be shared with the other parent or party involved in the case, serving to ensure transparency.
Assistance Availability Individuals seeking help with completing this form can reach out to their local Family Law Facilitator Office for guidance, available through the California Courts website.

Guide to Using Dcss 0569

Completing the DCSS 0569 form requires careful attention to the details of your support payments. After filling out this form, it will be submitted to the appropriate authorities for review. Below are the steps to effectively fill out the form.

  1. Provide your name in the section labeled "Person completing this form."
  2. Indicate your role by checking the appropriate box: "Custodial Party" or "Noncustodial Parent."
  3. Select the type of support payment history you are providing by checking one of the options: "Child," "Spousal," "Family," "Unreimbursed medical expenses," "Medical," or "Other." If selecting "Other," specify the type.
  4. For each year, fill in the "Amount Ordered" and "Amount Paid" sections for each month from January to December. Ensure that the amounts ordered reflect any changes over time.
  5. If multiple payments were made in any month, total those payments and enter the amount beside the relevant month.
  6. Complete the "Incarceration/Institutionalization History" section if it is applicable. Provide the BEGIN DATE and RELEASE DATE, along with the facility name and additional details like offense or conviction information.
  7. Review the filled-out form for completeness and accuracy.
  8. Sign and date the form, stating that the information is true and correct, under penalty of perjury.
  9. Include your CSE Case Number in the appropriate field at the bottom of the form.

After completing these steps, ensure that you keep a copy of the form for your records before submitting it to the designated authority or the other party involved in your case.

Get Answers on Dcss 0569

What is the DCSS 0569 form used for?

The DCSS 0569 form is used to declare the payment history of support obligations, such as child support or spousal support. It helps in providing a detailed record of the payments ordered by the court and the payments actually made over a specific time period. This information is crucial for determining any past due amounts owed.

How do I fill out the Amount Ordered and Amount Paid columns?

In the Amount Ordered column, you should fill in the amount of support that the court ordered for each month since the support order began. In the Amount Paid column, enter the total amount paid for that month. If multiple payments were made in a month, combine them and note the total next to the month when the payment was made, not when it was due.

What if my support amount has changed?

If there has been a change in your support amount as ordered by the court, make sure to update the Amount Ordered column for the months that reflect the new amount. It’s important to keep this information accurate for a definitive payment history.

Do I need to attach additional sheets?

If you require more space, you may attach additional sheets to provide complete and accurate information. This includes detailing incarceration periods for the other parent, or if you have additional types of support payments to report.

Is this form confidential?

No, the DCSS 0569 form is not confidential. The information provided may be shared with the other parent or parties involved in your case for their review. It’s important to recognize that any disagreement over payment history may require both parties to present proof of payments, such as receipts or canceled checks.

What should I do if I have questions about filling out this form?

If you have questions or need assistance while completing the DCSS 0569 form, you can seek help from your local court’s Family Law Facilitator Office. They offer free guidance on completing child support forms and can provide the resources you need. Visit the California Courts website for more information.

Who signs the DCSS 0569 form?

The person completing the form, whether they are the custodial party or the noncustodial parent, must sign the document. This signature verifies that the information provided is true and correct under penalty of perjury as per California law.

What happens after I submit the DCSS 0569 form?

After submitting the form, the payment history will be reviewed. If there are any disputes regarding payment amounts, both parties may be required to provide documentation as proof of payments made. Keep a copy of the submitted form and any attached materials for your own records.

Common mistakes

Completing the DCSS 0569 form is an important task that requires attention to detail. Mistakes can lead to misunderstandings and potential disputes regarding child support obligations. One common mistake is failing to accurately enter the amount ordered by the court. Each entry should reflect the correct amount for each month. If there have been changes to the order, it is crucial to update these amounts accordingly. Otherwise, inaccurate information may impede the calculation of past due support.

Another frequent error occurs when individuals do not record the amount paid for each month. Simply stating the total support paid without indicating when payments were made is inadequate. The form asks for the dollar amount next to the month in which the payment was actually submitted, not when it was meant to cover. Omitting this detail can create confusion and complicate any discussions about payment history.

Some may overlook the section for incarceration or institutionalization history. If the other parent has been confined for any reason, details regarding these periods should be included. Failing to document this information can negatively impact the understanding of support obligations during those times. If it applies to your case, ensure these records are thorough and accurate.

Using the form to combine different types of support is another mistake people often make. For instance, individuals should not merge child support and spousal support unless the court order explicitly combines them into a “family support order.” Mixing these categories can lead to further complications in determining the correct support arrangements and obligations.

Submitting incomplete information can lead to complications. It is advisable to use additional sheets if necessary. If you run out of space on the form for certain months or details, do not hesitate to provide further documentation. This extra step can prevent confusion later and bolster your case.

Another common oversight is the misunderstanding that the declaration is confidential. This form is not confidential and may be shared with the other parent. As a result, it is important to be mindful of the information you include. If there are sensitive details, consider how they might be perceived by others involved in the case.

Many individuals may neglect to sign and date the form. A signature signifies acceptance of the information provided and its accuracy under penalty of perjury. Without it, the form may be considered incomplete, potentially leading to delays or further inquiries.

Having questions or doubts about the completion of the DCSS 0569 form is natural. Many people erroneously believe they should sort it out independently. However, it is beneficial to seek assistance if needed. You can contact the local court’s Family Law Facilitator Office for guidance, which can greatly ease the process.

Finally, individuals sometimes forget to keep records of their payments. It is wise to maintain documentation such as canceled checks or receipts. These proofs can be critical if disagreements arise concerning the payment history. Being prepared can help ensure your rights are protected throughout the child support process.

Documents used along the form

The DCSS 0569 form is a crucial document in child support proceedings in California. It captures the payment history of support obligations, allowing both parents and the courts to track payments over time. Several other forms complement this main document, enhancing the process of establishing and verifying support obligations.

  • Child Support Order (CSO): This legal document outlines the specific amount of child support the noncustodial parent must pay. It typically includes details about payment schedules and any additional support obligations.
  • Income and Expense Declaration (IED): This form provides a detailed picture of a parent’s financial situation, including income, expenses, and assets. It is often used to determine appropriate support amounts based on each parent's financial status.
  • Request for Order (RFO): A party may file this form to request changes to an existing child support order. It can be used to modify support amounts, payment schedules, or enforcement actions.
  • Judicial Council Form FL-150: This form is a financial disclosure document that supports the IED by detailing income and expenses. It is essential for transparency in child support hearings and negotiations.
  • Proof of Service: When filing any court documents, this form verifies that all parties involved have received copies of the submitted documents. Proper notice is critical to the fairness of the process.

Each of these documents plays a distinct role in ensuring that child support orders are fair and enforceable. They work together to provide a clear and comprehensive picture of the financial responsibilities of parents, helping to safeguard the best interests of the child involved.

Similar forms

  • CCS 0560 - Child Support Service Verification: This form requires individuals to confirm their current child support obligations and payment history, similar to the DCSS 0569’s focus on detailing amounts owed and paid.
  • FL-150 - Income and Expense Declaration: Like the DCSS 0569, this document is utilized in court to assess an individual’s financial situation for determining support amounts, making detailed financial disclosures important.
  • FL-155 - Financial Statement: This form gathers extensive financial information about an individual’s income and expenses, similar to the payment history requested in the DCSS 0569, which involves detailing payments made and ordered.
  • CS 1030 - Request for Modification of Child Support Order: Just like the DCSS 0569, this form is used when individuals need to adjust their child support obligations. Both forms facilitate discussion about the current support amounts.
  • FL-320 - Spousal Support Declaration: This declaration details an individual’s spousal support payments, paralleling the DCSS 0569 in its objective to document payments and ensure clear communication between parties.
  • JS 55 - Judgment of Support Obligation: This legal document outlines the ordered support obligations, similar to how the DCSS 0569 requires individuals to report the amounts set by the court regarding support payments.
  • FL-341 - Order to Show Cause: This form is used to notify parties of upcoming hearings regarding support orders, much like how the DCSS 0569 aims to clarify any disputes regarding past due support amounts.

Dos and Don'ts

Filling out the DCSS 0569 form can seem overwhelming, but keeping a few simple guidelines in mind can make the process smoother. Here’s a handy list of dos and don’ts to help you through it:

  • Do read the instructions carefully before starting.
  • Do fill in the correct amounts for both "Amount Ordered" and "Amount Paid."
  • Do include documentation, like receipts or canceled checks, if there are discrepancies.
  • Do double-check your information for accuracy before submitting the form.
  • Do attach additional sheets if necessary to provide complete details.
  • Don't combine child and spousal support unless your order specifies to do so.
  • Don't forget to indicate any changes in support amounts over time.
  • Don't leave any fields blank; if something doesn’t apply, write “N/A.”
  • Don't submit your form without signing and dating it.
  • Don't assume the form is confidential; others may receive a copy for review.

Misconceptions

There are several misconceptions surrounding the DCSS 0569 form that can lead to confusion. Clarifying these points is essential for accurate completion and understanding.

  • Misconception 1: Only custodial parents need to fill out the form.
  • Both custodial and noncustodial parents may need to complete this form, depending on the circumstances of the case. It applies to anyone involved in a child support case.

  • Misconception 2: The form is confidential.
  • This form is not confidential. It can be shared with the other parent or involved parties in the case. Transparency is crucial for verifying the accuracy of payment histories.

  • Misconception 3: You can combine different types of support payments.
  • You must keep child support and spousal support separate unless a court order specifies a combined "family" support order. Mixing these can lead to inaccuracies in your reporting.

  • Misconception 4: Payment details are not important.
  • The amount ordered and the amount paid for each month are crucial. These figures help establish any past due support owed, making accuracy in this area vital.

  • Misconception 5: No documentation is needed when submitting the form.
  • If there is a disagreement regarding the payment history, documentation like canceled checks or receipts may be required. Thus, keeping thorough records is a wise practice.

Key takeaways

When filling out the DCSS 0569 form, there are several important considerations to ensure accuracy and compliance.

  • Accurate Reporting of Court Orders: Start by providing the correct amount of support ordered by the court. It's crucial to list these amounts for each month accurately.
  • Monthly Payment Tracking: Record the payment amounts for each month. If multiple payments were made, total them for the specific month they were received, not when they were meant to cover.
  • Incarceration Information: If applicable, document any periods where the other parent was confined in a facility. Include relevant details such as the facility name and any charges.
  • Separate Payments by Type: Ensure that you complete separate sections for different types of support. Do not combine child support with spousal support unless specified by the court.
  • Confidentiality Considerations: Keep in mind that this form is not confidential. The other parent may see it, and both parties might have to present evidence if there is a disagreement about payment history.

In conclusion, careful attention to detail when filling out the DCSS 0569 form can help prevent misunderstandings and facilitate the child support process.