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LET H.I.A COLLECT YOUR CHILD SUPPORT NOW!
First Name
Last Name
Email Address
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H.I.A. Experts
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CUSTODIAL PARENT
(parent collecting child support)
First Name
Last Name
Middle Name
Address
City, State
Zip
Home Phone
Mobile Phone
Work Phone
Court Cause or Case Number and County
Atty. General CIN #
Date of Birth
Social Sec #
Drivers Lic. #
Email
Are you/have you collected TANF?
NON CUSTODIAL PARENT
(parent owing child support).
Fill out as much as possible and H.I.A. will help you with the rest.
First Name
Last Name
Middle Name
Address
City, State
Zip
Home Phone
Mobile Phone
Work Phone
Date of Birth
Social Sec #
Drivers Lic. #
Is NCP currently employed? (if YES, where?)
NCP's training and usual type of employment
Children
Child 1
First Name
Last Name
Middle Name
Date of Birth
Social Sec. #
Male/Female
Child 2
First Name
Last Name
Middle Name
Date of Birth
Social Sec. #
Male/Female
Child 3
First Name
Last Name
Middle Name
Date of Birth
Social Sec. #
Male/Female
Additional Information:
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