Nebraska DHHS System: Application for Child Support Services: Applicant Information

Applicant Information

Note: an asterisk [*] indicates a required field.

* First Name

Middle Name

* Last Name

Suffix

Other names used (Nicknames/Alias)

Maiden Name

* Sex

Male

Female

* Social Security Number (SSN)

Unknown

Do Not Have an SSN

* Date of Birth

Unknown

Age
(mm-dd-yyyy)

Cellular Phone Number

Home Phone Number

Work Phone Number

Email Address