Nebraska Department of Health and Human Services Nebraska Department of Health and Human Services
Application for Child Support Services

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

A minimum of one child must be entered on your application.


* First Name
Middle Name
* Last Name
Suffix
* Gender
* Social Security Number (SSN)
  
Unknown
Do Not Have an SSN
  
* Date of Birth
  
Unknown
  
* What is your relationship to this child?
* Does this child live with you?
What is the child's relationship to the Custodial parent?
What is the child's relationship to the Non-custodial Parent?