Transcription of IV-D Child Support Services Application/Referral
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DHS-1201 (Rev. 6-15) Previous edition may be used. MS Word 1 IV-D Child Support Services Application/Referral FOR OFFICE USE ONLY Michigan Department of Health and Human Services Date Requested Date Provided Date Filed Program 748 Provided Office of Child Support (OCS) Please check your relationship to the children for whom you are applying for Child Support Services : IV-D Case No. MDHHS Case No. County District Unit Worker Custodial Parent Non-Custodial Parent or Alleged Father Other Caretaker, Specify Custodial Parent - Complete all sections of the form, enter information about you in Section A.
DHS-1201 (Rev. 6-15) Previous edition may be used. MS Word 1 IV-D CHILD SUPPORT SERVICES APPLICATION/REFERRAL FOR OFFICE USE ONLY Michigan Department of Health and Human Services Date Requested
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Individual Support Services (ISS) CYBER, In-Home Services, Individual Support Services ISS, Blending of Companion, In -Home Support Services, In-Home, SERVICES, Support, Support Services, Home Support, Home, FAMILY SUPPORT SERVICES, Based Services HCBS, CALIFORNIA – HEALTH AND HUMAN SERVICES, CALIFORNIA DEPARTMENT OF SOCIAL SERVICES