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The DCSS 0569 form, officially titled the Declaration of Support Payment History, is a crucial document used in California's child support system. This form is designed to capture and report the payment history of support obligations, whether for child support, spousal support, or other related expenses. Individuals must accurately fill out the amounts ordered by the court and the actual payments made each month. The form requires a detailed breakdown of support payments, allowing for a clear view of any past due amounts. Additionally, it includes sections for documenting any periods of incarceration or institutionalization that may affect support obligations. It is essential to note that this declaration is not confidential and can be shared with the other party involved in the case. In the event of discrepancies, both parties may need to provide proof of payments, such as receipts or canceled checks. Assistance is available for those who need help completing this form through local Family Law Facilitator Offices, ensuring that individuals can navigate their child support responsibilities effectively.

Form Sample

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF CHILD SUPPORT SERVICES
INSTRUCTIONS FOR COMPLETING THE DECLARATION
OF SUPPORT PAYMENT HISTORY
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.
DCSS 0569 (06/17/2018)
Page 1 of 2
Person completing this form (name):
I am the: Custodial Party
Noncustodial Parent
Child Spousal Family
Medical
Support Payment History for (check one):
Unreimbursed medical expenses
Other (specify):
AMOUNT
ORDERED
AMOUNT
ORDERED
AMOUNT
ORDERED
AMOUNT
PAID
AMOUNT
PAID
AMOUNT
PAID
January
February
March
April
May
June
July
August
September
October
November
December
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:
Page 2 of 2
YEAR YEAR YEAR
DECLARATION OF SUPPORT PAYMENT HISTORY
DCSS 0569 (06/17/2018)
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF CHILD SUPPORT SERVICES
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.
Incarceration/Institutionalization History

Document Specifications

Fact Name Description
Form Title This form is officially titled "Declaration of Support Payment History." It is used to document support payments.
Governing Law The form is governed by California Family Code Sections 4000-4005, which outline child support obligations.
Purpose The primary purpose is to provide a detailed account of the support payments ordered by the court and those actually made.
Monthly Breakdown Users must fill in the amounts ordered and paid for each month since the support order began.
Incarceration History If applicable, the form includes a section to document any periods of incarceration of the other parent.
Non-Confidential This declaration is not confidential and may be shared with the other parent or party involved in the case.
Assistance Available Free help is available through local court's Family Law Facilitator Office for questions regarding this form.

Steps to Filling Out Dcss 0569

After completing the DCSS 0569 form, you will submit it to the appropriate child support agency. This form will provide a clear record of support payments and any relevant incarceration history, if applicable. Be sure to keep copies for your records.

  1. Begin by writing your name at the top of the form where indicated.
  2. Identify 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 boxes: Child, Spousal, Family, Unreimbursed Medical Expenses, Medical, or Other (specify).
  4. In the "YEAR" columns, enter the applicable years for which you are reporting support payments.
  5. For each month from January to December, fill in the "Amount Ordered" column with the support amount ordered by the court.
  6. Next, in the "Amount Paid" column, record the total amount of support paid for each corresponding month. Make sure to document payments for the month they were actually made.
  7. If there were any periods of incarceration or institutionalization for the other parent, complete the "Incarceration/Institutionalization History" section. Provide the begin and release dates, facility name, and any relevant details.
  8. If necessary, attach additional sheets for more information regarding payments or incarceration details.
  9. Sign and date the form at the bottom, confirming that the information provided is true and correct.
  10. Include your CSE case number in the designated space.

More About Dcss 0569

What is the purpose of the DCSS 0569 form?

The DCSS 0569 form, known as the Declaration of Support Payment History, is used to document the support payments that have been ordered by the court and the actual payments made. This information is essential for determining any past due support owed by either party involved in the case.

Who should complete the DCSS 0569 form?

The form should be completed by the individual who is responsible for reporting the payment history. This could be either the custodial party or the noncustodial parent, depending on the circumstances of the case.

What information is required on the form?

The form requires detailed information about the support payments, including the amount ordered by the court for each month and the amount actually paid during that time. Additionally, if applicable, it includes a section for detailing any periods of incarceration or institutionalization of the other parent.

How should I report multiple payments made in a single month?

If more than one payment was made in a given month, you should total the payments and report that total next to the month in which the payments were actually made. It is important to ensure that the amounts reflect when the payments were received, not when they were intended to cover.

Can I attach additional sheets to the DCSS 0569 form?

Yes, if you need more space to provide the required information, you may attach additional sheets. This is particularly useful if you are reporting multiple types of support or if there are extensive details regarding incarceration or institutionalization.

Is the information provided on the DCSS 0569 form confidential?

No, the information on the DCSS 0569 form is not confidential. It may be shared with the other parent or party involved in the case for verification purposes. Both parties may need to present proof of payments if there is a disagreement regarding the reported history.

What should I do if I have questions about completing the 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 assistance and can provide guidance on how to fill out the form correctly.

What happens if there is a dispute over the payment history?

In the event of a dispute regarding the payment history, both parties may be required to provide documentation to support their claims. This could include cancelled checks, receipts, or other proof of payments made during the relevant time periods.

Common mistakes

  1. Incomplete Information: One common mistake is not filling out all required fields. Each section of the form must be completed accurately, including the "Amount Ordered" and "Amount Paid" columns for each month. Missing information can lead to delays or disputes.

  2. Incorrect Payment Dates: Some individuals mistakenly enter payment amounts under the wrong month. It is crucial to record payments in the month they were actually made, not the month they were intended to cover. This ensures an accurate payment history.

  3. Failure to Update Changes: If there have been changes to the support order, such as an increase or decrease in the amount owed, these changes must be reflected in the form. Neglecting to update this information can create confusion regarding the total amount of support due.

  4. Combining Support Types: Another frequent error is combining different types of support payments, such as child support and spousal support, unless specifically ordered by the court. Each type of support should be documented separately to maintain clarity and accuracy.

  5. Neglecting Documentation: Many people forget to include supporting documentation, such as receipts or canceled checks, when necessary. This documentation may be required to verify the payment history and can help resolve disputes if they arise.

Documents used along the form

The DCSS 0569 form is an important document for tracking support payments. To effectively manage your child support case, you may need to complete additional forms. Below is a list of other documents commonly used in conjunction with the DCSS 0569 form.

  • Income and Expense Declaration (FL-150): This form provides a detailed account of your financial situation, including income, expenses, and assets. It helps the court understand your ability to pay support.
  • Child Support Order (FL-300): This document outlines the specific amount of child support that one parent is required to pay to the other. It serves as the legal basis for any payments made.
  • Request for Order (FL-300): Use this form to ask the court for a modification of an existing support order. It is necessary when circumstances change and a new support amount is needed.
  • Notice of Motion (FL-301): This form notifies the other party of your intent to request a court hearing regarding child support or related issues. It is essential for ensuring all parties are informed.
  • Proof of Service (FL-335): This document confirms that the other party has been properly notified of any court actions or documents filed. It is crucial for maintaining legal procedures.
  • Declaration Under Uniform Child Custody Jurisdiction and Enforcement Act (FL-105): This form is used to establish jurisdiction over custody matters, especially if parents live in different states.
  • Child Support Guidelines (FL-150): These guidelines provide a framework for calculating child support amounts based on income and other factors. They help ensure fair support determinations.

Completing these forms accurately is vital for your child support case. Each document plays a specific role in ensuring that your rights and responsibilities are clearly defined. Seek assistance if you have questions about any of these forms or how they relate to your situation.

Similar forms

The DCSS 0569 form is similar to the Child Support Worksheet, which is used in many jurisdictions to outline the financial obligations of a noncustodial parent. This worksheet typically requires the same information regarding income, expenses, and payment history. Both documents serve to clarify the financial responsibilities established by the court and ensure that all parties are aware of the amounts owed and paid over time.

Another related document is the Spousal Support Declaration. This form focuses specifically on the financial support provided to a spouse after separation or divorce. Like the DCSS 0569, it requires detailed records of payments made and amounts ordered, helping to establish a clear financial history. Both forms aim to provide transparency and accountability in support payments.

The Income and Expense Declaration is also similar. This document collects information about an individual's income, expenses, and financial obligations. It is often used in family law cases to assess a party's ability to pay child or spousal support. The thoroughness required in both forms helps courts make informed decisions regarding support obligations.

The Child Support Enforcement (CSE) Payment History is another comparable document. This form records the payment history of child support obligations, similar to the DCSS 0569. It tracks amounts ordered and paid, providing a clear picture of compliance with court orders. Both documents are crucial for resolving disputes over payment history.

The Financial Disclosure Form is also relevant. This form requires parties to disclose their financial situation, including income and expenses. Like the DCSS 0569, it is used to determine support obligations. Both documents aim to ensure that the court has a complete understanding of each party's financial circumstances.

The Affidavit of Support is another similar document. This affidavit outlines the financial support provided to a dependent, similar to the DCSS 0569's focus on child and spousal support. Both forms require detailed financial information and help establish the support obligations legally recognized by the court.

The Child Support Modification Request Form is also comparable. This form is used to request changes to existing support orders based on changes in circumstances. Like the DCSS 0569, it requires a detailed account of the payment history and the reasons for the requested modification. Both documents are essential for ensuring that support orders reflect current financial realities.

Finally, the Request for Order form is similar as well. This document is used to initiate a request for changes to support orders or to enforce existing orders. It often requires similar financial information as the DCSS 0569. Both forms facilitate communication between parties and the court regarding support obligations and compliance.

Dos and Don'ts

When filling out the DCSS 0569 form, it is essential to approach the task with care and attention to detail. Here are six important things to consider, both what you should do and what you should avoid.

  • Do provide accurate figures for both the amount ordered and the amount paid for each month.
  • Do ensure that each month's figures reflect any changes in your support order.
  • Do include any necessary additional sheets if you need more space for details.
  • Do complete the incarceration/institutionalization section if it applies to your case.
  • Don't combine different types of support unless your court order specifies a "family" support order.
  • Don't forget that this declaration is not confidential and may be shared with the other parent.

By following these guidelines, you can help ensure that the information you provide is clear and complete, which can be beneficial for your case. If you have any questions or need assistance, consider reaching out to your local court's Family Law Facilitator Office for support.

Misconceptions

Understanding the DCSS 0569 form can be crucial for those involved in child support cases. However, there are several misconceptions that may lead to confusion. Here are five common misunderstandings about this form:

  • The DCSS 0569 form is only for custodial parents. This form can be completed by both custodial and noncustodial parents. It provides a comprehensive overview of support payment history, regardless of which parent is filling it out.
  • You only need to report payments made in the current year. It is important to include the payment history for each month since the court order began. This helps establish a complete record of payments over time.
  • Combining child support and spousal support is acceptable. You should not combine these payments unless your court order specifically combines them into a "family" support order. Each type of support should be documented separately for clarity.
  • The form is confidential and cannot be shared. The DCSS 0569 is not confidential. It may be shared with the other parent or party involved in the case for review, which is why accuracy is essential.
  • Proof of payments is not necessary. If there is a disagreement regarding the payment history, both parties may be required to present proof of payments. This could include cancelled checks or receipts, so it’s wise to keep thorough records.

By addressing these misconceptions, individuals can better navigate the requirements of the DCSS 0569 form and ensure that their child support cases are handled effectively.

Key takeaways

Here are some key takeaways for filling out and using the DCSS 0569 form:

  • Accurate Information is Crucial: Ensure that the amounts you enter for both "Amount Ordered" and "Amount Paid" are correct. This will help establish the accurate payment history.
  • Monthly Breakdown Required: Fill in the details for each month since your support order began. If there were changes in the support amount, reflect those changes for the relevant months.
  • Attach Additional Sheets if Necessary: If you need more space to provide details, you can attach extra sheets. Just make sure they are clearly labeled and organized.
  • Understand the Public Nature of the Declaration: This document is not confidential. It may be shared with the other parent or party involved in your case, so be prepared for possible discussions regarding the information provided.