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COVID-19 Child Support Response Program Application

Below you will find our online application to see if you are eligible to receive funding through the Prevention, Retention and Contingency (PRC) Program. If you believe you meet the below criteria, please fill out all fields and hit the submit button at the bottom of the page:

  • Your family has been negatively financially impacted by the COVID-19 crisis
  • You are owed at least 3 months of past-due child support
  • You are caring for a child(ren) under the age of 18
  • You are at or below 200% of the Federal Poverty Level

Applications will be processed in the order they are received and you will receive notification if you are eligible for funding through this program.


* Name
* Social Security Number (last 4 digits)
* Address (line 1):
   Address (line 2):
* City:
* State:
* ZIP Code:
* Phone Number:
 
1. List everyone living in the household (including yourself):
  # Name Relationship to Applicant Age Income and Source: IE Employment
* 1.
  2.
  3.
  4.
  5.
  6.
  7.
  8.

* 2. Select family size below:
  Household Size Monthly Gross Income at 200% of the FPL
1 $2,082
2 $2,819
3 $3,555
4 $4,292
5 $5,029
6 $5,765
7 $6,502
8 $7,239

* 3. Income Declaration: Check One:
I declare that my family's gross monthly income is at or below the standard listed for family size.
          OR
I declare that my family's gross monthly income is above the standard listed for family size.
 
4. Please check all that apply:
My child receives child support and payments are in arrears by at least 3 months or more.
My household has been financially impacted by COVID-19.
I do not currently receive OWF cash assistance.
I am a US citizen or meet requirements for a qualified alien.
 
* 5. Sign this application (electronic signature is acceptable for this application):
I acknowledge the information provided above is complete and correct to the best of my knowledge. I agree that I have not received fraudulent benefits through OWF or PRC. The failure to be truthful on this application could result in a denial of benefits and/or a finding of an overpayment. By checking this box I am electronically signing this application.
* Enter signed date:
 
Voter Registration Notification: If you are not registered to vote where you live now, would you like to register to vote at this time?
Yes, I want to register to vote. No, I don't want to register to vote.
(If you do not check either box, you will be considered to have decided NOT to vote at this time. This does NOT affect your benefits application in any way.)
 

 
       * are required fields
     



Butler County CSEA | Executive Director William Morrison | Assistant Director Narka Gray 
Government Services Center, 7th Floor, Hamilton, OH 45011

Phone (513) 887-3362 | Fax (513) 887-3699

Board of Commissioners: Donald L. Dixon, T.C. Rogers, Cindy Carpenter