The program encourages non custodial parents (NCP) to make consistent child support payments by:• Reducing arrears by half if the NCP makes full child support payments for one year. • Eliminating the balance owed if the (NCP) makes full child support payments for two years.

Note: Any arrears owed to the family will not be reduced.

To ApplyThe Non-Custodial Parent must:

• Submit a completed application to the local CSE agency; and

• Provide copies of the most recent pay stubs, if available.

Eligibility Criteria• Applicant has a Maryland court order

and there is an arrears balance owed to the State because the custodial parent received public assistance.

• Applicant’s gross income is less than 225 percent of the federal poverty level. The number of household members is considered.

• Applicant has not been terminated from this program three (3) times.

Child Support Payment Incentive ProgramPlease Print

_____________________________________________________________________________________ Your Name (First, Middle, Last)_____________________________________________________________________________________Custodial Parent’s Name Case Number

_____________________________________________________________________________________Your Address City State Zipcode

________________________ _________________________ ________________________Your Social Security Number Home Phone Number Business Phone Number

_____________________________________________________________________________________Your Employer

_____________________________________________________________________________________Employer’s Address City State Zipcode

______________________________________Income (Hourly, Weekly, Bi-Weekly, Monthly)

___________________________ ________________________Signature Date

( ) Qualifies to participate in the program/Acceptance letter sent ________________________ Date

( ) Does not qualify to participate in the program/Denial letter sent ______________________ Date Yes No Gross income less than 225 percent of the federal poverty level Yes No Arrears are permanently assigned to State of Maryland Yes No Previously terminated from the program three (3) times

Application for Child Support Payment Incentive Program

DO NOT WRITE BELOW THIS LINE

Note: Please provide proof of income if available.(Last 2 pay stubs.)

CHILD SuPPORT PAymENT INCENTIvE PROgRAm

ALLEgANy CO. CSEP. O. BOX 1647CUMBERLAND, MD 21501

ANNE ARuNDEL CO. CSEPO BOX 187044 CALVERT STREETANNAPOLIS, MD 21404

BALTImORE CO. CSE170 W. RIDGELY RD. SUITE 200LUTHERVILLE, MD 21093

BALTImORE CITy OCSEONE NORTH CHARLES STREET5th FLOORBALTIMORE, MD 21201

CALvERT CO. BOSE200 DUKE STREETPRINCE FREDERICK, MD 20678

CAROLINE CO. DSS/CSEPO BOX 400300 MARKET STREETDENTON, MD 21629

CARROLL CO. DSS/CSEPO BOX 9301232 TECH COURTWESTMINSTER, MD 21157

CECIL CO. DSS/CSEPO BOX 1160170 E. MAIN STREETELKTON, MD 21922

CHARLES CO. DSS/BCSE200 KENT AVELAPLATA, MD 20646

DORCHESTER CO. BOSEPO BOX 259627 RACE STREETCAMBRIDGE, MD 21613

FREDERICK CO. DSS/BCSEPO BOX 3066100 EAST ALL SAINTS STREETFREDERICK, MD 21705

gARRETT CO. DSS/BCSE12578 GARRETT HIGHWAYOAKLAND, MD 21550

HARFORD CO. DSS/BCSE101 S. MAIN STREETBEL AIR, MD 21014

HOWARD CO. DSS/BCSE7121 COLUMBIA GATEWAY DRCOLUMBIA, MD 21046

KENT CO. DSS/BCSE315 HIGH STREET, SUITE 208CHESTERTOWN, MD 21620

mONTgOmERy CO. CSE51 MONROE STREETSUITE 811ROCKVILLE, MD 20850

PRINCE gEORgE’S CO OCSE4235 28TH AVENUE, SUITE 135TEMPLE HILLS, MD 20748

QuEEN ANNE’S CO. OCSEPO BOX 387122 COURSEVALL DRIVECENTREVILLE, MD 21617

SOmERSET CO. OCSEPO BOX 36930397 MT. VERNON ROADPRINCESS ANNE, MD 21853

ST mARy’S CO. BOSEPO BOX 50923110 LEONARD HALL DRIVELEONARDTOWN, MD 20650

TALBOT CO. DSS/OCSEPO BOX 1479301 BAY STREET, UNIT 5EASTON, MD 21601

WASHINgTON CO. DSS/CSEPO BOX 1419122 N. POTOMAC STREETHAGERSTOWN, MD 21740

WICOmICO CO. DSS/CSE201 BAPTIST STREET, SUITE 101SALISBURY, MD 21801

WORCESTER CO DSS/CSEPO BOX 39424 WEST MARKET ST. SUITE BSNOW HILL, MD 21863

LOCAL CHILD SUPPORT AGENCIES

Department of Human Resources

If you have any question, please call 1-800-332-6347 for more information.

make your Payments Reduce your State Owed Arrears!

DHR Pub/CSEA 955 Revised (06/10)

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