INSTRUCTIONS: ARIZONA CHILD SUPPLEMENTAL PAGE (Form CS-167-A)

When filing an Arizona request for Title IV-D Child Support Services using a form CS-167, a form CS-167-A is used supplementally if you need to document more than two children from the same father. Both forms can be obtained from the website maintained by the Arizona Department of Economic Security.

Arizona Child Supplemental Page CS-167-A Step 1: In the first blank box, enter the child's last name.

Arizona Child Supplemental Page CS-167-A Step 2: In the second blank box, enter the child's first and middle names.

Arizona Child Supplemental Page CS-167-A Step 3: In the third blank box, enter the child's Social Security number.

Arizona Child Supplemental Page CS-167-A Step 4: In the fourth blank box, indicate with a check mark whether or not the child lives with you.

Arizona Child Supplemental Page CS-167-A Step 5: In the fifth blank box, write your relationship to the child.

Arizona Child Supplemental Page CS-167-A Step 6: In the sixth blank box, enter the child's date of birth.

Arizona Child Supplemental Page CS-167-A Step 7: In the seventh blank box, enter the child's place of birth.

Arizona Child Supplemental Page CS-167-A Step 8: In the eighth blank box, enter the child's place of conception.

Arizona Child Supplemental Page CS-167-A Step 9: In the ninth blank box, indicate the child's gender with a check mark.

Arizona Child Supplemental Page CS-167-A Step 10: In the tenth blank box, indicate with a check mark whether the child's non-custodial parent has lived with them in Arizona.

Arizona Child Supplemental Page CS-167-A Step 11: In the eleventh blank box, indicate the child's race with a check mark.

Arizona Child Supplemental Page CS-167-A Step 12: In the twelfth blank box, indicate with a check mark whether or not the child is a member of a tribe. If yes, give their name and tribal census number.

Arizona Child Supplemental Page CS-167-A Step 13: Indicate whether the biological parents were married, divorced or never married at the time of birth with a check mark in the thirteenth blank box.

Arizona Child Supplemental Page CS-167-A Step 14: The next section concerns any man the woman was married to at the time of birth. The section after that concerns establishment of paternity. The last section concerns any court orders concerning the child.