INSTRUCTIONS: ARIZONA REVIEW AND ADJUSTMENT REQUEST (Form CSE-1159A)

A parent that is paying or receiving child support payments in Arizona may request that the child support order in effect be adjusted by filing a form CSE-1159A. This request may be submitted no more than once every three years. This document can be obtained from the website maintained by the Arizona Department of Economic Security.

Arizona Review And Adjustment Request CSE-1159A Step 1: On the first blank line, enter the name of the custodial parent.

Arizona Review And Adjustment Request CSE-1159A Step 2: On the second blank line, enter the Social Security number of the custodial parent.

Arizona Review And Adjustment Request CSE-1159A Step 3: On the third blank line, enter the name of the non-custodial parent.

Arizona Review And Adjustment Request CSE-1159A Step 4: On the fourth blank line, enter the Social Security number of the non-custodial parent.

Arizona Review And Adjustment Request CSE-1159A Step 5: On the fifth blank line, enter your ATLAS case number.

Arizona Review And Adjustment Request CSE-1159A Step 6: In the blank section provided, give a written explanation as to why you wish to have the child support order reviewed and modified. If sufficient space is not provided for your explanation, use the other side of this form to continue. Reasons which are considered substantial enough to warrant reconsideration include the addition of or a change in your health insurance, job loss, the development of a disability, or a significant increase or decrease in wages.

Arizona Review And Adjustment Request CSE-1159A Step 7: On the first blank line before this box, enter your signature.

Arizona Review And Adjustment Request CSE-1159A Step 8: On the second blank line, enter the date.

Arizona Review And Adjustment Request CSE-1159A Step 9: On the third blank line, enter your printed name.

Arizona Review And Adjustment Request CSE-1159A Step 10: On the fourth blank line, enter your home phone number.

Arizona Review And Adjustment Request CSE-1159A Step 11: On the fifth blank line, enter your email address.

Arizona Review And Adjustment Request CSE-1159A Step 12: On the sixth blank line, enter your work or daytime phone number.

Arizona Review And Adjustment Request CSE-1159A Step 13: Enter your mailing address on the last blank line.

Arizona Review And Adjustment Request CSE-1159A Step 14: Mail the completed form to the address given at the bottom of the page.