INSTRUCTIONS: ARIZONA EMPLOYER ADDRESS INFORMATION (Form CSE-1163A)

Arizona employers whose employees have child support payments withheld from their wages have their address documented with child support enforcement services using a form CSE-1163A. This document can be obtained from the website maintained by the Arizona Department of Economic Security.

Arizona Employer Address Information CSE-1163A Step 1: Indicate with a check mark whether you are documenting an employer or insurance address.

Arizona Employer Address Information CSE-1163A Step 2: In the first blank box, enter your corporate street address, city, state and zip code.

Arizona Employer Address Information CSE-1163A Step 3: In the second blank box, enter your company legal name.

Arizona Employer Address Information CSE-1163A Step 4: In the third blank box, enter your company "doing business as" name.

Arizona Employer Address Information CSE-1163A Step 5: In the fourth blank box, enter your company street address, city, state and zip code.

Arizona Employer Address Information CSE-1163A Step 6: In the fifth blank box, enter your federal employer identification number.

Arizona Employer Address Information CSE-1163A Step 7: In the seventh blank box, enter your phone number, including the area code.

Arizona Employer Address Information CSE-1163A Step 8: In the eighth blank box, enter your fax number, including the area code.

Arizona Employer Address Information CSE-1163A Step 9: If your company uses the address given for processing all employee related correspondence, check the box where indicated.

Arizona Employer Address Information CSE-1163A Step 10: If you wish to enter an additional address that also receives employee related correspondence, you must indicate with a check mark what type of address you are providing. Check the first box if the additional address is a job site.

Arizona Employer Address Information CSE-1163A Step 11: Check the second box if the additional address processes income withholding orders.

Arizona Employer Address Information CSE-1163A Step 13: Check the third box if the additional address processes national medical support notices.

Arizona Employer Address Information CSE-1163A Step 14: Check the fourth box if the additional address processes employment verification.

Arizona Employer Address Information CSE-1163A Step 15: Check the fifth box if the additional address is that of a statutory agent.

Arizona Employer Address Information CSE-1163A Step 16: The official completing this form should email it to the address given on the second page.