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National Medical Support Notice Forms & Instructions

OMB 0970-0222 & 1210-0113
March 5, 2020

Legal notice that the employee is obligated to provide health care coverage for the child(ren) identified

Completed by employers or third party processors to register to use Employer Services Portal applications

Used by multistate employers to register to report all newly hired employees to one state

Used for income withholding in tribal, intrastate, and interstate cases

Provides an efficient method for employers to respond to a child support agency's request for verification of employment