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National Medical Support Notice Forms & Instructions

OMB 0970-0222 & 1210-0113

Published: October 30, 2019

These documents serve as legal notice that the employee identified on this National Medical Support Notice is obligated by a court or administrative child support order to provide health care coverage for the child(ren) identified on this Notice. This National Medical Support Notice replaces any Medical Support Notice that the Issuing Agency has previously served with respect to the employee and the children listed on this Notice.

The Notice has two parts:

View the Medical Support – FAQs for answers to employers’ common questions.

Last Reviewed: October 30, 2019

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