1805.000.00 Eligibility and Verification

1805.040.05 Referral to FSD-CS

IM-19 February 6, 2019; IM-46 July 15, 2016; IM-97 November 9, 2015

The following steps should be taken prior to referring a MO HealthNet case to FSD-CS when a child is deprived of parental support due to the continued absence of the child’s parent/s from the home.

A parent or caretaker must complete a Referral/Information for Child Support Services (CS-201) form, but the form is not required prior to approval of the MO HealthNet case. Do not hold an application pending completion of the CS-201.

EXCEPTIONS: Do not refer to FSD-CS when:

  • The applicant is a child under the age of 19 who is not living with a caretaker and who applies for Family MO HealthNet in his/her own name
  • A non-related caretaker is applying for MO HealthNet benefits for a child in their physical custody for whom they do not have legal guardianship or legal custody

If the MO HealthNet application is made in-person, staff must have the CS-201 completed by the applicant.

If the MO HealthNet application was completed online, by telephone, or by mail, the CS-201 may be:

  • Completed by the Family Support Division staff during a telephone call with the applicant prior to approving the application.

    NOTE: If completed by telephone call send the CS-201 to FSD-CS and note the information was obtained by telephone in the signature section along with the date of the call.

If unable to contact applicant by telephone, mail a Request for Information (IM-31A) allowing 10 days for the applicant to complete and return the form.

The applicant should provide as much information as possible on the CS-201. However, if the CS-201 is not returned or returned incomplete, FSD staff must fill out the form with at least the following information:

  • The name of the custodial parent;
  • There is at least one dependent child listed; and
  • The name of the non-custodial parent/alleged parent or mark “unknown”

    NOTE: The applicant’s signature is not necessary on the CS-201 for opening the child support case. FSD-CS Intake Center staff has been advised to go ahead and open the case without the signature. Do not hold up sending the document or do anything different due to the lack of a signature.

    NOTE: The FSD must approve the MO HealthNet case before the CS-201 is sent. If MO HealthNet coverage is denied, the CS-201 is sent to the virtual file room. If the parent still wishes to receive Child Support services he/she may apply online at dss.mo.gov or request the appropriate form by calling the Child Support Call Center at 866-313-9960.

For all completed CS-201 forms where all parties can be identified (including custodial, non-custodial/alleged parent, and children), scan and email to:

For all completed CS-201 forms where the non-custodial/alleged parent is “unknown” and cannot be identified, scan and email to:

All forms may also be submitted:

  • By mail to Family Support Division, PO Box 6790, Jefferson City, MO 65102-6790; or
  • Faxed to 573-635-7545
    • NOTE: If birth certificates for children born out-of state are provided by the applicant or available in the case file, attach a copy of the birth certificate to the CS-201 prior to submitting to FSD-CS.