The Massachusetts AM 3 form is a request for equitable adjustment of past-due child support owed to the Commonwealth of Massachusetts. This form allows individuals to seek relief from arrears under specific circumstances, but it does not apply to amounts owed to custodial parents. If you need to fill out the form, please click the button below.
The Massachusetts Am 3 form, officially known as the Request for Equitable Adjustment, serves a crucial purpose for individuals seeking to address past-due child support owed to the Commonwealth of Massachusetts. This form is specifically designed for those who wish to request an adjustment of arrears, but it's important to note that it only applies to amounts owed to the state, not to custodial parents. To successfully submit this request, applicants must provide a range of documentation, including a completed Statement of Financial Condition, verification of income, and bank statements. Additionally, the form requires information from the Social Security Administration, particularly for those receiving benefits like Supplemental Security Income or Social Security Disability Insurance. Medical records may also be necessary if a medical disability is claimed. The process emphasizes the importance of accuracy and completeness, as any missing documentation can lead to delays or rejection of the application. Furthermore, the form includes an authorization for the Department of Revenue to obtain the applicant's credit report, which is a standard procedure in evaluating financial situations. Understanding the requirements and ensuring all necessary information is included can significantly impact the outcome of the request.
Commonwealth of Massachusetts
Department of Revenue
Child Support Enforcement Division
REQUEST FOR EQUITABLE ADJUSTMENT
Name:
APPLICATION
SSN:
Case No:
IMPORTANT! You can request equitable adjustment of arrears owed to the Commonwealth only.
Arrears owed to a custodial parent are not eligible for equitable adjustment.
Check List of Required Items
The following documentation must be submitted with your application or your application will be returned as incomplete. Indicate if any of the items are not applicable by writing N/A. DOR may require you to provide additional documentation as the evaluation of your request proceeds.
Unless DOR has specifically asked for the original document, please submit copies only. DOR will not return any documents to you.
Completed Request for Equitable Adjustment (this two-page form).
Completed Statement of Financial Condition.
Verification of Income
Complete pay stubs for the past 3 months, or financial statements for the past 2 years if you are self-employed.
Information from the Social Security Administration (SSA).
Social Security Earnings Statement (required for all applicants). Go to www.ssa.gov for instructions on requesting an Earnings Statement. If you receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), attach a copy of the award letter.
Bank Information
Complete bank statements for all checking, savings and other bank accounts for the past 3 months.
Medical Records
Copies of any doctors’ letters, reports or medical records that support any claim of medical disability.
Power of Attorney
Power of Attorney if this offer is submitted by a designated representative.
Authorization to Request Consumer Credit Report
I, ____________________, hereby authorize DOR to obtain, and all consumer credit reporting agencies to furnish,
my full credit report in accordance with §§ 1681b(a)(2), (4) and (5), 1681b(f), 1681e and any other applicable sections of the Fair Credit Reporting Act (FCRA). (15 USC § 1681 et. seq.). I agree that DOR’s use of my credit report for collection and enforcement of my child support order is a permissible purpose as that term is defined in § 1681b of the FCRA. This authorization does not expire and any revocation of this authorization must be made in writing to DOR. Copies of this authorization are as good as the original.
____________________________________________
____________________________
Signature
Date
Mail your completed and signed application, with copies of all required documents, to:
Attn:
AM-3 2/23/10
Name
Social Security Number
Date of Birth
Address
City/Town
State
Zip Code
Home Phone Number
Work Phone Number
Cell Phone Number
E-mail
To the Deputy Commissioner of the Child Support Enforcement Division (DOR):
1.I submit this request for equitable adjustment of past-due child support that I owe to the Commonwealth of Massachusetts. DOR’s records indicate and I believe that I owe a total of $___________ to the Commonwealth, including interest and penalty.
2.I understand that any past-due child support owed to the custodial parent is NOT subject to equitable adjustment and that even if this request is approved, DOR will continue its enforcement actions to collect any past-due support owed to the custodial parent.
3.Submission of this request for equitable adjustment does not waive any rights I might have to challenge the amount stated in paragraph 1 in the event no equitable adjustment is made.
4.I have attached a completed Statement of Financial Condition which shows that I do not have the present financial ability to pay the past-due support in full.
5.The past-due support I owe to the Commonwealth should be equitably adjusted because (check all that apply):
a. The past-due support accrued during periods I received needs-based benefits (e.g., SSI,TANF/AFDC, state
veterans’ benefits). Type of benefit: ________________________________ Dates received: ___________________
b. The past-due support accrued during periods I was unable to pay my child support because:
I had the following disability: _____________________________________________________________________
Dates of disability: ________________________ Received SSDI Yes No Injured at work Yes No
I was unemployed and did not receive unemployment benefits.
Reason for unemployment: ______________________________________________________________________
Dates of unemployment: ________________________
I was incarcerated. Dates and place of incarceration: __________________________________________________
Other. Please explain: __________________________________________________________________________
_____________________________________________________________________________________________
If you checked any box in Paragraph 5b: Did you file for modification of your support order during the period you were
unable to pay support? Yes No Explain: ______________________________________________________________
c. I have custody of the minor child for whom I owe support. Yes No Attach custody order or proof of residence.
d. I am reconciled and reside with the custodial parent and the minor child for whom I owe past-due support. Date of reconciliation/marriage: __________ Has support order been terminated by the court? Yes No
I certify under the pains and penalties of perjury that the information provided above is true and accurate to the best of my knowledge and belief. I understand that if I fail to provide complete information or provide false information, my request for equitable adjustment will be denied. I also understand that DOR may continue its enforcement actions while this request for equitable adjustment is under consideration.
Filling out the Massachusetts AM 3 form can seem daunting, but taking it step by step will make the process manageable. After completing the form, you will need to submit it along with various required documents to the Department of Revenue. Ensure that you provide accurate information and follow the instructions closely to avoid delays.
Once you have completed the form and gathered all required documents, mail everything to the Department of Revenue, Child Support Enforcement Division. Make sure to keep copies for your records. This will help ensure that your request is processed smoothly.
The Massachusetts Am 3 form is used to request an equitable adjustment of past-due child support owed to the Commonwealth of Massachusetts. This form allows individuals to explain their financial situation and provide reasons why they believe the amount owed should be adjusted. It is important to note that this form only addresses arrears owed to the Commonwealth, not to custodial parents.
When submitting the Am 3 form, several documents must be included to ensure the application is complete. These documents include:
Failure to provide these documents may result in the application being returned as incomplete.
No, the Am 3 form only allows for equitable adjustments of arrears owed to the Commonwealth. Any past-due child support owed to the custodial parent is not eligible for adjustment through this process. Even if your request is approved, enforcement actions to collect support owed to the custodial parent will continue.
If you fail to provide complete or accurate information on the Am 3 form, your request for equitable adjustment may be denied. It is crucial to ensure that all information is truthful and comprehensive. The Department of Revenue may also continue enforcement actions while your request is being considered, regardless of the outcome.
Once you have completed the Am 3 form and gathered all necessary supporting documents, mail your application to the Department of Revenue, Child Support Enforcement Division. Ensure that you send copies of all documents, as DOR will not return any submitted materials. The mailing address is:
Department of Revenue Child Support Enforcement Division Attn: AM-3 [Insert address here]
Incomplete Documentation: Failing to include all required documents can lead to the application being returned. Ensure you submit the completed Request for Equitable Adjustment, Statement of Financial Condition, and verification of income, among others.
Incorrect Personal Information: Double-check your name, Social Security Number, and contact details. Any discrepancies can delay processing or result in rejection.
Missing Signatures: Ensure that you sign and date the application. An unsigned application will not be processed.
Failure to Indicate N/A: If any required items do not apply to you, write "N/A" next to those items. Omitting this can lead to confusion and may be considered incomplete.
Not Providing Copies: Submit only copies of documents, unless the Department of Revenue specifically requests originals. They will not return any documents.
Ignoring Additional Documentation Requests: Be prepared to provide further documentation if requested by the Department of Revenue during the evaluation process. Ignoring these requests can hinder your application.
The Massachusetts Am 3 form is an important document for those seeking an equitable adjustment of child support arrears owed to the Commonwealth. When submitting this form, there are several other documents that may be required to support your application. Below is a list of these documents, along with a brief description of each.
Gathering these documents can streamline the process and improve your chances of a successful adjustment. Make sure to double-check that everything is complete before submission to avoid any delays.
The Massachusetts Am 3 form is similar to the Child Support Modification Request form. Both documents allow individuals to request changes to their child support obligations based on their current financial situations. The Child Support Modification Request form requires the applicant to provide evidence of income, expenses, and any significant changes in circumstances that may affect their ability to pay. This ensures that the child support amount is fair and reflects the current reality of the parent's financial situation.
Another related document is the Financial Affidavit. This form is used to disclose a person's financial status, including income, expenses, assets, and liabilities. Like the Am 3 form, the Financial Affidavit is crucial for evaluating a person’s ability to meet their financial obligations. It provides a detailed snapshot of the individual's finances, which can influence decisions about child support adjustments or modifications.
The Request for Hearing form is also similar. This document allows individuals to contest decisions made by the Child Support Enforcement Division. If a person disagrees with a ruling related to their child support obligations, they can submit this form to request a hearing. It serves as a formal way to challenge decisions and ensures that individuals have a platform to present their case, much like the Am 3 form allows for adjustments to past-due support.
The Affidavit of Support is another relevant document. Often used in immigration contexts, it requires the sponsor to demonstrate their financial ability to support an immigrant. This form shares similarities with the Am 3 form in that it requires a detailed account of financial resources. Both forms aim to ensure that obligations can be met without undue hardship on the individual responsible for support.
The Income Withholding Order is also noteworthy. This document is used to automatically deduct child support payments from a parent's paycheck. Similar to the Am 3 form, it is a tool for enforcing child support obligations. The Income Withholding Order ensures that payments are made consistently, which is essential for the financial stability of the child involved.
The Child Support Enforcement Application is another related document. This form is used to initiate the process of establishing or enforcing child support. Like the Am 3 form, it collects necessary information about the parents and the child to facilitate support enforcement. Both documents aim to ensure that children receive the financial support they need.
Lastly, the Notice of Child Support Obligation form is similar. This document informs parents of their child support responsibilities and the amounts owed. It serves as a formal notification, much like the Am 3 form, which addresses past-due support. Both documents play a critical role in ensuring that parents are aware of their obligations and the consequences of non-compliance.
When filling out the Massachusetts AM 3 form, it’s crucial to follow specific guidelines to ensure your application is processed smoothly. Here are six important do's and don'ts:
Following these guidelines can help prevent delays in processing your request for equitable adjustment. Take the time to review your application and ensure all necessary information is included.
Understanding the Massachusetts AM 3 form is essential for those navigating child support obligations. However, several misconceptions can lead to confusion. Below is a list of common misconceptions regarding the form, along with clarifications.
By addressing these misconceptions, individuals can better prepare their applications and understand the limitations and requirements of the Massachusetts AM 3 form.
The Massachusetts Am 3 form is a critical document for individuals seeking an equitable adjustment of child support arrears owed to the Commonwealth of Massachusetts. Here are some key takeaways about filling out and using this form: