Notice and Agreement for Child Spousal Medical Support
This file contains important information about child, spousal, and medical support agreements in California. It outlines the responsibilities of individuals receiving cash aid or Medi-Cal. Proper understanding and completion of this document are essential for legal compliance.
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How do I fill this out?
To fill out this form, start by gathering all necessary documentation. Ensure that you read each section carefully to understand your responsibilities. Lastly, follow the guidelines provided to complete the form accurately.

How to fill out the Notice and Agreement for Child Spousal Medical Support?
1
Read the document thoroughly.
2
Gather required information related to both custodial and noncustodial parents.
3
Complete the Child Support Questionnaire (CW 2.1Q).
4
Sign the form where necessary.
5
Submit the completed document as instructed.
Who needs the Notice and Agreement for Child Spousal Medical Support?
1
Parents receiving cash aid need to complete this form to assign support rights.
2
Individuals seeking medical support from a noncustodial parent.
3
Caregivers of children needing legal recognition of support.
4
Participants in child support enforcement processes by the county.
5
Applicants for Medi-Cal benefits needing to establish paternity.
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What are the instructions for submitting this form?
To submit this form, you can send it via email to your county's support agency. Alternatively, you may fax the completed document to the specified number on the form. Lastly, physical submissions can be made at your local county office during business hours. Ensure to keep a copy for your records.
What are the important dates for this form in 2024 and 2025?
There are no specific important dates for this form in 2024 and 2025. However, it’s essential to submit it promptly upon request to ensure timely support.

What is the purpose of this form?
The purpose of this form is to ensure that individuals receiving cash aid understand their responsibilities regarding support. It outlines the process for assigning rights to the county for support payments. This helps in establishing support and maintaining benefits like Medi-Cal.

Tell me about this form and its components and fields line-by-line.

- 1. Noncustodial Parent Name: The name of the noncustodial parent or alleged father.
- 2. Case Number: Unique identifier for your case.
- 3. Signature: Signature of the parent or caretaker relative.
- 4. Date: Date when the form is signed.
What happens if I fail to submit this form?
If you fail to submit this form, you may lose eligibility for cash aid and Medi-Cal benefits. Additionally, your family's support may not be enforced, affecting financial stability.
- Ineligible for benefits: Refusal to assign support rights may lead to ineligibility for cash aid.
- Lowered grant amounts: Failure to cooperate can result in a 25% reduction in aid until compliance.
- Legal implications: Not submitting may result in complications in legal support enforcement.
How do I know when to use this form?

- 1. Cash Aid Application: Mandatory for applicants who are seeking financial assistance.
- 2. Medi-Cal Application: Required for those wanting health benefits tied to support.
- 3. Child Support Agreement: Necessary for establishing legal support arrangements.
Frequently Asked Questions
What is this form for?
This form is used to outline responsibilities regarding child, spousal, and medical support.
Who needs to fill out this form?
Parents receiving cash aids or anyone needing to establish support agreements.
Can I edit this form?
Yes, you can easily edit the form using PrintFriendly's PDF editor.
How do I share this PDF?
You can share the PDF via email directly from PrintFriendly.
What happens if I don't submit this form?
Failure to submit may affect your eligibility for aid.
How can I sign this form?
You can sign the form electronically on PrintFriendly.
Is this form required for Medi-Cal applicants?
Yes, it is necessary for applicants wanting to establish medical support.
What information do I need to fill this out?
You will need details about custodial and noncustodial parents.
What is good cause for not cooperating?
Good cause is recognized in situations where cooperation may risk harm.
How do I claim good cause?
You must inform your worker and submit a claim form.
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