DHS-681/FEN681, requEst to forgive debt owed to the state

(Revised 4-25)

You can ask the Friend of the Court to consider forgiving some of the money you owe to the State of Michigan for child support. Complete this form and send it to the Friend of the Court office where your child support case is located. The information you enter on this form could help the Friend of the Court find ways to reduce the money that you owe. The Friend of the Court will not forgive money you owe to the other parent. If you have court orders in more than one county, you may send a copy of this form to each county.

section 1 – tell us your personal information

Name (First, Middle, Last, Suffix)	Date of birth

Social Security number	Driver’s license or state ID number

Street address	City	State	Zip code

Email	Home phone	Cell phone

List the other parent’s name(s) and case number(s), if known, for any child support cases that you have in Michigan.

List the state(s) and case number(s), if known, for any child support cases that you have in other states.

section 2 – tell us who lives with you

Name (First, Middle, Last, Suffix)	Age	How is the person related to you?	Does this person help to pay your monthly expenses?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

SECTION 3 – TELL US ABOUT YOURSELF

The questions below will help us determine your ability to pay your child support debt. Friend of the Court staff may schedule a follow-up meeting with you in person or by phone. You may be asked to complete more paperwork or provide more information.

Your Situation
Do you have child support cases in other states?	Yes No
Do you care for your child(ren) when the other parent is at work or school?	Yes No
Do you provide non-money support such as transportation and clothing for your child(ren)?	Yes No
Your Education and Skills
Did you complete high school?	Yes No
Do you have a college degree?	Yes No
Do you have any special job training or skills?	Yes No
Are you permanently disabled?	Yes No
Your Other Sources of Income and Assistance
Are you receiving Social Security benefits?	Yes No
Are you receiving veterans’ benefits?	Yes No
Are you receiving unemployment benefits?	Yes No
Are you receiving pension benefits or spousal support?	Yes No
Are you expecting any money from an insurance claim or legal settlement?	Yes No
Are you expecting any money from a will, estate, or trust fund?	Yes No
Are you receiving food assistance, Medicaid, or cash assistance payments?	Yes No
Are you currently homeless or living in a homeless shelter?	Yes No
Assets
Do you own a motorcycle, boat, or camper?	Yes No
Do you have any checking, savings, or other bank accounts?	Yes No
Do you have a 401(k) account or retirement savings?	Yes No
Do you own a car?	Yes No
Expenses
Do you have a car payment each month?	Yes No
Do you have medical bills that you must pay?	Yes No
Do you have to pay any medical bills for a family member?	Yes No
Has the court ordered you to pay any other debts besides child support?	Yes No
Do you owe any court fines or fees?	Yes No
Have you filed for bankruptcy?	Yes No
Additional Information
Are you willing to take a budgeting class?	Yes No
Are you currently in jail or prison?	Yes No
Are you willing to do volunteer work?	Yes No
Are you willing to attend a job training program?	Yes No

section 4 – tell us about your income and expenses

How much money do you make from work each month?	$
How much money do you receive from Social Security, unemployment, or other income each month?	$
How much more can you pay for your current child support each month?	$
How much more can you pay each month toward your past-due child support?	$
How much can you pay all at once toward your past-due child support debt?	$
How much is your rent or mortgage each month?	$
How much do you pay for medical bills each month?	$
How much do you pay for your credit card debt each month?	$

section 5 – tell us about your employeR

Employer’s name	Employer’s phone number

Employer’s street address	City	State	Zip code

section 6 – tell us more (optional)

You may use the space below to enter additional information that you feel the Friend of the Court should consider when determining your eligibility to forgive some of your child support debt. You may include more pages if you need more space.

Note: If any of your child support debt is forgiven based on incorrect, incomplete, or false information you provided, the Friend of the Court may add your child support debt back to the total amount that you owe.

section 7 – Signature

Sign below if you believe the information you have provided on this form is correct and complete.

Signature	Print Name	Date

NEXT STEPS

1.	Make a copy of this form for each Friend of the Court office where you have a child support case with child support debt.

2.	Send a copy of this form to each office.

The Friend of the Court will review your information and contact you.

You can find Spanish and Arabic versions of this form at www.michigan.gov/childsupportpubs. Puede encontrar versiones de este formulario en español y árabe en www.michigan.gov/childsupportpubs. يمكنك العثور على النسختين الإسبانية والعربية من هذا النموذج على الرابط www.michigan.gov/childsupportpubs.

The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group on the basis of race, national origin, color, sex, disability, religion, age, height, weight, familial status, partisan considerations, or genetic information. Sex-based discrimination includes, but is not limited to, discrimination based on sexual orientation, gender identity, gender expression, sex characteristics, and pregnancy.