SANTA CLARA COUNTY DEPARTMENT OF CHILD SUPPORT

SERVICES
880 RIDDER PARK DR
SAN JOSE CA 95131-2486

07/22/2022

Participant ID #:
JONATHAN D ABRIAM 0850000719065
138 E 12300 S STE C486
DRAPER UT 84020-7976 Total Past Due Amount:*
$6300.28

CHILD SUPPORT WARNING NOTICE

Our records show you are past due in paying child, family, or spousal support.
We will use collection methods during the next 12 months, including, but not limited to, those
authorized under state or federal law.
The following may be taken:
Federal and state tax refunds
Any federal payment owed to you
Any lottery winnings or other money owed to you by the state
Money or assets in bank accounts that have your name or Social Security Number
A portion of any money owed to you as an independent contractor
A portion of any disability or unemployment benefits
A portion of any personal injury settlement or workers' compensation payments
A portion of retirement or pension benefits, including military retirement and the public
employee retirement system
Any other payments or credits coming to you, regardless of source

In addition to taking these funds, you may also experience:

Suspension or Denial of: Any State issued licenses including drivers licenses, recreational
and professional licenses
Cancellation or restriction of an existing passport, and denial of any application for a new
or renewed passport
Credit report information submitted to credit bureaus: We may report your monthly child
support, total past due balance, and whether you make your payments on time
You can avoid these actions!
Pay $6300.28 to:
CALIFORNIA STATE DISBURSEMENT UNIT
PO BOX 989067, WEST SACRAMENTO CA 95798-9067

Pay your full support amount every month

A Child Support Warning Notice will be sent to you every 12 months as long as you owe
past due support.
PLEASE KEEP THIS NOTICE FOR YOUR RECORDS
*May not include accrued interest. Please contact the LCSA at the address listed on page 2 for an updated balance.
CHILD SUPPORT WARNING NOTICE STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
DCSS 0284 (06/20/2021) DEPARTMENT OF CHILD SUPPORT SERVICES
Page 1 of 2
ENF 1
DS2488421743
RIGHT TO ADMINISTRATIVE REVIEW

You have the right to contest the amount of past due support owed, and you may request an
administrative review. If you want to request an administrative review or have any questions
regarding this notice or your past due support amount, you must contact the local child support
agency (LCSA) listed below. Someone from that agency will explain how you can have your
case(s) reviewed by the LCSA.

RIGHT TO JUDICIAL REVIEW

You may also seek a judicial determination of the amount of past due support you owe while your
request is pending before the court. You may contact your local Family Law Facilitator (FLF) for
more information on how you can ask the proper court for help. Contact information for your local
FLF office is available at http://www.courts.ca.gov/documents/flfquickref.pdf

RESPONSIBILITY TO PAY

You must continue to make payments on your past due support amount until either the local child
support agency listed below notifies you to stop payment or the proper court issues an order
stopping enforcement of your past due support amount.

FEDERAL TAX REFUND

If you are married filing a joint income tax return and you incurred this debt separately from your
spouse, who has no legal responsibility for the debt and who has income and withholding and/or
estimated tax payments, your spouse may be entitled to receive his or her portion of any joint
federal tax refund. If your spouse meets these criteria, he or she may receive his or her portion of
the joint refund by filing a Form 8379 Injured Spouse Claim and Allocation. Form 8379 should be
attached to the top of Form 1040 or 1040A when you file, or filed according to other instructions as
indicated on the Form 8379.

If your support order was not issued in California, you have the right to ask the state that issued the
order to review your federal income tax refund offset. The local child support agency listed below
will contact that state when they receive your request. You will be notified of the time and place of
your administrative review by the state that issued the order.

If you have additional questions regarding the child support program or your case(s),
please visit http://www.childsupport.ca.gov

CONTACT ADDRESS AND CUSTOMER SERVICE PHONE NUMBER:

SANTA CLARA COUNTY DEPARTMENT OF CHILD SUPPORT SERVICES
880 RIDDER PARK DR
SAN JOSE CA 95131-2486
(866) 901-3212

Persons with hearing or speech impairments, please call the TTY number at (866) 399-4096.

CHILD SUPPORT WARNING NOTICE STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
DCSS 0284 (06/20/2021) DEPARTMENT OF CHILD SUPPORT SERVICES
Page 2 of 2
ENF 1
COMPLAINT RESOLUTION - STATE HEARING INFORMATION
RIGHT TO COMPLAINT RESOLUTION:
If you have a complaint against a local child support agency for any action or inaction regarding your child
support case, you have the right to request complaint resolution from the local child support agency.
You can make a complaint in writing by completing the Request for Complaint Resolution form, or you can
call the local child support agency.
IMPORTANT: Your request for complaint resolution must be made within 90 days from the date you
knew, or should have known, about the subject of your complaint.
The local child support agency has 30 days from the date it receives your complaint to give you a written
resolution of your complaint, unless the local child support agency needs more information or time to resolve
your complaint. The local child support agency will contact you if it needs more information or time to resolve
your complaint.
RIGHT TO A STATE HEARING:
If the local child support agency does not respond to you within 30 days from receiving your complaint, you
have the right to request a State Hearing before an Administrative Law Judge. IMPORTANT: Your request
for a State Hearing must be made within 90 days after you complained to the local child support agency.
If the local child support agency does respond to you within 30 days of making your complaint, and you are not
satisfied with the local child support agency's complaint resolution or response, you have the right to request a
State Hearing before an Administrative Law Judge. IMPORTANT: Your request for State Hearing must be
made within 90 days after you received the local child support agency's written response to your
complaint.
You can request a State Hearing in writing by sending a Request for State Hearing form to the State Hearing
Office, or you can call the State Hearing Office toll free at 1-866-289-4714.
The State Hearing Office will let you know the date, time, and place of your State Hearing.
The State Hearing Office will provide an interpreter or disability accommodation for you at the hearing if you
need one.
IMPORTANT: Not all complaints can be heard at a State Hearing.
State Hearings will only be granted for the following issues:
An application for child support has been denied or has not been acted upon within the required time frame.
The child support services case has been acted upon in violation of federal or state law or regulation, or
California Department of Child Support Services policy letter, or has not been acted on within the required
timeframe, including services for the establishment, modification, and enforcement of child support orders and
child support accountings.
Child support collections have not been distributed, or have been distributed or disbursed incorrectly, or the
amount of child support arrears, as calculated by the local child support agency is inaccurate.
The local child support agency's decision to close a child support case.
IMPORTANT: The following issues cannot be heard at a State Hearing:
Child support issues that must be addressed by motion, order to show cause, or appeal in a court.
A review of any court order for child support or child support arrears.
A court order or equivalent determination of paternity.
A court order for spousal support.
Child custody determinations.
Child visitation determinations.
Complaints of alleged discourteous treatment by a local child support agency employee, unless such
conduct resulted in a hearable action or inaction.
OMBUDSPERSON SERVICES:
Every local child support agency has an Ombudsperson available to help you through the complaint resolution
and/or State Hearing process.
The Ombudsperson can help you obtain information regarding your complaint to help you prepare for your
State Hearing.
IMPORTANT: The Ombudsperson cannot represent you at the State Hearing or give you legal advice.
COMPLAINT RESOLUTION - STATE HEARING INFORMATION STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
DCSS 0642 (12/18/2016) DEPARTMENT OF CHILD SUPPORT SERVICES
ENF 1
This page intentionally left blank