KERN COUNTY DCSS - MAIN OFFICE

3701 N SILLECT AVE

BAKERSFIELD CA 93308-6330

Custodial Party: kadedra Campbell:

CP Participant Number:
Dear Kadedra Campbell: 0290000303688 Collection
Month:10/2022
This is your monthly statement of child Date of Notice:10/14/2022

support collections and distributions.

1. TOTAL COLLECTIONS: $1,500.00

2. TOTAL DISTRIBUTIONS: $1,500.00

Received CalWORKs: Yes No
Current support paid to you: $1,500.00
Disregard paid to you: $0.00
Current support applied to repay CalWORKs: $0.00
Past due support paid to you: $1,500.00
Past due support applied to repay CalWORKs: $0.00
Excess support paid to you: $0.00
Other: $0.00

The dollar amounts for "Total Collections" and "Total Distributions" provided above may not be the
same because collections may be received in one month and distributed to you in another month.
If you were a CalWORKs recipient during the month of this statement and did not receive a disregard
payment it is for one of the following reasons:

There is no current support order for which a collection has been received.
A collection was received during the month that is not required to be disbursed within two
days under federal law. If this type of collection was received, the collection date will
appear here:10/14/2022

If you have any questions, please visit Customer Connect at

www.childsupport.ca.gov/customer-connect for assistance on-line or call Customer Connect
at (866) 901-3212. Persons with hearing or speech impairments, please call the TTY number
at (866) 399-4096.
MONTHLY STATEMENT OF COLLECTIONS AND DISTRIBUTION STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY
DCSS 0281 (10/14/2022) DEPARTMENT OF CHILD SUPPORT SERVICES
Page 1 of 2
ENFORCEMEN

DS2481958581
3. COLLECTIONS BY CASE NUMBER:

Date Case Number Amount Received Date Case Number Amount Received
Received Received
10/14/2022 200000000795561 $1,500.00

NOTE: Includes payments that were either paid to you or applied to repay
4. DISTRIBUTIONS BY CASE NUMBER: CalWORKs. "Disregard" and "Excess" payments are shown as paid to you.
Distributions identified as "Other" are not shown.
Case Number Current Past Due Suport Support Applied to
Support Paid Paid to You Repay CalWORKs
200000000795561 to You $1,500.00 $0.00
$1,500.00

MONTHLY STATEMENT OF COLLECTIONS AND DISTRIBUTION STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY
DCSS 0281 (10/14/2022) DEPARTMENT OF CHILD SUPPORT SERVICES
Page 2 of 2
ENFORCEMEN
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF CHILD SUPPORT SERVICES

NOTICE REGARDING MONTHLY STATEMENT OF COLLECTIONS AND DISTRIBUTION

DCSS 0279 (10/14/2022)

THIS NOTICE HAS IMPORTANT INFORMATION THAT WILL HELP YOU UNDERSTAND YOUR
MONTHLY CHILD SUPPORT STATEMENT - PLEASE READ IT CAREFULLY

The Monthly Statement of Collections and Distribution (DCSS 0281) informs you of collections received
and distributed during the month identified on the statement. If you believe any information on your
statement is incorrect, you should contact your local child support agency at (866) 901-3212. For information
about the complaint resolution process, please see the enclosed form Complaint Resolution -State Hearing
Information (DCSS 0642).

NOTE: You will only receive a statement if collections were received for, or distributed to, your case(s)
within the month.

The amounts reported in Section 1 (TOTAL Disregard paid to you: The amount of the
COLLECTIONS) and Section 2 (TOTAL collection paid to you as a disregard payment if you
DISTRIBUTIONS) may not be the same because received CalWORKs during the month. If you
collections may be received in one month and received CalWORKs, you are entitled to receive up
distributed to your case or paid to you in another to the first $100 collected for current support for
month. In addition, a change in your circumstances families with one child or the first $200 collected for
(i.e. retroactive changes to court ordered support, current support for families with two or more
receiving California Work Opportunity and children. These limits apply even if current support
Responsibility to Kids (CalWORKs), etc.) that is received from more than one parent. This
occurs after the date in which information for your collection amount is called a disregard because it is
statement was collected may not be reflected on not counted against your eligibility for public
your statement. assistance. The disregard payment is sent to you
within two business days from the date the current
1. TOTAL COLLECTIONS: The total amount of support payment was collected.
collections applied to the case(s) for the month.
This amount may include adjustments, such as If a collection date does not appear at the end of
collections that were applied, reversed, and then the second bullet under Section 2, this does not
reapplied. apply to you. If a collection date does appear, it
means that a collection(s) was received that is not
2. TOTAL DISTRIBUTIONS: The total amount of required to be disbursed within two days under
collections distributed to your case(s), including federal law.
adjustments, as follows: Current support applied to repay CalWORKs:
The total amount collected for your case(s) for
Received CalWORKs: Indicates whether or not current support that was applied to repay
you received CalWORKs during the month. CalWORKs.
Current support paid to you: The total amount Past due support paid to you: The total amount
collected for your case(s) paid to you as current collected for your case(s) paid to you for past due
support during the month.
support.

Past due support applied to repay CalWORKs:

The total amount collected for your case(s) for
past due support that was applied to repay
CalWORKs.

Page 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF CHILD SUPPORT SERVICES

NOTICE REGARDING MONTHLY STATEMENT OF COLLECTIONS AND DISTRIBUTION

DCSS 0279 (10/14/2022)

Excess support paid to you: Excess support can 3. COLLECTIONS BY CASE NUMBER: Detailed
come from either current support or past due information about the collection(s) for your case(s),
support. The total amount of CalWORKs that may including adjustments, during the month as follows:
be recovered is limited to the total amount of
assistance that has been paid to you. The amount Date Received: The date the collection was
to be repaid may be recovered from support received.
collections assigned as a condition of receiving
CalWORKs. When you are currently receiving Case Number: The case number for which the
CalWORKs, you will receive this amount only after collection was applied.
all CalWORKs has been repaid.
Amount Received: The dollar amount of the
Other: This amount may include an adjustment or collection received.
fees as follows:
NOTE: Collection adjustments will be stated with
Adjustment: the same date received as the original collection.
An adjustment is made to correct an error so that a
collection(s) can be applied or reapplied correctly. 4. DISTRIBUTIONS BY CASE NUMBER:
Detailed information about the distribution(s) to
The adjusted amount is included in the total dollar your case(s) during the month, whether paid to you
amount reported in Section 1 (TOTAL or applied to repay CalWORKs, as follows:
COLLECTIONS) and Section 2 (TOTAL
DISTRIBUTIONS), and is specifically reported in Case Number: The case number for which the
"Other". payments received were applied.
Each adjustment is reported in detail (date, case Current Support Paid to You: Includes
number and amount received) in Section 3 "Disregard" and/or "Excess" payments if stated in
(COLLECTIONS BY CASE NUMBER). Note that Section 2.
a collection that has been reversed will appear as a
collection received. Past Due Support Paid to You: Includes
"Excess" payments if stated in Section 2.
The dollar amount(s) reported in Section 4
(DISTRIBUTIONS BY CASE NUMBER) is the Support Applied to Repay CalWORKs: The total
resulting distribution(s) after an adjustment(s) has amount of support that was applied to repay
been made. CalWORKs.
Fee:
An annual $35 application fee is charged to families NOTE: "Other" distributions will not be stated in
that have never received public assistance (e.g. this section.
Temporary Assistance for Needy Families) if at least
$550 is collected annually on their behalf. The fee is If you have new information about the other
assessed annually in October for cases meeting this parent's income, employment, assets, or
criterion. Once the fee is assessed it will be change of address for you or the other parent,
collected from the custodial party's next support please contact your local child support agency
payment(s) until the $35 is paid in full. at (866) 901-3212.

NOTE: Information obtained from the Customer

Connect phone number or website may not be the
same as your statement due to adjustments made
to your case(s).
Page 2 of 2
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 (10/14/2022) DEPARTMENT OF CHILD SUPPORT SERVICES
ENFORCEMEN
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