Texas > Statewide > Attorney General > Child Support
Request For Review Of National Medical Support Notice (NMSN) - Texas
| Request For Review Of National Medical Support Notice (NMSN) Form. This is a Texas form and can be used in Child Support Attorney General Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Request for Review of National Medical Support Notice (NMSN) To: Office of the Attorney General Medica l Support Unit P O BO X 1328 AUSTIN, TX 78767-1328 From: Name: Cause #: OAG #: Custodial Parent: Address: Telephone Number: (800) 522-2421 Fax Number: (512) 279-1723 Child(ren): Telephone Number: I, _____________________________________________________________ (obligor / employee name), contest the National Medical Support Notice (NMSN) sent to my employer, _______________________________________________________________________ (name of employer), on or about __________/__________/__________ (date), and request an administrative review based upon the following mistake(s) of fact: . It has been within 30 calendar days from the date of the notice of issuance of the National Medical Support Notice. I understand: · I will receive notice of the date, time, and place of the review within 10 days of the Office of the Attorney General (OAG) receiving this request; · the review may be in person or over the telephone; · my employer and I must comply with the terms of the NMSN during this review period; · at the end of the review, which will be completed within 30 days of receipt of this request, the OAG may issue a revised NMSN, terminate the NMSN, or send me notice of a determination that the NMSN is proper and should remain in effect as previously issued; and · if the OAG does not revise or terminate the NMSN, I may request a hearing with the court of continuing jurisdiction to resolve any issue in dispute. Obligor / Employee Signature __________/___________/__________ Date Form 1669 R E Q U E S T F O R R E V IE W O F N A T I O N A L M E D I C A L SU P P O R T N O T IC E ( NM S N ) October 2010 American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
