Nebraska Child Support Payment Center
Remittance Form
P.O. Box 82890, Lincoln, NE 68501
Customer Service: 1-877-631-9973
Fax: 402-471-1193
Important Note:
Use this form each time you remit a payment.
Employer Name
Contact Name
Address
City
State
Zip
Telephone Number
Fax Number
Employer FEIN (FTIN)
Email
Check #
Employee Name
SSN
Case Number
Date Paid
Dollar Amount
Total Amount: $
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