These forms and instructions are available in the General Clerk's Office, Room 108, in the Nassau County. Child Support Forms ; 4-9a.If you recieve Medicaid through your local department of social service (LDSS), you may fill out form DOH-5247 and submit this with your renewal. Spouse- Spousal Refusal AND assignment of support rights (or unable to execute). Medicaid is a program designed to help those unable to meet the cost of health care. This application can be used to apply for Medicaid, the. Family Planning Benefit Program, or for assistance paying your health insurance premiums. An overview of Community Medicaid and Community Medicaid with Long-Term Care including what is covered, the eligibility requirements, and tips to qualify. The amount of child support that either parent may have to pay following a divorce is based on several factors, and one of those factors is alimony. You are required to make to the Court, under oath, a FULL DISCLOSURE of your income, net worth and financial condition on this form.