Title IV-D of the Social Security Act requires each state to provide child support services and establish paternity. Anyone can receive these services for a $25 annual fee. The process begins with establishing paternity through genetic testing or marriage. Child support is then established through a court order and enforced through methods like income withholding, liens, and suspending licenses. The order can later be modified if circumstances change significantly, such as a change in income, which is determined through a review process.