Kansas Payment Center Child Support Order Information Sheet
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Kansas Payment Center Child Support Order Information Sheet Form. This is a Kansas form and can be use in 4th Judicial District Local District Court.
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Tags: Kansas Payment Center Child Support Order Information Sheet, Kansas Local District Court, 4th Judicial District
CHILD SUPPORT ORDER INFORMATION SHEET
As per Supreme Court Administrative Order No. 168 (amended), all new or modified nonIVD support orders filed in the Kansas district courts must be accompanied by this child
support order information sheet.
Purpose: Federal law requires Kansas to process child support through a single location in the
state. To insure that processing of child support payments is not delayed, the Kansas
Payment Center must have all information listed on the form below.
Who submits this information sheet: The payee's attorney shall submit a child support order
information sheet with any new or modified non-IVD support orders filed with the Clerk of the
District Court.
Case Number: You must give the full, accurate case number, or payments may be delayed.
The case number may be copied from the child support order.
Date:
Trustee Fee:
Active or
Inactive (please check one)
Case Number:
Payer’s Name:
Gender:
Male
Date of Birth:
Female
SSN:
*If SSN or
DOB not known, give reason for unavailability:
Address, City, State, Zip
E-mail Address:
Phone Numbers (mark primary):
)
Work (
)
Cell
Payee’s Name:
Home (
)
(
Date of Birth:
Revised date: 11/2010
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www.FormsWorkFlow.com
Gender:
Male
Female
SSN:
DOB not known, give reason for unavailability:
*If SSN or
Address, City, State, Zip
E-mail Address:
Phone Numbers (mark primary):
)
Cell
Amount
)
Work (
Debt Type:
Home (
)
(
Start Date
Obligation Frequency:
Weekly
CS
MN
Bi-weekly
OT
Semi-Monthly
Monthly
Child #1: Name:
Gender:
Male
SSN:
Female
Child #2: Name:
Gender:
Male
SSN:
Female
Child #3: Name:
Gender:
Male
SSN:
Female
Child #4: Name:
Gender:
Male
SSN:
Female
Child #5: Name:
Gender:
Male
SSN:
Female
Child #6: Name:
Gender:
Male
SSN:
Female
Date of Birth:
Date of Birth:
Date of Birth:
Date of Birth:
Date of Birth:
Date of Birth:
List additional children on a separate sheet.
Revised date: 11/2010
American LegalNet, Inc.
www.FormsWorkFlow.com
Third Party Payee:
Provide the following if payee is an individual:
Gender:
Male
Female
SSN:
reason for unavailability)
Date of Birth:
(*If SSN or DOB not known, give
Address, City, State, Zip:
*Absent extenuating circumstances as determined by the Kansas Payment Center,
Payers' and Payees' Social Security Numbers and Dates of Birth must be provided on
this form.
Form Completed By:
Revised date: 11/2010
American LegalNet, Inc.
www.FormsWorkFlow.com
