Revised date: 11/2010 CHILD SUPPORT ORDER INFORMATION SHEET As per Supreme Court Administrative Order No. 168 (amended), all new or modified non-IVD 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: Payer222s Name: Date of Birth: Gender: Male Female SSN: *If SSN or DOB not known, give reason for unavailability: Address, City, State, Zip E-mail Address: Phone Numbers (mark primary): Home ( ) Work ( ) Cell ( ) Payee222s Name: Date of Birth: American LegalNet, Inc. www.FormsWorkFlow.com Revised date: 11/2010 Gender: Male Female SSN: *If SSN or DOB not known, give reason for unavailability: Address, City, State, Zip E-mail Address: Phone Numbers (mark primary): Home ( ) Work ( ) Cell ( ) Debt Type: Amount Start Date Obligation Frequency: CS Weekly MN Bi-weekly OT Semi-Monthly Monthly Child #1: Name: Date of Birth: Gender: Male Female SSN: Child #2: Name: Date of Birth: Gender: Male Female SSN: Child #3: Name: Date of Birth: Gender: Male Female SSN: Child #4: Name: Date of Birth: Gender: Male Female SSN: Child #5: Name: Date of Birth: Gender: Male Female SSN: Child #6: Name: Date of Birth: Gender: Male Female SSN: List additional children on a separate sheet. American LegalNet, Inc. www.FormsWorkFlow.com Revised date: 11/2010 Third Party Payee: Provide the following if payee is an individual: Gender: Male Female Date of Birth: SSN: (*If SSN or DOB not known, give reason for unavailability) 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: American LegalNet, Inc. www.FormsWorkFlow.com