Pin Change Form This form is to be used for obtaining a new, temporary Personal Identification Number (PIN) for access to child support case information through the Interactive Voice Response (IVR) telephone system. Your Name (Please Print using black ink): Last First Middle Phone Numbers: Home Phone Work Phone Other Phone Address: Number/Street/Apt# Social Security Number: City State/Zip Country (if not US) Case ID or Court Case (Docket) #: Number Sign Here: County Date: I hereby request the issuance of a temporary PIN. This temporary PIN will be the last four digits of my social security number and will be available within approximately five business days. I may then use that PIN, but also I understand that I must create a different PIN at the time I use this temporary PIN. I should not provide the PIN to any unauthorized person. Mail this Form to: MiSDU Attn: PIN Change PO Box 30354 Lansing, MI 48909 - 7854 FAX: 517-318-4697 Revised DHS 01/26/06 American LegalNet, Inc. www.FormsWorkflow.com