20.E Notice of Confidentiality Packet

Notice of Confidential Information

In order to ensure the privacy of all parties, please list all confidential information i.e. social security numbers and dates of birth, on this cover page rather than in the UIFSA Transmittal. In some situations, the Child Support UIFSA Transmittal is filed in the court file or sent to the parties. The information below is for IV-D use only. Please DO NOT file this cover page with the court or otherwise release it, unless your court requests it.

Obligee Name

[ ] Mother [ ] Father [ ] Caretaker

Obligee Alias

Obligee Address

Obligee SSN

Obligee Date of Birth

Obligor Name

[ ] Mother [ ] Father

Obligor Alias

Obligor Address

Obligor SSN

Obligor Date of Birth Caretaker Name

Caretaker Address

Caretaker SSN

Caretaker Date of Birth

Child(ren) Name Child(ren) SSN Child(ren) Date of Birth

Cross Reference

20.6 Order of Confidentiality

Version Number


Last Revised Date

July 1, 2013