Kansas Payment Center - Child Support Order Information Sheet
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2Kansas Payment Center - 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 the completed form: The payee’s attorney shall file the completed form along with the Journal Entry with the Clerk of the
District Court per Kansas Supreme Court Administrative Order No. 154.
Case Number: You must give the full, accurate court order number, or payments may be delayed. The case number may be copied from the
child support order. The case number format is as follows:
County Year
Case Type
Case Number
Example: LN00D 000123 (LN)
(00)
(D)
(000123)
Please call your local Clerk of the District Court if you need additional information to complete this form.
Additional copies may be made as necessary.
PLEASE print or type all information.
Case Number
Check if applicable:
Check one:
____________________
New case/order
Court Trustee case
Modified order
Circle One
File stamp date of order:
Interstate:
Y N
_____________________
Obligation Information
Support
Frequency
Start
Payment Frequency Codes
Amount
Code
Date
$________
________
__________
(W)
Weekly
Current Child Support due:
(B)
Biweekly
____________________________
$________
________
__________
(M)
Monthly
(SM)
Semi-Monthly
Current Maintenance (Alimony) due:
$________
________
__________
(Q)
Quarterly
______________________________
(A)
Annually
$________
________
__________
(SA)
Semi-Annually
Other Support due:
(L)
Lump Sum
_____________________________
$________
________
__________
______________________________
$________
________
__________
Information about the PAYING Parent
NAME: (First, Middle Initial, Last): _________________________________________________________________
Address: ____________________________City: ____________________________State: __________ Zip: ______
Social Security Number: _______________ Date of Birth:____________
Phone Number: _________________
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