The information highlighted is the minimum required information on the case.
First Name:         Last Name:
Social Security Number:
Case ID: County: State:
Back obligee court order total $:
Government amount owed $:
Individual amount owed $:
Current court order:
Monthly $: Annual $:
Age of child: Age order ends:
Future court order amount owed total $: (Age Order Ends less Age of Child x Annual $)
Source of payment:
(Income Withholding, Direct Payment, Social Security, IRS, Other)
Payment on back obligations:
Year court order entered:
Payments since order entered total $:
Number of years: Average per Year $:
Collections on current order:
Amount paid last year total $:
State Interest Rate: State Fee Rate:
Obligor Age: Smoker/Nonsmoker: Health Exam: