Child Support Enforcement Transmittal 2 Subsequent Actions {UIFSA-2}

Section I. Case Processing Action s : (Provide additional information in section III or as an attachment as appropriate.) Providing: 1.[ ] Status update8.[ ] Arrears balance and/or accrued interest (affidavit of arrears)2.[ ] Notice of hearing9.[ ] Notice of health care coverage change (see section Ill or attachment)3.[ ] Notice of case forwarding10 and enforcement program 5.[ ] Order issued11.[ ] Nondisclosure finding/affidavit6.[ ] Arrears calculation (month by month)12.[ ] Other7.[ ] Payment history (provide details under section III) Requesting: 13.[ ] Status update 14.[ ] Arrears balance and/or accrued Interest (affidavit of arrears) 15Please return the requested information. CHILD SU PPORT ENFORCEMENT TRANSMITTAL #2 226 SUBSEQUENT ACTIONS The information on this form may be disclosed as authorized by law.If you are not the intended recipient, you are hereby notified that any use, disclosure, distribution, or copying of this form or its contents is strictly prohibited. [ ] Child Support Agency Confidential Information Form A ttached Petitioner: Legal Name (first, middle, last, suffix) [ ] TANF Tribal Affiliation (if applicable) [ ] IV-E Foster Care File Stamp [ ] Medicaid Only Respondent: Legal Name (first, middle, last, suffix) [ ] Former Assistance [ ] Never Assistance Tribal Affiliation (if applicable) State To: (Agency Name and Address) Responding IV-D Case Identifier: Responding Tribunal Number: Initiating Locator Code: State From: (Agency Name and Address) Initiating Tribunal Number: Payment Locator Code: State NOTE: [ ] Nondisclosure Finding/Affidavit attached [ ] This form sent t hrough EDE [ ] This request or information sent through CSENet Child Support Enforcement Transmittal #2 226 Subsequent Actions OMB 0970 226 0085 Expiration Date: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com CHILD SUPPORT ENFORCEMENT TRANSMITTAL #2 226 SUBSEQUENT ACTIONS, PAGE 2 Section II. Intergovernmental Closure Actions: From Initiating Agency: 1.[ ] The initiating agency has closed its IV-D intergovernmental case because . Proceed with closure of your responding IV-D intergovernmental case. 2.[ ] Close the responding agency222s IV-D intergovernmental case and stop income withholding, if applicable. We are keeping ourIV-D case open and your agency222s intergovernmental services are no longer needed. From Responding Agency: 3.[ ] The responding agency has closed its IV-D intergovernmental case at your request.4.[ ] The responding agency intends to close its IV-D intergovernmental case on (mm/dd/yyyy) becauseyour agency failed to provide . 5.[ ] The responding agency has closed its IV-D intergovernmental case because your agency failed to respond to the 60-daynotice dated (mm/dd/yyyy). Section III. Other Pertinent Information: ( ) Date Contact person (first, middle, last, suffix) Direct telephone number and extension Fax: ( ) E-mail: Encryption Requirements: When communicating this form through electronic transmission, precautions must be taken to ensure the security of the data. Child support agencies are encouraged to use the electronic applications provided by the federal Office of Child Support Enforcement. Other electronic means, such as encrypted attachments to e-mails may be used if the encryption method is compliant with Federal Information Processing Standard (FIPS) Publication 140-2 (FIPS PUB 140-2). Child Support Enforcement Transmittal #2 226 Subsequent Actions Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR CHILD SUPPORT ENFORCEMENT TRANSMITTAL #2 - SUBSEQUENT ACTIONS PURPOSE OF THE FORM: Either the initiating or responding IV-D agency may use this transmittal form to request or provide additional information or services in previously-referred IV-D intergovernmental cases. Do not use the CSE Transmittal #2 for making initial referrals. Send the CSE Transmittal #2 to the local entity working the case, unless directed otherwise by the state222s central registry or the local entity working the case is unknown. Also, when an obligor has contested debt certification in the federal collection and enforcement program and requested an administrative review in the order-issuing state, the submitting state that has an intergovernmental case with the order-issuing state should use this form to ask the order-issuing state to provide the arrears balance and explain in section III. To request administrative review in an order-issuing state where there is no open intergovernmental case, use CSE Transmittal #3. HEADING/CAPTION: 225 Check if a Child Support Agency Confidential Information Form is attached. 225 Identify the petitioner and respondent by full legal name (first, middle, last, suffix), and, if applicable, include the name of the tribe with which the petitioner or respondent is affiliated. 225 Check the appropriate box to identify the type of IV-D case: TANF, IV-E foster care, Medicaid only, former assistance, or never assistance. 225 In the space marked 223To:224, list the name and address (street, PO Box, city, state, and zip code) of the agency to which you are sending the CSE Transmittal #2. 225 In the appropriate spaces, enter the responding jurisdiction222s locator code, state, IV-D case identifier, and, if applicable, tribunal number. 225 In the space marked 223From:224, list the name and address (street, PO Box, city, state, and zip code) of the agency that is sending the CSE Transmittal #2. 225 In the appropriate spaces, enter the initiating jurisdiction222s locator code, state, IV-D case identifier, and, if applicable, tribunal number. The responding jurisdiction is the jurisdiction that is working the case at the request of the initiating jurisdiction. Under 223IV-D case identifier224, enter the number/identifier identical to the one submitted on the Federal Case Registry, which is a left-justified up to 15-character alphanumeric field, allowing all characters except asterisk and backslash, and with all characters in uppercase. Under 223tribunal number224, you may enter the docket number, cause number, or any other appropriate reference number that the responding tribunal may use to identify the case, if known. Tribal IV - D programs may choose to use the federal Intergovernmental forms. However, they are not required to use or accept such forms. If you have any questions, contact the tribal IV-D agency directly using the contact information on the OCSE website. If this is a tribal IV-D case, note that tribal locator codes uniquely identify tribal cases with 2239224 in the first position, 0 (zero) in the second position, and then a 3 - character tribal code defined by the Bureau of Indian Affairs (BIA). Italicized text that appears within a 223box224 refers to policy or provides additional information. TANF means the obligee222s family is currently receiving IV-A cash payments. A Medicaid only case is a case in which the obligee222s family receives Medicaid but does not receive TANF. A former assistance case might be a case for state arrears only or for a family that previously received TANF, but is not doing so at this time. For an address outside the United States, be sure to include the foreign country and postal code. Instructions for Child Support Enforcement Transmittal #2 226 Subsequent Actions Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 225 Enter the payment locator code and state to which payments should be sent. In the 223NOTE:224 section, check any of the following that apply: 225 Nondisclosure Finding/Affidavit attached 226 If there is a finding prohibiting disclosure of a party222s or child(ren)222s address/identifying information or an affidavit alleging that disclosure of such information would result in risk of harm, check the box for 223Nondisclosure Finding/Affidavit attached224 and attach a copy of the finding/affidavit in accordance with section 312 of UIFSA. If there is a finding/affidavit prohibiting disclosure, the information must be sealed and may not be disclosed to the other party or the public. You may provide the address of the IV-D agency as a substitute address for the protected party. 225 This form sent through EDE 226 Check if this form was sen