Request For Privacy Protection Form - Department Of Children And Families printable pdf download

Request For Privacy Protection Form - Department Of Children And Families

Division of Family and Economic Security

Bureau of Child Support

Privacy Protection

for Child Support Participants

Privacy protection prevents the release of information for those at risk of harm from domestic violence. If

releasing your address, telephone number, employer or other location information would put you at risk, please

fill out and return the form (on the back of this page) to the county child support agency handling your case.

If you believe you are at risk and you meet one of the protection reasons identified below, a privacy indicator

will be entered into your computer records in KIDS, the statewide child support computer system. The indicator

will be displayed on the child support worker’s computer screen for all your child support cases. In most

situations, it will also prohibit and prevent the release of your address and employer information. (The privacy

protection won’t stop or interrupt most child support enforcement or collection efforts. It doesn’t affect your

requirement to cooperate with the child support agency.)

You may qualify for privacy protection if you meet any of the following conditions:

• You or your child is covered by a protective order.

• You or your child have a history of domestic violence or are at risk of domestic violence.

• A child support agency has reason to believe that you or your child might be physically or

emotionally harmed if information was released.

• You have been granted good cause for non-cooperation with child support by a Wisconsin Works

(W-2) agency or another county social services agency.

You may request protection at any time. Fill out this form and return to your county child support agency. In case

of an emergency, call your child support agency by telephone. Agency staff may ask you to verify the information

provided on the form.

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Request For Privacy Protection Form - Department Of Children And Families