Common use of Child Information Clause in Contracts

Child Information. The following identifying information is provided concerning the child: (a)   (Child’s Legal Name) (b)  - -  (Social Security number) (c)  / /  (Date of Birth) (d)   (Home Address) (e)   (Child's child welfare information system identification number)   (Child welfare system case number) (f) Name and address of child's parent(s), legal guardian, or legal custodian (other than Placing Agency). If parents have different addresses, give the address of the parent with primary legal custody The placing agency has determined that Child Is Is Not eligible for Medicaid on the effective date of this agreement. If eligible for Medicaid, the Child’s Medicaid Number is