INSTRUCTIONS: ARKANSAS PATERNITY ACKNOWLEDGMENT SUPPLY ORDER FORM

For a hospital to obtain forms from the Paternity Acknowledgment Program operated by the Child Support Enforcement department of the Arkansas Department of Finance and Administration, use the document discussed in this form. This document can be obtained from the website operated by the Arkansas Department of Finance and Administration.

Arkansas Paternity Acknowledgment Supply Order Form Step 1: On the first blank line, enter the date.

Arkansas Paternity Acknowledgment Supply Order Form Step 2: On the second blank line, enter your name.

Arkansas Paternity Acknowledgment Supply Order Form Step 3: On the third blank line, enter the name of the hospital where birth was given.

Arkansas Paternity Acknowledgment Supply Order Form Step 4: On the fourth blank line, enter the hospital's street address.

Arkansas Paternity Acknowledgment Supply Order Form Step 5: On the fifth blank line, enter the hospital's city, state and zip code.

Arkansas Paternity Acknowledgment Supply Order Form Step 6: On the sixth blank line, enter the hospital's phone number.

Arkansas Paternity Acknowledgment Supply Order Form Step 7: On the seventh blank line, enter the hospital's fax number.

Arkansas Paternity Acknowledgment Supply Order Form Step 8: On the eighth blank line, enter the hospital's email address.

Arkansas Paternity Acknowledgment Supply Order Form Step 9: If requesting paternity acknowledgment brochures in English, enter the quantity needed on the ninth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 10: If requesting paternity acknowledgment brochures in Spanish, enter the quantity needed on the tenth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 11: If requesting paternity affidavits in English, enter the quantity needed on the tenth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 12: In requesting paternity affidavits Spanish translation flyers, enter the quantity needed on the eleventh blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 13: If requesting a video in English, enter the quantity needed on the twelfth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 14: If requesting a video in Spanish, enter the quantity needed on the thirteenth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 15: If requesting a staff training video, enter the quantity needed on the fourteenth blank line.

Arkansas Paternity Acknowledgment Supply Order Form Step 16: Enter any miscellaneous comments where indicated.