PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:
OTHER PARENT:

CASE NUMBER:

FL-461

ATTACHMENT TO
QUALIFIED DOMESTIC RELATIONS ORDER FOR SUPPORT (form FL-460)

STATEMENT OF CONFIDENTIAL INFORMATION 

DO NOT FILE WITH COURT 

This separate statement of confidential information sets forth the social security number of the Employee and 
any alternate participant for whose benefit spousal or family support is being withheld under the Qualified 
Domestic Relations Order for Support (form FL-460). The Plan will require this information for tax reporting 
purposes. Do not include social security numbers for persons receiving child support or for a child alternate 
payee. This form must be completed and served on the Plan with a copy of the order.

1.

EMPLOYEE INFORMATION

a.

Employee name:

b.

Employee social security number:

2.

SPOUSAL OR FAMILY ALTERNATE PAYEE INFORMATION (for spousal or family support only):

a.

Spousal or family alternate payee's name:

b.

Spousal or family alternate payee's social security number:

Form Approved for Optional Use
Judicial Council of California
FL-461 [Rev. January 1, 2003]

 ATTACHMENT TO QUALIFIED DOMESTIC RELATIONS ORDER
FOR SUPPORT (EARNINGS ASSIGNMENT ORDER FOR SUPPORT)

Family Code, § 5208; 42 U.S.C. § 405

www.courtinfo.ca.gov

Page 1 of 1

 Laura Lynn Morgan 31/03

 Morgan I Love You



Attachment to Qualified Domestic Relations Order for Support (Earnings Assignment Order for Support)

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• Sourced from selfhelp.courts.ca.gov (2023-03)
• Page(s): 1
• Fields(s): 8
• Average fields per page: 8
• Reading Level: Grade 9
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