Confidential Information Form

Document Overview

This document is a Confidential Information Form for the Appellate and Trial Courts of Pennsylvania. It serves as a cover sheet to be filed alongside legal documents that contain sensitive personal information, ensuring compliance with the Public Access Policy of the Unified Judicial System.

Purpose and Usage

The form is required when a filing includes confidential information mandated by law, court order, or necessary for the disposition of a matter.

• Confidentiality: The form and any attached pages remain confidential, accessible only to the parties, counsel of record, the court, and the custodian.
• Service: The form must be served on all unrepresented parties and counsel of record.

Required Information

The form is divided into sections to capture specific details:

Case Identification:

• Party names (as displayed in the case caption).
• Docket/Case Number.
• Court name.
• Title and date of the associated pleading.

Confidential Data Fields: Users must select whether the information pertains to an adult or a minor and provide:

• Social Security Number (SSN)
• Financial Account Number (FAN)
• Driver’s License Number (DLN) and State of Issuance.
• State Identification Number (SID)

Abuse Victim Addendum: A specific section is included for family court actions involving abuse victims. This requires:

• Type of Action: Divorce, Child Custody, Support, Paternity, or Protection from Abuse.
• Confidential Details: Address, employer information, work schedule, and other contact info.
• Protection Order Details: Docket number and Court/County.

Certification

The final page requires the Signature of Attorney or Unrepresented Party, along with:

• Date.
• Name and Address.
• Attorney Number (if applicable).
• Telephone and Email contact information.

Revision History

The document is marked as Rev. 11/2017.