STATE OF KANSAS
Accounts Receivable Setoff Program
Debt Adjustment Form Instructions
All of the information on the Debt Adjustment Form is needed by the Setoff Program
to correctly enter an adjustment or a collection, or to decertify a debt. First
of
all, we need
to know your creditor agency name. We also need to know the name of the person
requesting the change, and a way to contact that person, whether by telephone,
fax or e-mail.
This form has room for up to five different adjustments. Please note the corresponding
numbers next to the field names on the first section of the form. Fill in the 1)
social security number (SSN), 2) debtor name, and 3) agency
account number (if one was submitted) as it was certified to the Setoff Program. If the
adjustment is from a collection received at your office, we need to know 4)
the date the money was received. Provide the 5) balance of the debt before
your adjustment or collection, If our current balance varies from yours, we will contact
you to determine the correct amount. We would like to know 6) the
amount that was paid or adjusted, and 7) if this was a collection, who
paid the money, especially if it is someone other than the debtor. Also we need to know
8) the reason for the payment or adjustment. This is to determine whether
we can post an agency collection. If we have notified the debtor within six months prior
to the payment being received, we feel the payment was due to our efforts and we will charge
our fee on the collection. If the payment was made to a collection agency, through a court,
or from your own legal staff, we will not charge a fee even if we have notified the debtor
within the last six months. If the adjustment is being made due to a miscalculation to the
original debt balance, or for some other reason that you feel we should not charge a fee,
please give a brief explanation in the 'Reason for Adjustment' field. If we have never notified
the debtor, we will either adjust or decertify the debt without charging a fee. The last
piece of information we need is 9) the balance of the debt after the adjustment
or collection has been made.
