Sec. 2. The department shall develop a form to be used for requests made under this chapter. The form must include a section requiring the individual requesting the Social Security number to attest that the individual:
(1) is requesting the child's Social Security number exclusively for income tax purposes;
(2) has read and understands the Internal Revenue Service guidelines for claiming dependents; and
(3) understands that the child's Social Security number is confidential and that there may be criminal and civil penalties for unauthorized disclosure of the child's Social Security number.