Fillable Order/notice To Withhold Income For Child Support (Page 2 of 2) in pdf

ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS

If checked, you are required to provide a copy of this form to your employee/obligor. If your employee works in a state that is

different from the state that issued this order, a copy must be provided to your employee/obligor even if the box is not checked.

Priority: Withholding under this Order or Notice has priority over any other legal process under state law (or tribal law, if

applicable) against the same income. If there are federal tax levies in effect, please notify the contact person listed below. (See 10

below.)

Combining Payments: You may combine withheld amounts from more than one employee’s/obligor's income in a single payment

to each agency/party requesting withholding. You must, however, separately identify the portion of the single payment that is

attributable to each employee/obligor.

Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The

paydate/date of withholding is the date on which the amount was withheld from the employee's wages. You must comply with the

law of the state of employee’s/obligor’s principal place of employment with respect to the time periods within which you must

implement the withholding and forward the support payments.

Employee/Obligor with Multiple Support Withholdings: If there is more than one Order or Notice against this employee/obligor

and you are unable to honor all support Orders or Notices due to federal, state, or tribal withholding limits, you must follow the

state or tribal law/procedure of the employee's/obligor's principal place of employment. You must honor all Orders or Notices to

the greatest extent possible. (See 9 below.)

Termination Notification: You must promptly notify the Child Support Enforcement (IV-D) Agency and/or the contact person

listed below when the employee/obligor no longer works for you. Please provide the information requested and return a complete

copy of this Order or Notice to the Child Support Enforcement (IV-D) Agency and/or the contact person listed below. (See 10

below.)

THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR:

EMPLOYEE'S/OBLIGOR'S NAME:

CASE IDENTIFIER:

DATE OF SEPARATION FROM EMPLOYMENT:

LAST KNOWN HOME ADDRESS:

NEW EMPLOYER/ADDRESS:

Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or

severance pay. If you have any questions about lump sum payments, contact the Child Support Enforcement (IV-D) Agency.

Liability: If you have any doubts about the validity of the Order or Notice, contact the agency or person listed below under 10. If

you fail to withhold income as the Order or Notice directs, you are liable for both the accumulated amount you should have

withheld from the employee’s/obligor's income and any other penalties set by state or tribal law/procedure.

Anti-discrimination: You are subject to a fine determined under state or tribal law for discharging an employee/obligor from

employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a child support withholding.

Withholding Limits: For state orders, you may not withhold more than the lesser of: 1) the amounts allowed by the Federal

Consumer Credit Protection Act (15 U.S.C. § 1673(b)); or 2) the amounts allowed by the state of the employee's/obligor's principal

place of employment. The federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income

left after making mandatory deductions such as: state, federal, local taxes, Social Security taxes, statutory pension contributions,

and Medicare taxes. The Federal CCPA limit is 50% of the ADWE for child support and alimony, which is increased by 1) 10% if

the employee does not support a second family; and/or 2) 5% if arrears greater than 12 weeks.

For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who

receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order.

Child(ren)’s Names and Additional Information:

10.

If you or your employee/obligor have any questions, contact

(Circuit Clerk)

by telephone at

by Fax at

or by internet at

Order/notice To Withhold Income For Child Support Page 2

Related Articles

Related forms

Related Categories