Arkansas > Statewide > Child Support
Income Withholding For Support - Arkansas
| Income Withholding For Support Form. This is a Arkansas form and can be used in Child Support Statewide . |
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INCOME WITHHOLDING FOR SUPPORT 9 9 9 9 ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) ORDER/NOTICE - LUMP-SUM PAYMENTS TERMINATION OF IWO AMENDED IWO Date: ____________________________ 9 Court 9 Attorney 9 Private Individual/Entity (Check One) 9 Child Support Enforcement (CSE) Agency NOTE: If you receive this document from someone other than a State or Tribal Child Support Enforcement agency or a court, a copy of the underlying order that contains a provision authorizing income withholding must be attached. Or if under State law an attorney in that State, or if under Tribal law a Tribal legal representative, may issue an income withholding order, the attorney or Tribal legal representative must include a copy of the State or Tribal law authorizing the attorney or Tribal legal representative to issue an income withholding order. State/Tribe/Territory City/County/Dist./Tribe Private Individual/Entity ARKANSAS Case Identifier ______________________ ____________________ Order Identifier ______________________ ______________________________________________________________ RE: _________________________________________ Employee/Obligor's Name (Last, First, MI) ________________________________________ Employee/Obligor's Social Security Number (if known) ________________________________________ Custodial Party/Obligee's Name (Last, First, MI) ________________________________________ Employer/Income W ithholder's Name ________________________________________ Employer/Income W ithholder's Address ________________________________________ ________________________________________ ________________________________________ Employer/Income W ithholder's Federal EIN Child's Name (Last, First, MI) ____________________________ ____________________________ ____________________________ ____________________________ Child's Birth Date ______________ ______________ ______________ ______________ Child's Name (Last, First, MI) ________________________ ________________________ ________________________ ________________________ Child's Birth Date _____________ _____________ _____________ _____________ ORDER INFORMATION: This document is based on the support or withholding order from ____________. You are required by law to deduct these amounts from the employee/obligor's income until further notice. $ _____________ Per ______________ current child support $ _____________ Per ______________ past-due child support - Arrears greater than 12 weeks? 9 Yes 9 No $ _____________ Per ______________ current cash medical support $ _____________ Per ______________ past-due cash medical support $ _____________ Per ______________ current spousal support $ _____________ Per ______________ past-due spousal support $ _____________ Per ______________ other (must specify) ___________________________________________ for a total of $ ____________ Per ________________ to be forwarded to the payee below. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the following amounts: $ ________ per weekly pay period $ _______ per semimonthly pay period (twice a month) $ ________ per biweekly pay period (every two weeks) $ _______ per monthly pay period W ithhold 50% of any net lump-sum payment not to exceed the amount of the past-due child support. Remittance Information: If the employee/obligor's principal place of employment is Arkansas, you must begin withholding no later than the first pay period that occurs 14 days after the date of this notice. Send payment within 1 working day of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to ____ % (CCPA withholding limits) of disposable income for all orders. If the employee/obligor's principal place of employment is not Arkansas see the ADDITIONAL INFORMATION FOR EMPLOYERS AND OTHER INCOM E W ITHHOLDERS for limitations on withholding, applicable time requirements and any allowable employer's fees. AOC FORM INCOME WITHHOLDING PAGE 1 OF 6 (1) EMPLOYER For EFT/EDI instructions, contact the EFT/EDI office at the website listed below. If paying by check, make check payable to: Office of Child Support Enforcement. Include this Remittance Identifier with payment: ___ Send check to: Arkansas Child Support Clearinghouse, P.O. Box 8125, Little Rock, AR 72203. FIPS code (if necessary): ____________________________________ Signature (if required by State or Tribal law): _______________________________________________________________ Print Name: __________________________________________________________________________________________ Title of Issuing Official: ________________________________________________________________________________ 9 If checked, you are required to provide a copy of this form to the employee/obligor. If your employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy must be provided to the employee/obligor even if the box is not checked. _______________________________________________________________________________________________________ ADDITIONAL INFORMATION TO EMPLOYERS AND WITHHOLDERS State-specific information may be viewed on the OCSE Employer Services website located at: http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contacts.htm Priority: Withholding for support has priority over any other legal process under State law (or Tribal law if applicable) against the same income. If a Federal tax levy is in effect, please notify the contact person listed below. Combining Payments: You may combine withheld amounts from more than one employee/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 Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/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/Notice against this employee/obligor and you are un
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