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Income Withholding For Support (Non-IV-D b) - New York
| Income Withholding For Support (Non-IV-D b) Form. This is a New York form and can be used in Matrimonial (Divorce) Supreme Court Statewide . |
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1a 1b 1c 1d IWO Form Non-IV-D b (August, 2012) ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) AMENDED ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT Date: 1e _______________ TERMINATION IWO Court Attorney Private Individual/Entity (Check One) INCOME WITHHOLDING FOR SUPPORT 1f Child Support Enforcement (CSE) Agency NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http:// www.acf.hhs.gov/programs/cse/forms/OMB-0970-0154_instructions.pdf). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribe/Territory: City/County/Dist./Tribe: 20 Private Individual/Entity: 1g ________________ Remittance Identifier (include w/payment): 1h ______________ 1i _______________ Order Identifier: 1j __________________________________ 1l __________________________ 1k ________________ New York Case Identifier: RE: 3a___________________________________________ Employee/Obligor's Name (Last, First, Middle) _____________________________________________ Employee/Obligor's Address _____________________________________________ 3b _______________________________________ Employee/Obligor's Social Security Number 3c ______________________________________ Custodial Party/Obligee's Name (Last, First, Middle) _____________________________________________ Custodial Party/Obligee's Address _____________________________________________ _____________________________________________ Custodial Party/Obligee's Social Security Number Child(ren)'s Name(s) (Last, First, Middle) 3d ________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Child(ren)'s Birth Date(s) 3e ________ ___________________ ___________________ ___________________ ___________________ ___________________ 2a ___________________________________________ Employer/Income Withholder's Name 2b ___________________________________________ Employer/Income Withholder's Address _____________________________________________ 2c ___________________________________________ Employer/Income Withholder's FEIN 3f ORDER INFORMATION: This document is based on the support or withholding order issued from the Supreme or Family Court of New York, __________4__________ County. You are required by law to deduct these amounts from the employee/obligor's income until further notice. $ 5a ____ Per 5b ______ current child support $ 6a____ Per 6b______ past-due child support - Arrears greater than 12 weeks? Yes No 6c $ 7a _____ Per 7b _____ current cash medical support $ 8a ____ Per 8b _____ past-due cash medical support $ 9a ____ Per 9b ____ current spousal support $ 10a ___ Per 10b ____ past-due spousal support $ 11a ___ Per 11b ____ other (must specify) 11c ___________________________________ . for a Total Amount to Withhold of $ 12a ____ per 12b ___________ . 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: $ 13a ____ per weekly pay period $ 13b ___ per semimonthly pay period (twice a month) $ 13c ___ per biweekly pay period (every two weeks) $ 13d ___ per monthly pay period $ 14 ____ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. Document Tracking Identifier______21_______________________________ OMB 0970-0154 American LegalNet, Inc. www.FormsWorkFlow.com REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is New York State, you must begin withholding no later than the first pay period that occurs 14 days after the date of service of this notice. Send payment within 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, see Withholding Limits. If the employee/obligor's principal place of employment is not New York State, obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm for the employee/obligor's principal place of employment. Include the pay date, custodial party/obligee's name, address, social security number, employee/obligor's name, address, and social security number on the payment. Make payments payable in the name of the custodial party/obligee identified on page 1. Remit payment to: (See Form 4-9d Non-IV-D Income Withholding Order/Notice for Support: Additional Information) 25 Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): 26 __________________________________ Print Name of Judge/Issuing Official: 27 _________________________________________________________ Title of Judge/Issuing Official: 28 ______________________________________________________________ Date of Signature: 29 _______________________________________________________________________ If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. 30 If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS State-specific contact and withholding information can be found on the Federal Employer Services website located at: http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm Priority: Withholding for support has priority over any other legal process under State law against the same income [42 USC §666(b)(7)]. If a Federal tax levy is in effect, please notify the sender. See CONTACT INFORMATION. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/obligor's portion of the payment by identifying the pay date, the Remittance Iden
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