New York > Statewide > Family Court > Child Support
Income Withholding For Support 4-9 - New York
| Income Withholding For Support Form. This is a New York form and can be used in Child Support Family Court Statewide . |
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Form 4-9 (IWO Form Non-IV-D) Income Withholding Order: Child Support and Combined Child and Spousal Support 8/2012 INCOME WITHHOLDING FOR SUPPORT ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) AMENDED IWO ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT TERMINATION IWO Date: Child Support Enforcement (CSE) Agency Court Attorney Private Individual/Entity (Check One) 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 Remittance Identifier (include w/payment): City/County/Dist./Tribe: __________________________ Order Identifier: _____________________________________________ ___ New York Case Identifier: Private Individual/Entity: _____________________________________________ Employer/Income Withholder's Name _____________________________________________ Employer/Income Withholder's Address ______________________________________ ______________________________________ Employer/Income Withholder's FEIN RE: ____________________________________________ Employee/Obligor's Name (Last, First, Middle) ____________________________________________ Employee/Obligor's Address Employee/Obligor's Social Security Number ____________________________________________ 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) ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Child(ren)'s Birth Date(s) _______________ __________________ __________________ __________________ __________________ __________________ ORDER INFORMATION: This document is based on the support or withholding order issued from the Supreme or Family Court of New York, ____________County. 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? Yes 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 Amount to Withhold of $ ________________ per __________________ . 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 $ __________ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. Document Tracking Identifier: _______________________________________ OMB 0970-0154 American LegalNet, Inc. www.FormsWorkFlow.com Form 4-9 Page 2 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: NYS Child Support Processing Center (SDU) at PO Box 15365, Albany, NY12212-5365 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): __________________________________________________ Print Name of Judge/Issuing Official: ____________________________________________________________________________ Title of Judge/Issuing Official: __________________________________________________________________________________ Date of Signature: ___________________________________________________________________________________________ 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. 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
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