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Order Notice To Withhold Income For Child Support - Indiana
| Order Notice To Withhold Income For Child Support Form. This is a Indiana form and can be used in Child Support Circuit Court Delaware Local County . |
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DELAWARE COUNTY Instructions to Complete the Order/Notice to Withhold Income Child Support or Notice of an Order to Withhold Income for Child Support If you or your employee/obligor has any questions, contact the Delaware County Clerk's office by telephone at 1-765-747-7726. Or email Mary.Francis@fssa.in.gov. For specific and general questions regarding Indiana child support income withholding law call 1-800-292-0403 or 1-317-232-4893. Instructions to complete the Order/Notice to Withhold Income for Child Support or Notice of an Order to Withhold Income for Child Support The Order/Notice to Withhold Income for Child Support (Order/Notice) or Notice of an Order to Withhold Income for Child Support (Notice) is a standardized form used for income withholding in tribal, intrastate, interstate, and intergovernmental cases. Please note that information provided on this form may be shared with the obligor. When completing the form, please include the following information. The following information 1a 1f refers to the government agency, non-government entity, or individual completing and sending this form to the employer: 1a. Check whether this is an Order/Notice to Withhold Income for Child Support or a Notice of an Order to Withhold Income for Child Support. Attorneys, individuals, and non-governmental entities must submit a Notice of an Order to Withhold and include a copy of the income withholding order unless, under a state's law, an attorney in that state may issue an income withholding order/notice. In that case, the attorney may submit an Order/Notice to Withhold and include a copy of the state law authorizing the attorney to issue an income withholding order/notice. 1b. 1c. 1d. 1e. Check the appropriate status of the Order or Notice. Date this form is completed and/or signed. Identify the county and state sending this form. This must be a governmental entity. Check and indicate the non-governmental entity or individual sending this Order or Notice. Complete this item only if a non-governmental entity or individual is submitting this Order or Notice. Identify ISETS (Indiana Support Enforcement Tracking System) number used by the entity or individual sending this Order or Notice. This number is available from the county clerk's office. 1f. The following information in 2 and 3 refers to the obligor, obligor's employer, and case identification: 2a. 2b. Employer's/Withholder's name. Employer's/Withholder's mailing address, city, and state. (This may differ from the Employee's/Obligor's work site.) Employer's/Withholder's nine-digit federal employer identification number (if available). Include three-digit location code. Employee's/Obligor's last name, first name, and middle initial. Employee's/Obligor's Social Security Number (if known). The employee's/ obligator's court cause/case number. Custodial Parent's last name, first name, and middle initial (if known). 2c. 3a. 3b. 3c. 3d. ORDER INFORMATION - The following information in 4 14d refers to the dollar amounts taken directly from the child support order: 4. Name of the state that issued the support order. ( Indiana ). corresponds to 5a-b. Dollar amount to be withheld for payment of current child support, time period that the amount in #6a (such as month, week, etc.). 6a-b. Dollar amount to be withheld for payment of past-due child support, time period that corresponds to the amount in #6a (such as month, week, etc.). 7a-b. Dollar amount to be withheld for payment of current cash medical support, as appropriate, based on the underlying Order, time period that corresponds to the amount in #7a (such as month, week, etc.). 8a-b. Dollar amount to be withheld for payment of past-due cash medical support, if appropriate, based on the underlying Order and the time period that corresponds to the amount in #8a (such as month, week, etc.). 9a-b. Dollar amount to be withheld for payment of spousal support (alimony), if appropriate, based on the underlying Order, time period that corresponds to the amount in #9a (such as month, week, etc.). 10a-b. Dollar amount to be withheld for payment of past-due spousal support (alimony), if appropriate, based on the underlying Order, time period that corresponds to the amount in #10a (such as month, week, etc). 11a-c. Dollar amount to be withheld for payment of miscellaneous obligations, if appropriate, based on the underlying Order, time period that corresponds to the amount in #11a (e.g., month, week, etc.), and description of the miscellaneous obligation. 12a. 12b. 13. 14a. 14b. 14c. 14d. Total of #5a, #6a, #7a, #8a, #9a, #10a and #11a. Time period that corresponds to the amount in #12a (e.g., month). Check this box if in arrears more than 12 weeks. Amount an employer should withhold if the employee is paid weekly. Amount an employer should withhold if the employee is paid every two weeks. Amount an employer should withhold if the employee is paid twice a month. Amount an employer should withhold if the employee is paid once a month. Complete only for EFT/EDI transmission. 15a. 15b. Telephone number of contact to provide EFT/EDI instructions. Federal Information Process Standard (FIPS) code for transmitting payments through EFT/EDI. The FIPS code is five characters that identify the state or county. It is seven characters when it identifies the state, county, and a location within the county. It is necessary for centralized collections. Receiving agency's bank routing number. Receiving agency's bank account number. 15c. 15d. If you are not required to pay by EFT/EDI transmission and are paying by check: 16a. When paying by check to the State Central Collection Unit, make check payable to the State Central Collection Unit and, Indicate on the check the ISETS number and, The employee's/obligator's social security number. Mail the check to the: State Central Collection Unit P.O. Box 6219 Indianapolis, IN 46206-6219 16b. 16c. 16d. If you would like to pay online: 17. To make payments using the Child Support Bureau website, log on to www.Mychildsupport.in.gov click on Payment Processing under Employer Services and follow the links. If this is an Order/Notice to Withhold or if this is a Notice of an Order to Withhold: 18a. 18b. Date of Order. Signature of the Judge issuing Order/Notice to Withhold or Notice of Order to Withhold. 18c-d. Check the appropriate box to indicate whether you are an attorney, individual, or private entity sending this Order / Notice of an Order. ) ) SS: COUNTY OF DELAWARE
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