Income Withholding For Support Instructions {OMB 0970-0154In}

INCOME WITHHOLDING FOR SUPPORT - Instructions The Income Withholding for Support (IWO) is the OMB-approved form used for income withholding in Tribal, intrastate, and interstate cases as well as all child support orders which are initially issued in the State on or after January 1, 1994, and all child support orders which are initially issued (or modified) in the State before January 1, 1994 if arrearages occur. This form is the standard format prescribed by the Secretary in accordance with USC 42 §666(b)(6)(A)(ii). Except as noted, the following information must be included. Please note: For the purpose of this IWO form and these instructions, "State" is defined as a State or Territory. COMPLETED BY SENDER: 1a. Original Income Withholding Order/Notice for Support (IWO). Check the box if this is an original IWO. Amended IWO. Check the box to indicate that this form amends a previous IWO. Any changes to an IWO must be done through an amended IWO. One-Time Order/Notice For Lump Sum Payment. Check the box when this IWO is to attach a one-time collection of a lump sum payment. When this box is checked, enter the amount in field 14, Lump Sum Payment, in the Amounts to Withhold section. Additional IWOs must be issued to collect subsequent lump sum payments. Termination of IWO. Check the box to stop income withholding on an IWO. Complete all applicable identifying information to aid the employer/income withholder in terminating the correct IWO. Date. Date this form is completed and/or signed. Child Support Enforcement (CSE) Agency, Court, Attorney, Private Individual/Entity (Check One). Check the appropriate box to indicate which entity is sending the IWO. If this IWO is not completed by a State or Tribal CSE agency, the sender should contact the CSE agency (see http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact_map.htm) to determine if the CSE agency needs a copy of this form to facilitate payment processing. 1b. 1c. 1d. 1e. 1f. NOTE TO EMPLOYER/INCOME WITHHOLDER: This IWO must be regular on its face. Under the following circumstances, the IWO must be rejected and returned to sender: · IWO instructs the employer/income withholder to send a payment to an entity other than a State Disbursement Unit (e.g., payable to the custodial party, court, or attorney). Each State is required to operate a State Disbursement Unit (SDU), which is a centralized facility for collection and disbursement of child support payments. Exception: If this IWO is issued by a Court, Attorney, or Private Individual/Entity and the initial child support order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, the employer/income withholder must follow the payment instructions on the form. · Form does not contain all information necessary for the employer to comply with the withholding. · Form is altered or contains invalid information. · Amount to withhold is not a dollar amount. · Sender has not used the OMB-approved form for the IWO (effective May 31, 2012). · A copy of the underlying order is required and not included. If you receive this document from an Attorney or Private Individual/Entity, a copy of the underlying order containing a provision authorizing income withholding must be attached. INCOME WITHHOLDING FOR SUPPORT (OMB 0970-0154) ­ Instructions Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com COMPLETED BY SENDER: 1g. State/Tribe/Territory. Name of State or Tribe sending this form. This must be a governmental entity of the State or a Tribal organization authorized by a Tribal government to operate a CSE program. If you are a Tribe submitting this form on behalf of another Tribe, complete line 1i. Remittance Identifier (include w/payment). Identifier that employers must include when sending payments for this IWO. The remittance identifier is entered as the case identifier on the Electronic Funds Transfer/Electronic Data Interchange (EFT/EDI) record. 1h. NOTE TO EMPLOYER/INCOME WITHHOLDER: The employer/income withholder must use the Remittance Identifier when remitting payments so the SDU or Tribe can identify and apply the payment correctly. The remittance identifier is entered as the case identifier on the EFT/EDI record. COMPLETED BY SENDER: 1i. City/County/Dist./Tribe. Name of the city, county or district sending this form. This must be a governmental entity of the State or the name of the Tribe authorized by a Tribal government to operate a CSE program for which this form is being sent. (A Tribe should leave this field blank unless submitting this form on behalf of another Tribe.) Order Identifier. Unique identifier that is associated with a specific child support obligation. It could be a court case number, docket number, or other identifier designated by the sender. Private Individual/Entity. Name of the private individual/entity or non-IV-D Tribal CSE organization sending this form. CSE Agency Case Identifier. Unique identifier assigned to a State or Tribal CSE case. In a State CSE case, this is the identifier that is reported to the Federal Case Registry (FCR). For Tribes this would be either the FCR identifier or other applicable identifier. 1j. 1k. 1l. Fields 2 and 3 refer to the employee/obligor's employer/income withholder and specific case information. 2a. 2b. Employer/Income Withholder's Name. Name of employer or income withholder. Employer/Income Withholder's Address. Employer/income withholder's mailing address including street/PO box, city, state and zip code. (This may differ from the employee/obligor's work site.) If the employer/income withholder is a federal government agency, the IWO should be sent to the address listed under Federal Agencies ­ Addresses for Income Withholding Purposes at http://www.acf.hhs.gov/programs/cse/newhire/contacts/iw_fedcontacts.htm. Employer/Income Withholder's FEIN. Employer/income withholder's nine-digit Federal Employer Identification Number (FEIN) (if available). Employee/Obligor's Name. Employee/obligor's last name, first name, middle name. Employee/Obligor's Social Security Number. Employee/obligor's Social Security number or other taxpayer identification number. Custodial Party/Obligee's Name. Custodial party/obligee's last name, first name, middle name. Child(ren)'s Name(s). Child(ren)'s last name(s), first name(s), middle name(s). (Note: If there are more than six children for this IWO, list additional children's names and birth dates in field 33 - Additional Information). 2c. 3a. 3b.