Distribution of Federally Approved Standardized Income Withholding Form
This is a historical document. Use for research and reference purposes only.
January 27, 1998
TO: STATE AGENCIES ADMINISTERING THE CHILD SUPPORT ENFORCEMENT PLANS UNDER TITLE IV-D OF THE SOCIAL SECURITY ACT AND OTHER INTERESTED INDIVIDUALS AND INDIVIDUALS
SUBJECT:Distribution of Federally approved standardized income withholding form.
ATTACHMENT:Attached is a copy of the Federally approved standardized income withholding form packet, as required by Section 324 of the Personal Responsibility and Work Opportunity Reconciliation Act 1996 (P.L. 104-193). The packet includes the standardized form titled "Order/Notice to Withhold Income for Child Support", the instructions (with a numbered copy of the Order/Notice) to complete the Order/Notice.
STATUTORY REFERENCE:42 U.S.C. 652(a)(11) and 42 U.S.C 654(9)(E)
BACKGROUND:The Uniform Interstate Family Support Act (UIFSA) was drafted in 1992 by the National Conference of Commissioners on Uniform State Laws and approved by the American Bar Association (ABA) in 1993. The Act enables States to use direct income withholding as an immediate remedy in interstate child support cases. Many State CSE agencies began enacting UIFSA shortly after the ABA endorsed the Act.
OCSE, in conjunction with State CSE agencies and representatives from the American Payroll Association, the American Society for Payroll Management, and employers established a work group to develop a one-page (two-sided) standardized form to use for income withholding cases. The purpose of this standardized form is to facilitate uniformity in the processing of child support wage attachments.
In 1994, the work group began developing the standardized form called "Order/Notice to Withhold Income for Child Support." After the first draft was developed, it was mailed to all State IV-D Directors for comments. The work group reviewed the comments and revised the Order/Notice to incorporate the changes.
By 1996, UIFSA was revised and the draft Order/Notice was further revised to reflect the changes to UIFSA. For approximately six months, many States participated in a pilot test of the Order/Notice. Shortly after the pilot test was completed, the Personal Responsibility and Work Opportunity and Reconciliation Act of 1996 passed. This Act mandated States, no later than March 1, 1997, to use the Office of Management and Budget approved standardized form (Order/Notice) for interstate income withholding cases. Section 454A (g) (A) (ii) further requires that States transmit orders and notices for income withholding to employers (and other debtors) using uniform formats prescribed by the Secretary, no later than October 1, 1998 to employers (and other debtors)
Now that PRWORA has mandated the nationwide implementation of UIFSA, the Order/Notice will be a useful tool in direct income withholding cases. These cases will be both processed and executed more efficiently.
INQUIRIES:Dianne Offett, Interstate Liaison, (202) 401-5425.
David Gray Ross
Deputy Director & Commissioner
Office of Child Support Enforcement
INSTRUCTIONS TO COMPLETE ORDER/NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT
The Order/Notice to Withhold Income for Child Support is a standardized form used for income withholding in intrastate and interstate cases. Submit the Order/Notice to employers in States that have adopted the Uniform Interstate Family Support Act (UIFSA) or have similar State laws.
The following are instructions to complete the Order/Notice to Withhold Income for Child Support. When completing the form, please include the following information.
1a.Name of your State or territory.
1b.Name of your jurisdiction.
2.Date the Order/Notice to Withhold is to be mailed.
3.Identifying number used by the court/agency issuing this Order/Notice, if appropriate.
4 a-c.Check the appropriate case status of the Order/Notice to Withhold.
5.Employer/Withholder's nine digit Federal employer identification number (if available). Include three digit location code (if known).
6b-e.Employer/Withholder's mailing address. (This may differ from the Employee/Obligor work site.)
7.Employee/Obligor's last name, first name, and middle initial (if known).
8.Employee/Obligor's Social Security Number.
9.Case identifier (or other identifier) used for recording the payment. (May be the same as #3.)
10.Custodial Parent's last name, first name, and middle initial (if known).
11.Child(ren)'s name(s) and date of birth listed in the support order.
12.Name of State that issued the underlying child support order.
13.Termination date of the support order.
14.Check if the child support order requires enrollment of the child(ren) in any health insurance coverage available to the employee's/obligor's employment. The space on the form is provided for your instructions to the employer, i.e. "see attached medical support form."
15a.Dollar amount to be withheld for payment of current child support.
15b.Time period that corresponds to the amount in #15a (e.g., month).
16a.Dollar amount to be withheld for payment of past-due child support under your State law.
16b.Time period that corresponds to the amount in #16a (e.g., month).
17a.Dollar amount to be withheld for payment of medical support, as appropriate, based on the underlying order.
17b.Time period that corresponds to the amount in #17a (e.g., month).
18a.Dollar amount to be withheld for payment of miscellaneous obligations, if appropriate, based on the underlying order.
18b.Time period that corresponds to the amount in #18a (e.g., month).
18c.Describe the amount(s) represented in #18a separately by fee type (e.g., court fees).
19a.Dollar amount to be withheld for payment of miscellaneous obligations, if appropriate, based on the underlying order and time period that corresponds to the amount in #19a (e.g., month).
19b.Time period that corresponds to the amount in #19a (e.g., month).
19c.Describe the amount(s) represented in #19a separately by fee type (e.g., court fees).
20a.Total of #15a, #16a, #17a, #18a, and #19a.
20b.Time period that corresponds to the amount in #15b (e.g., month).
21.Check this box if arrears are 12 weeks or greater.
22a.Amount an employer withholds if the employee is paid weekly.
22b.Amount an employer withholds if the employee is paid every two weeks.
22c.Amount an employer withholds if the employee is paid twice a month.
22d.Amount an employer withholds if the employee once a month.
When completing numbers 23 through 25, please note the following:
If the Order/Notice is completed for an interstate withholding, apply the law of the state of the obligor's principal place of employment.
If the Order/Notice is completed for an intrastate withholding or the employer's agent is served with a copy in the state that issued the order, you are to follow the law of the state that issued this order.
23.Number of days in which the withholding must begin pursuant tothe issuing State's law.
24.Number of working days an employer or other payor of income must remit amounts withheld pursuant to the issuing State's law.
25.Maximum percentage that can be withheld based on the applicable withholding limit of the issuing State. If the employer is a Federal agency and you add the additional 5 percentage points allowed under the Federal Consumer Credit Protection Act to the percentage entered for #22 (i.e., 65%; or 55% instead of 50% if the obligor supports a second family), check #21 on the Order/Notice to indicate the support is 12 weeks or more in arrears.
26a.Case identifier or other identifier. (May be the same as #3 and/or #9.)
26b.Federal Information Process Standard (FIPS) code for transmitting payments through EFT/EDI. The FIPS code is five characters that identifies the State and county. It is seven characters when it identifies the State, county, and a location within the county. It is necessary for centralized collections. Complete only for EFT/EDI transmission.
26c.Receiving agency's bank routing number. Complete only for EFT/EDI transmission.
26d.Receiving agency's bank account number. Complete only for EFT/EDI transmission.
27a.Name of the collection unit specified by the tribunal that issued the controlling order to which payments are made and the case identifier.
27b-d. Street address, City, and State of the collection unit identified in #27a.
28a.Signature of official(s) authorized to send the Order/Notice. This line is optional if a signature is not required by State statute.
28b.Print name of the official(s) authorized to send the Order/Notice.
29.Check the box if the employer is to provide a copy of the Order/Notice to the employee.
30.Penalty and/or citation for an employer who fails to comply with the Order/Notice. Your State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
31.Penalty and/or citation for an employer who discharges, refuses to employ, or disciplines an employee/obligor as a result of the Order/Notice. Your State law governs unless the obligor is employed in another State, in which case the law of the State inwhich he or she is employed governs.
32.Use this space to provide the employer with additional information.
33a.Name of the agency or court requesting the income withholding.
33b-d. Address of the agency or court requesting the income withholding.
34a.Name of the child support enforcement agency's contact person who an employer and/or employee/obligor may call for information regarding the Order/Notice.
34b.Telephone number of the contact person who an employer may call for information regarding the Order/Notice.
34c.Facsimile number for the person whose name appears in #34a.
34d.Internet address for the person whose name appears in 34a.
If the employer is a Federal Government agency the following instructions apply.
Serve the Order/Notice upon the governmental agent listed in 5 CFR part 581, appendix A.
Sufficient identifying information must be provided in order for the obligor to be identified. It is, therefore, recommended that the following information, if known and if applicable, be provided: (1) full name of the obligor; (2) date of birth; (3) employment number, Department of Veterans Affairs claim number, or civil service retirement claim number; (4) component of the government entity for which the obligor works, and the official duty station or worksite; and (5) status of the obligor, e.g., employee, former employee, or annuitant.
You may withhold from a variety of income and forms of payment, including voluntary separation incentive payments (buy-out payments), incentive pay, and cash awards. For a more complete list see 5 CFR 581.103.
The Paperwork Reduction Act of 1995
This information collection is conducted in accordance with 45 CFR 303.7 of the child support enforcement program. Standard forms are designed to provide uniformity and standardization for interstate case processing. Public reporting burden for this collection of information is estimated to average one hour per response. The responses to this collection are mandatory in accordance with 45 CFR 303.7. This information is subject to State and Federal confidentiality requirements; however, the information will be filedwith the tribunal and/or agency in the responding State and may, depending on State law, be disclosed to other parties. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
Note: The "Order/Notice to Withhold Income for Child Support" form is not included in this Internet version of the document However, the forms listed below may be downloaded as WordPerfect 5.1 files.
Note: To access the WordPerfect files, you need to use your browser's download procedures. For example, in Netscape, click on the right mouse button for the reference and choose "save link as."
1. Order/Notice to Withhold Income for Child Support (with numbers corresponding to instructions)
2. Order/Notice to Withhold Income for Child Support (blank form)