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Used for income withholding in tribal, intrastate, and interstate cases

National Medical Support Notice Forms & Instructions (Updated)

OMB 0970-0222 & 1210-0113
January 19, 2023

Legal notice that the employee is obligated to provide health care coverage for the child(ren) identified

Used by multistate employers to register to report all newly hired employees to one state

e-IWO Employer Agreement and Profile Form

OMB 0970-0370
September 7, 2022

Employers must complete the form to use the electronic Income Withholding Order process

e-NMSN Agreement and Profile Forms

OMB 0970-0370
July 21, 2022

Completed by employers or plan administration to register to use electronic National Medical Support Notice

Completed by employers or third party processors to register to use Employer Services Portal applications

Provides an efficient method for employers to respond to a child support agency's request for verification of employment