Order/notice To Withhold Income For Child Support Form Page 2
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1
2ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
[ ]If checked you are required to provide a copy of this form to your employee.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor’s income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to
each employee/obligor.
3. Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which the employee is paid and controls the income, i.e. the date the income check or cash is
given to the employee, or the date in which the income is deposited directly in his/her account.
4. Employee/Obligor with Multiple Support Withholdings: If you receive more than one Order/Notice against this employee/obligor
and you are unable to honor them all in full because together they exceed the withholding limit of the State of the employee’s principal
place of employment (see #9 below), you must allocate the withholding based on the law of the State of the employee’s principal place
of employment. If you are unsure of that State’s allocation law, you must honor all Orders/Notices’ current support withholdings before
you withhold for any arrearages, to the greatest extent possible under the withholding limit. You should immediately contact the last
agency that sent you an Order/Notice to find the allocation law of the Sate of the employee’s principal place of employment.
5. Termination Notification: You must promptly notify the payee when the employee/obligor is no longer working for you. Please
provide the information requested and return a copy of this order/Notice to the agency identified below.
EMPLOYEE’S/OBLIGOR’S NAME:_________________________________________________________________________
EMPLOYEE’S CASE IDENTIFIER:____________________________ DATE OF
SEPARATION:______________________.
LAST KNOWN HOME ADDRESS:__________________________________________________________________________.
NEW EMPLOYER’S ADDRESS:____________________________________________________________________________.
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions,
or severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Notice directs, you are liable to for both the accumulated amount you should have
withheld format he employee/obligor’s income and any other penalties set by State law. You may be found liable for the total amount,
which you fail to withhold or pay over and fines up to $100.00 per day for each day after the grace period. In Illinois, subsection (g) of
305 ILCS 5/10-16.2, 750 ILCS 5/706.1, 750 ILCS 15/4.1 or 750 ILCS 45/20.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment,
refusing to employ, or taking disciplinary action against any employee/obligor because of a child support withholding.
9. Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (15 U.S.C. Sec. 1673(B); or 2) the amounts allowed by the State of the employee’s/obligor’s principal place of
employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after
making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. The Federal CCPA limits
is 50% of the ADWE for child support and alimony, which is increase by: 1) 10% if the employee does not support a second family;
and/or 2) 5% if arrears are more than 12 weeks old. (See boxes on front)
10. For the obligor’s rights, remedies and duties, if the principal place of employment is Illinois, see Illinois Statutes 305 ILCS 5/10-16.2,
750 ILCS 5/706.1, 750 ILCS 15/4.1 and 750 ILCS 45/20.
Requesting Agency:
If you or your employee/obligor have any questions, contact:
By telephone at:_______________________________________________ or
By FAX at:___________________________________________________ or
By Internet :____________________________________________________
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