Income Withholding For Support
Download a blank fillable Income Withholding For Support in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Income Withholding For Support with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4INCOME WITHHOLDING FOR SUPPORT
INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO)
AMENDED IWO
ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT
Date:
TERMINATION OF IWO
(Check One)
Child Support Enforcement (CSE) Agency
Court
Attorney
Private Individual/Entity
NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the
sender (see IWO instructions ). If you receive this
document from someone other than a state or tribal CSE agency or a court, a copy of the underlying support order must be
attached.
State/Tribe/Territory
Remittance ID (include w/payment)
City/County/Dist./Tribe
Order ID
Private Individual/Entity
Case ID
RE:
Employer/Income Withholder's Name
Employee/Obligor's Name (Last, First, Middle)
Employer/Income Withholder's Address
Employee/Obligor's Social Security Number
Employee/Obligor's Date of Birth
Custodial Party/Obligee’s Name (Last, First, Middle)
Employer/Income Withholder's FEIN
Child(ren)'s Name(s) (Last, First, Middle)
Child(ren)'s Birth Date(s)
ORDER INFORMATION: This document is based on the support order from
(State/Tribe).
You are required by law to deduct these amounts from the employee/obligor's income until further notice.
$
Per
current child support
Yes
No
$
Per
past-due child support - Arrears greater than 12 weeks?
current cash medical support
$
Per
$
Per
past-due cash medical support
current spousal support
$
Per
$
Per
past-due spousal support
$
Per
other (must specify)
.
for a Total Amount to Withhold of $
per
.
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If
your pay cycle does not match the ordered payment cycle, withhold one of the following amounts:
$
per weekly pay period
$
per semimonthly pay period (twice a month)
$
per biweekly pay period (every two weeks)$
per monthly pay period
$
Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.
Document Tracking ID
Page 1 of 4
Income Withholding for Support (IWO)
Expiration Date: 08/31/2020
OMB 0970-0154
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal