Form Omb 0970-0154 - Income Withholding Order For Support Page 2
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4Employer's Name:
Employer FEIN:
Employee/Obligor's Name:
SSN:
CSE Agency Case Identifier:
Order Identifier:
Texas
REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is
(State/Tribe), you must begin withholding no later than the first pay period that occurs
days after the date
zero
of
delivery
. Send payment within
two
working days of the pay date. If you cannot withhold the full amount of support
50
for any or all orders for this employee/obligor, withhold up to
% of disposable income. If the obligor is a non-
employee, obtain withholding limits from Supplemental Information on page 3. If the employee/obligor's principal place of
employment is not
Texas
(State/Tribe), obtain withholding limitations, time requirements,
and any allowable employer fees at
program-information
for the employee/obligor's principal place of employment.
For electronic payment requirements and centralized payment collection and disbursement facility information (State
Disbursement Unit (SDU)), see
Include the Remittance ID with the payment and if necessary this FIPS code:
.
Remit payment to
TX CHILD SUPPORT SDU
(SDU/Tribal Order Payee)
at
PO BOX 659791, SAN ANTONIO, TX 78265-9791
(SDU/Tribal Payee Address)
Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in
accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed
to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender.
Signature of Judge/Issuing Official (if Required by State or Tribal Law):
Print Name of Judge/Issuing Official:
Title of Judge/Issuing Official:
Date of Signature:
If the employee/obligor works in a state or for a tribe that is different from the state or tribe that issued this order, a copy of
this IWO must be provided to the employee/obligor.
If checked, the employer/income withholder must provide a copy of this form to the employee/obligor.
ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS
State-specific contact and withholding information can be found on the Federal Employer Services website located at
program-information.
Priority: Withholding for support has priority over any other legal process under State law against the same income (42
USC §666(b)(7)). If a federal tax levy is in effect, please notify the sender.
Combining Payments: When remitting payments to an SDU or tribal CSE agency, you may combine withheld amounts
from more than one employee/obligor's income in a single payment. You must, however, separately identify each
employee/obligor's portion of the payment.
Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a
tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the
custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this
IWO was sent by a court, attorney, or private individual/entity and the initial order was entered before January 1, 1994 or
the order was issued by a tribal CSE agency, you must follow the “Remit payment to” instructions on this form.
Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the
amount was withheld from the employee/obligor's wages. You must comply with the law of the state (or tribal law if
applicable) of the employee/obligor's principal place of employment regarding time periods within which you must
implement the withholding and forward the support payments.
Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs
due to federal, state, or tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to
current support before payment of any past-due support. Follow the state or tribal law/procedure of the employee/obligor's
principal place of employment to determine the appropriate allocation method.
OMB Expiration Date - 7/31/2017. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the
version of the form currently in use.
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