Form Omb 0970-0154 - Income Withholding Order For Support Page 3
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4Employer's Name:
Employer FEIN:
Employee/Obligor's Name:
SSN:
CSE Agency Case Identifier:
Order Identifier:
Lump Sum Payments: You may be required to notify a state or tribal CSE agency of upcoming lump sum payments to
this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are
required to report and/or withhold lump sum payments.
Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the
employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld
and any penalties set by state or tribal law/procedure.
Anti-discrimination: You are subject to a fine determined under state or tribal law for discharging an employee/obligor
from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.
Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer
Credit Protection Act (CCPA) (15 USC §1673(b)); or 2) the amounts allowed by the state of the employee/obligor's
principal place of employment or tribal law if a tribal order (see Remittance Information). Disposable income is the net
income after mandatory deductions such as: state, federal, local taxes; Social Security taxes; statutory pension
contributions; and Medicare taxes. The federal limit is 50% of the disposable income if the obligor is supporting another
family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase
5% --to 55% and 65% --if the arrears are greater than 12 weeks. If permitted by the state or tribe, you may deduct a fee
for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section.
For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal
employers/income withholders who receive a state IWO, you may not withhold more than the limit set by tribal law.
Depending upon applicable state or tribal law, you may need to consider amounts paid for health care premiums in
determining disposable income and applying appropriate withholding limits.
Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks,
then the employer should calculate the CCPA limit using the lower percentage.
Supplemental Information:
Non-employees' withholding limitations are the same as that for employees under Texas Family Code
IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor.
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