Fillable Notice To Withhold Income - Douglas County (Page 2 of 2) in pdf

ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS

(7)

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/notice have priority.

(8)

Combining Payments: You can combine withheld amounts from more than on employee/obligors income in a single payment. You

must, however, separately identify the portion of the single payment that is attributable to each employee/obligor.

(9)

Reporting the Pay date/Date of Withholding: You must report the pay date/date of withholding when sending the payment. The

pay date/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law

of the state of employee's/obligor's principal place of employment with respect to the time periods within which you must

implement the withholding order and forward the child support payments.

(10)

Employee/obligor with Multiple Support Withholding: If there is more than one Order/Notice to Withhold Income for Child

Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State

withholding limits, you must follow the law of the state of employee's/obligors principal place of employment. You must honor all

Order/Notices to the greatest extent possible. (See #11 below)

(11)

Withholding Limits: You may not withhold more than the lessor of: 1) the amounts allowed by the Federal Consumer Credit

Protection Act (15 U.S.C. § 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 limit is 50% of the ADWE for child support and alimony, which is increased 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 amounts on front)

(12)

Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or

severance pay.

(13)

Liability: if you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should

income

have withheld from the employee/obligor's

and any other penalties set by State Law. Nebraska Employers: Pursuant to

Neb. Rev. Slat. § 43-1724, if you fail to withhold income as the Order/Notice directs, you may be required to pay the certified

amount

(14)

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. Nebraska Employers: Pursuant to Neb. Rev. Slat. § 43-1725, you are subject to $500.00 fine and may be

required to make full restitution to the aggrieved employee or payee, including reinstatement and back pay for (1)

discrimination in hiring, (2) demotion of an employee or payee, (3) disciplinary action against an employee or payee, or (4)

termination of an employee or payee.

(15)

Nebraska Employers: Per Nebraska law you are entitled to deduct a fee not to exceed two dollars and fifty cents ($2.50) in any

calendar month to defray the costs of withholding.

(16)

Remitting Payment: When remitting payment, provide the pay date/date of withholding, name of county support order is

entered in, court case number, and employee/obligor's name and social security number.

Make it payable to: Nebraska Child Support Payment Center,

Send to: Nebraska Child Support Payment Center, P. 0. Box 82890, Lincoln, NE 68502-2890

If remitting by EFT/EDI, use this FIPS code: 31000; Bank routing code: 104000016; Bank account number: 22662057.

(17)

The income withholding requirement is binding and shall continue in full force and effect until 30 days after I cease

employment or the source of income terminates. The withholding shall also terminate when I supply proof that the child,

spousal maintenance and medical support obligation terminates. The income withholding requirement may be modified or

revoked by a court of competent jurisdiction. Notify the clerk of the district court if this wage assignment terminates because of

termination of employment.

___________________________________________________

___________________________________

Employee/Obligor's Signature

Date

_________________________________

Phone

Address: __________________________________ City: ________________________ , State: _____________ Zip: _________

Instructions: 1) Complete the form, use

typewriter or print with a ballpoint pen 2) Sign notice 3) Make 2 copies after signing

original 4) send or provide the original copy to your employer, send one of the copies

the Clerk of the District Court that your

support order is entered

in, and retain the second copy 'for your records.

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Notice To Withhold Income - Douglas County Page 2

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