Dear Colleague (DCL9516)

ACF/Office of Child Support Enforcement

Pilot Testing the Standardized Income Withholding Form

March 2, 1995

DC95-16

TO ALL STATE IV-D DIRECTORS

Dear Colleague:

Since our last communication regarding the standardized income
withholding form (DC 93-49), a total of twenty-one States have
passed the Uniform Interstate Family Support Act (UIFSA) which
enables States to submit interstate income withholding orders
directly to employers. As you know, the Income Withholding Form
Work Group has been developing a standardized form that expedites
intra and interstate income withholding orders for child support.
This form potentially will facilitate uniformity when processing
income withholding orders, especially for States that have
adopted UIFSA.

I have enclosed a copy of the Order/Notice to Withhold Income for
Child Support, the instructions to complete the Order/Notice, and
a draft of the pilot test for your review while the Work Group
finalizes requirements for the pilot test. The pilot does not
need to be conducted statewide, therefore I would like to
encourage all interested States, jurisdictions, and courts to
participate. Also, any jurisdiction wishing to participate in
the pilot will receive the form on a diskette so it can be
generated from a personal computer and thus will not necessitate
system changes. Once the pilot is completed and final revisions
are made to the form, States will be asked to adopt the form for
intra and interstate income withholding cases.

I am pleased with the cooperation from all the Work Group members
and entities that volunteered their time and effort to this
project. The Order/Notice is an example of a positive group
effort to enhance the Child Support Enforcement program. OCSE is
committed to marketing and providing technical assistance for
this project. If you are interested in participating in the
pilot test please contact Dianne Offett, OCSE, Division of
Program Operations, National Training Center, 370 L'Enfant
Promenade, SW, Washington, DC, 20447, or call her at (202) 401-
5425 by March 31, 1995. She will be glad to answer any questions
regarding the pilot test.

Sincerely,

David Gray Ross
Deputy Director
Office of Child Support
Enforcement

Enclosures

cc: Regional Administrators
Regional CSE Program Managers

ORDER/NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT

State of , Co./City/Dist. of
Date of Withholding Order/Notice Original Order/Notice
Court/Case Number Amended Order/Notice
Terminate Order/Notice
) RE: *
Employer/Withholder's Federal EIN Number ) Employee/Obligor's(Last, First, MI)
) *
Employer/Withholder's Name ) Employee/Obligor's Social Security Number
) *
Employer/Withholder's Address ) Employee/Obligor's Case Identifier
)
) Custodial Parent's (Last, First, MI)

This is an Order/Notice to Withhold Income for Child Support based upon an order for support from the State of .
Under Your State Code Provision , you are required to deduct these amounts from the above-named
employee/obligor's income:
$ per in current support
$ per in past-due support þ arrears 12 weeks or greater
$ per in medical support
$ per in other (specify)
for a total of $ per to be forwarded to the payee below.

You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ per pay period if paid weekly.
$ per pay period if paid biweekly (every two weeks).
$ per pay period if paid semimonthly (twice a month).
$ per pay period if paid monthly.

You may be required to honor this Order/Notice even if it was not issued by your State. Follow the laws and procedures
where the employee/obligor is employed even if such laws and procedures are different from the provisions below.

You must begin withholding no later than the first pay period occurring working days after the date of this
Order/Notice. Send payment within working days of the paydate/date of withholding. You are entitled to
deduct a fee of
to defray the cost of withholding. The total withheld amount, including your fee, cannot
exceed % of the employee/obligor's aggregate disposable weekly earnings. (see #11 on back)

When remitting payment indicate the paydate/date of withholding and the case identifier . If remitting
by EFT/EDI, use this FIPS code: * ; Bank routing code:* ;
Bank account number:* .

Make it payable to:
Payee and case identifier
Send check to:
Payee's Address

þ Please provide a copy of this form to your employee. If you have any questions, contact: by
telephone at or by FAX at . If your employee/obligor has questions,
he/she may contact at .
Authorized by
Printed signature

IF THE EMPLOYEE/OBLIGOR IS NO LONGER EMPLOYED BY YOU, PROVIDE THE INFORMATION REQUESTED AND RETURN A COPY OF THIS
ORDER/NOTICE TO THE AGENCY IDENTIFIED ON THE BACK. DATE OF SEPARATION (See #6 on back.)
FORWARDING INFORMATION ON EX-EMPLOYEE IF KNOWN:
LAST KNOWN HOME ADDRESS
NEW WORK ADDRESS

ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS

1. Binding Effect: This Order/Notice is binding on you until you receive further notice from the State.

2. 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 unless otherwise agreed to by IRS.

3. 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.

4. 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 amount was withheld from the employee's wages.

5. Employee/Obligor with Multiple Support Withholdings: If there is more than one Order/Notice To Withhold Income For
Child Support against this employee/obligor and are unable to honor all support Orders/Notices due to Federal or State
withholding limits, you must immediately contact the agency that sent the most recent Order/Notice to determine how to
divide the withheld income. You must honor all Order/Notices to the greatest extent possible.

6. Termination Notification: You must promptly notify the payee when the employee/obligor no longer works for you. Mark
the space provided on the front and provide the State with the employee/obligor's last known home address and the name
and address of the employee/obligor's new employer, if known.

7. Lump Sum Payments: If you have any questions about withholding from lump sum payments such as bonuses or
commissions, contact the person listed on the front.

8. If this Order/Notice was issued by a State where you are conducting business, follow the laws and procedures where the
employee/obligor is employed even if such laws and procedures are different from the provisions below.

9. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you
should have withheld from the employee/obligor's income and any other penalties set by State law.

10. 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.

11. Withholding Limits: You may not withhold more than the lesser of the amounts allowed by the Federal Consumer Credit
Protection Act (15 U.S.C. 1673(b)) or the limits of the State in which the employee/obligor is employed.

State limit:

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, and Medicare taxes.

Issuing Agency

The following are instructions to complete the Order/Notice to
Withhold Income for Child Support. When completing the form,
please include the following information.

1a. Name of your State.

1b. Name of your jurisdiction.

2. Date the Order/Notice to Withhold is to be mailed.

3. Identifying number used by the court/agency issuing this
Order/Notice, if appropriate.

4 a-c. Check the appropriate case status of the Order/Notice to
Withhold.

5. Employer/Withholder's nine digit Federal employer
identification number (if available). Include three digit
location code (if known).

6a. Employer/Withholder's name.

6b-d. Employer/Withholder's mailing address. (This may differ
from the Employee/Obligor work site.)

7. Employee/Obligor's last name, first name, and middle initial
(if known).

8. Employee/Obligor's Social Security Number.

9. Case identifier (or other identifier) used for recording the
payment. (May be the same as #3.)

10. Custodial Parent's last name, first name, and middle initial
(if known).

11. Name of State that issued the underlying child support
order.

12. Your State code provision that requires or authorizes income
withholding to pay child support.

13a. Dollar amount to be withheld for payment of current child
support.

13b. Time period that corresponds to the amount in #13a (e.g.,
month).

14a. Dollar amount to be withheld for payment of past-due child
support under your State law.

14b. Time period that corresponds to the amount in #14a (e.g.,
month).

14c. Check this box if arrears are 12 weeks or greater.

15a. Dollar amount to be withheld for payment of medical
support, as appropriate, based on the underlying order.

15b. Time period that corresponds to the amount in #15a (e.g.,
month).

16a. Dollar amount to be withheld for payment of miscellaneous
obligations, if appropriate, based on the underlying order.

16b. Time period that corresponds to the amount in #16a (e.g.,
month).

16c. Describe the amount(s) represented in #16a separately by
fee type (e.g., court fees).

17a. Total of #13a, #14a, #15a, and #16a.

17b. Time period that corresponds to the amount in #16a (e.g.,
month).

18a. Amount an employer withholds if the employee is paid
weekly.

18b. Amount an employer withholds if the employee is paid every
two weeks.

18c. Amount an employer withholds if the employee is paid twice
a month.

18d. Amount an employer withholds if the employee once a month.

19. Number of days in which the withholding must begin pursuant
to the law of your State.

20. Number of working days an employer or other payor of income
must remit amounts withheld pursuant to the law of your State.

21. Amount or percentage that an employer or other payor of
income may deduct in addition to child support from its payment
as a fee for withholding child support pursuant to the law of
your State. If your State does not permit deduction of a fee,
enter 0. Employers with employees/obligors located in another
State should know those State laws.

22. Maximum percentage that can be withheld based on the
applicable withholding limit of your State. If the employer
is a Federal agency and you add the additional 5 percentage
points allowed under the Federal Consumer Credit Protection
Act to the percentage entered for #22 (i.e., 65%; or 55%
instead of 50% if the obligor supports a second family),
check #14c on the Order/Notice to indicate the support is 12
weeks or more in arrears.

23a. Case identifier or other identifier. (May be the same as #3
and/or #9.)

23b. Federal Information Process Standard (FIPS) code for
transmitting payments through EFT/EDI. The FIPS code is
five characters that identifies the State and county. It is
seven characters when it identifies the State, county, and a
location within the county. It is necessary for centralized
collections. Complete only for EFT/EDI transmission.

23c. Receiving agency's bank routing number. Complete only for
EFT/EDI transmission.

23d. Receiving agency's bank account number. Complete only for
EFT/EDI transmission.

24a. Name of the child support enforcement agency to which
payments are made and the case identifier on the payment
line.

24b-d. Street address, City, and State of the child support
enforcement agency identified in #24a.

25. Check the box if the employer is to provide a copy of the
Order/Notice to the employee.

26a. Name of the child support enforcement agency's contact
person who an employer may call for information regarding
the Order/Notice.

26b. Telephone number of person who an employer may call for
information regarding the Order/Notice.

26c. Facsimile number for the person whose name appears in #26b.

27a. Name of the person who the employee/obligor can contact for
information regarding the Order/Notice.

27b. Telephone number of the person or office whose name appears
in #27a.

28a. Name of the official authorized to send the Order/Notice.

28b. Signature of official authorized to send the Order/Notice.
This line is optional if a signature is not required by
State statute.

29. Penalty and your State citation for an employer who fails to
comply with the Order/Notice. Your State law governs unless
the obligor is employed in another State, in which case the
law of the State in which he or she is employed governs.

30. Penalty and your State citation for an employer who
discharges, refuses to employ, or disciplines an
Employee/Obligor as a result of the Order/Notice. Your
State law governs unless the obligor is employed in another
State, in which case the law of the State in which he or she
is employed governs.

31. Your State law and citation regarding the Federal Consumer
Credit Protection Act. Your State law governs unless the
obligor is employed in another State, in which case the law
of the State in which he or she is employed governs.

32a-d. Name and address of the agency or court that issued the
Order/Notice.

If the employer is a Federal Government agency the following
instructions apply.

þ Serve the Order/Notice upon the governmental agent listed in
5 C.F.R. part 581, appendix A, by certified or registered
mail, return receipt requested, or by personal service.

þ Attach correspondence to the Order/Notice that indicates:
the obligor's date of birth; the component of the
governmental entity for which the obligor works; the
obligor's official duty station or work site; and the status
of the obligor (e.g., employee, former employee, or
annuitant).

þ You may withhold from a variety of income and forms of
payment, including incentive pay and cash awards. For a
complete list see 5 C.F.R. 581.103.

Pilot Plan to Test the Form for
Order/Notice To Withhold Income for Child Support

The Federal Office of Child Support Enforcement (OCSE) in
conjunction with State Child Support Enforcement (CSE) agencies
and employers would like to reduce the overwhelming burden of
processing and enforcing income withholding orders. To date,
State CSE agencies have received cooperation from employers, but
frequently many employers still have difficulty processing the
array of income withholding forms. In 1993, the Income
Withholding Form Work Group was established to develop a
standardized form that expedites intra (within the State) and
interstate (across State boundaries) income withholding for child
support. The Work Group members are Federal and State CSE staff,
representatives from the American Payroll Association and the
American Society for Payroll Management, and several employers.

Designing this standardized form to replace various types of
income withholding forms used by CSE agencies was our first
objective. In many ways the form will help standardize the
process of income withholding which is the ultimate objective.
Another objective was to help relieve problems and/or barriers of
income withholding such as: delays in receipt of payments to CSE
agencies which in turn delays payments to custodial parents;
employer resistance in processing child support orders; and
uncollected child support payments due to the burden of
complicated administrative paperwork.

Use of the standardized form should demonstrate that income
withholding orders can be processed and executed more quickly,
thus a benefit to CSE agencies and employers alike. Some of the
immediate benefits should be an increase in collections and
reduction in delinquent child support payments. Employers will
benefit by a reduction in paperwork.

The Work Group gave each State CSE agency an opportunity to
submit written comments on what information they require to
process income withholding orders. This was one way to build a
foundation for the form that would meet the CSE agencies' needs.
After consolidating the recommendations, a model form was
developed and distributed again for comments to State CSE
agencies, legal counsels, and employers. The Work Group reviewed
the responses and spent many hours discussing issues; both from
the CSE program's and the employers' perspectives, encountered in
processing income withholding orders. We recognized that
caseworkers and employers want a simple, descriptive, user-
friendly form to reduce time spent in processing income
withholding orders. After months of conference calls, regional
meetings, and revisions the Work Group developed a standardized
form titled "Order/Notice to Withhold Income for Child Support."

Now that the draft form is complete, the next step for the Work
Group is to pilot test the form with several States and local
child support enforcement agencies. The pilot test will indicate
whether the form is effective in expediting intra and interstate
income withholding orders, can reduce time in remitting child
support payments from an employer, and is arranged in an
acceptable user-friendly format providing pertinent information
for the caseworkers, court staff, and employers.

The pilot test period will be approximately six months in length.
This will enable caseworkers, court staff, and employers time to
use, process, and provide an accurate evaluation of the form. We
(the Work Group) would like to encourage as many State and local
CSE agencies, courts, and employers to participate in the pilot
test to ensure the form meets all its users' needs. Each agency
will be responsible for selecting appropriate cases for the
pilot.

The pilot is divided into four phases:

þ Phase I - The Work Group solicits CSE agencies to test the
form. Letters are sent to court administrators, associations,
and IV-D directors to encourage States to participate in the
pilot test. Statewide participation is not required for the
pilot test. The State may select one jurisdiction, or the
State may want to pilot the form on a statewide basis with a
few employers. The participating State should appoint a
representative contact person to coordinate the pilot with the
Work Group's Chairperson.

þ Phase II - This is the set-up/preparation time. The Work
Group Chairperson coordinates with the State CSE
Representative to determine the details of the pilot test. A
diskette is available for jurisdictions to produce diskette
generated forms. The diskette is in Wordperfect 5.1 format.
During this phase, States will provide information to the
appropriate employers and coordinate outreach efforts.

þ Phase III - This is the actual test phase when the form is
used for income withholding on selected CSE cases. The test
will be approximately six months in length. During the pilot
test the Chairperson will have frequent contact with the
appointed representatives to obtain feedback on the form's
usage. OCSE will work with States to provide technical
assistance as needed.

þ Phase IV - This is the analysis and evaluation phase. It is
important to get feedback from the users of the form in case
revisions are needed before the form is finalized. OCSE will
provide the pilot sites with an evaluation for employers and
users to complete. Comments from the caseworkers and
employers will be submitted to the Chairperson. The Work
Group will review the evaluation and make the appropriate
revisions to the form.

Frequent followup on the form's usage is important in the event
the form requires revisions during the test. Results from the
pilot test will indicate if it is feasible to use this
standardized form (or a similar version) for intra and interstate
income withholding.

The pilot test results will assist in determining the following:

þ Do the instructions serve as an informative guide to complete
the form?

þ Does the form assist in processing and collecting child
support payments faster?

þ Is the form user-friendly to employers' payroll
administrators?

þ Does the form meet all users' needs?

þ Does the form provide pertinent information needed to expedite
an income withholding order?

þ Is the form's format acceptable?

Survey questions for the CSE agency:

þ Is the spacing sufficient to enter the appropriate
information? Please provide specific examples.

þ Did you use the diskette version of the Order/Notice?

þ Does the diskette version of the form simple to install on
your personal computer? If not please explain.

- Were the problems related to your personal computer hardware
or software applications.

- What were the problems you experienced?

- What improvements could be made to the diskette generated
form?

þ How many cases were processed in the pilot test?