0970_0154_Instructions_Sample_Form_OCSS_071223

INCOME WITHHOLDING FOR SUPPORT - Instructions
The Income Withholding for Support (IWO) is the OMB-approved form used for income withholding in:
• Tribal, intrastate, and interstate cases enforced under Title IV-D of the Social Security Act
• All child support orders initially issued in the state on or after January 1, 1994
• All child support orders initially issued (or modified) in the state before January 1, 1994, if
arrearages occur
This form is the standard format prescribed by the Secretary in accordance with section 466(b)(6)(a)(ii) of
the Social Security Act. Except as noted, the following information is required and must be
included.
Please note:
• For the purpose of this IWO form and these instructions, “state” is defined as a state or territory.
• Dos and don’ts on using this form are found at www.acf.hhs.gov/css/resource/using-the-incomewithholding-for-support-form-dos-and-donts.

I. Sender Information: (Completed by the Sender) Check one box for fields 1a – 1d.
1a. Income Withholding Order/Notice for Support (IWO). Check the box if this is an initial IWO.
1b. Amended IWO. Check the box to indicate that this form amends a previous IWO. Any changes to an
IWO must be done through an amended IWO.
1c. One-Time Order/Notice For Lump Sum Payment. Check the box when this IWO is to attach a onetime collection of a lump sum payment after receiving notification from an employer/income withholder or
other source. When this box is checked, enter the amount in field 14, Lump Sum Payment, in the Amounts
to Withhold section. Additional IWOs must be issued to collect subsequent lump sum payments.
1d. Termination of IWO. Check the box to stop income withholding on a child support order. Complete
all applicable identifying information to aid the employer/income withholder in terminating the correct IWO.
1e. Date. Date this form is completed and/or signed.
1f. Child Support Agency (CSA), Court, Attorney, Private Individual/Entity (Check one box).
Check the appropriate box to indicate which entity is sending the IWO. If this IWO is not completed by a
state or tribal CSA, the sender should contact the CSA (see
www.acf.hhs.gov/programs/css/resource/state-income-withholding-contacts-and-program-requirements)
to determine if the CSA needs a copy of this form to facilitate payment processing.
NOTE TO EMPLOYER/INCOME WITHHOLDER: This IWO must be regular on its face. The IWO must be
rejected and returned to sender under the following circumstances:
•

•
•
•
•
•
•

IWO instructs the employer/income withholder to send a payment to an entity other than a state
disbursement unit (for example, payable to the custodial party, court, or attorney). Each state is
required to operate a state disbursement unit (SDU), which is a centralized facility for collection and
disbursement of child support payments. Exception: If this IWO is issued by a court, attorney, or
private individual/entity and the initial child support order was entered before January 1, 1994, or the
order was issued by a tribal CSA, the employer/income withholder must follow the payment
instructions on the form.
After processing an IWO, the payment is returned to income withholder because the order information is
not on the child support system and the SDU could not process the payment. The income withholder
should return the payment to employee.
Form does not contain all information necessary for the employer to comply with the withholding such as,
missing Remittance Identifier, invalid case identifier or missing sender contact information.
Form is altered or contains invalid information such as “step-down” provisions or other future events that
an employer is not required to monitor.
Amount to withhold is not a dollar amount.
Sender has not used the OMB-approved form for the IWO.
A copy of the underlying order is required and not included. If you receive this document from an
attorney or private individual/entity, a copy of the underlying support order containing a provision
authorizing income withholding must be attached.

INCOME WITHHOLDING FOR SUPPORT – Instructions

Page 1 of 7

1g. State/Tribe/Territory. Name of state or tribe sending this form. This must be a government entity of
the state or a tribal organization authorized by a tribal government to operate a child support program. If
you are atribe submitting this form on behalf of another tribe, complete field 1i.
1h. Remittance ID (include w/payment). Identifier for the SDU/Tribal Payee designated in the
Remittance Information section, field 22, that employers/income withholders must include when sending
payments for this IWO. The Remittance ID is entered as the case identifier on the electronic funds
transfer/electronic data interchange (EFT/EDI) record.

NOTE TO EMPLOYER/INCOME WITHHOLDER: The employer/income withholder must use
the Remittance ID when remitting payments so the SDU or tribe can identify and apply the payment
correctly. The Remittance ID is entered as the case identifier on the EFT/EDI record.

1i. City/County/Dist./Tribe. Optional field for the name of the city, county, or district sending this form.
If entered, this must be a government entity of the state or the name of the tribe authorized by a tribal
government to operate a child support program for which this form is being sent. If a tribe is submitting
this formon behalf of another tribe, enter the name of that tribe.
1j. Order ID. Optional unique identifier associated with a specific child support obligation. It could be a
court case number, docket number, or other identifier designated by the sender.
1k. Private Individual/Entity. Name of the private individual/entity or non-IV-D tribal child support
organization sending this form.
1l. Case ID. Unique identifier assigned to a state or tribal CSA case. In a state IV-D case as defined at
45 Code of Federal Regulations (CFR) 305.1, this is the identifier reported to the Federal Case Registry
(FCR). One IWO must be issued for each IV-D case and must use the unique CSA Case ID. Fortribes,
this would be either the FCR identifier or other applicable identifier.

II. Employer and Case Information: (Completed by the Sender)
2a. Employer/Income Withholder's Name. Name of employer or income withholder.
2b. Employer/Income Withholder's Address. Employer/income withholder's mailing address including
street/PO box, city, state, and zip code. (This may differ from the employee/obligor’s work site.) If the
employer/income withholder is a federal government agency, the IWO should be sent to the address
listed under Federal Agency Income Withholding Contacts and Program Information at
www.acf.hhs.gov/css/resource/federal-agency-iwo-and-medical-contact-information.
2c. Employer/Income Withholder's FEIN. Employer/income withholder's nine-digit Federal Employer
Identification Number (if available).
3a. Employee/Obligor’s Name. Employee/obligor’s last name and first name. A middle name is
optional.
3b. Employee/Obligor’s Social Security Number. Employee/obligor’s Social Security number or other
taxpayer identification number.
3c. Employee/Obligor’s Date of Birth. Employee/obligor’s date of birth is optional.
3d. Custodial Party/Obligee’s Name. Custodial party/obligee’s last name and first name. A middle
name is optional. Enter one custodial party/obligee’s name on each IWO form. Multiple custodial
parties/obligees are not to be entered on a single IWO. Issue one IWO per state IV-D case as defined at
45 CFR 305.1.

INCOME WITHHOLDING FOR SUPPORT – Instructions

Page 2 of 7

3e. Child(ren)’s Name(s). Child(ren)’s last name(s) and first name(s). A middle name(s) is optional.
(Note: If there are more than six children for this IWO, list additional children’s names and birth dates in
the Supplemental Information section, field 33). Enter the child(ren) associated with the custodial
party/obligee and employee/obligor only. Child(ren) of multiple custodial parties/obligees is not to be
entered on an IWO.
3f. Child(ren)’s Birth Date(s). Date of birth for each child named.
3g. Blank box. Space for court stamps, bar codes, or other information.

III. Order Information: (Completed by the Sender)
The first field identifies which state or tribe issued the order. The other fields identify the dollar amounts
for specific kinds of support (taken directly from the support order) and the total amount to withhold for
specific time periods.
4. State/Tribe. Name of the state or tribe that issued the support order.
5a-b. Current Child Support. Dollar amount to be withheld per the time period (for example, week,
month) specified in the underlying support order.
6a-b. Past-due Child Support. Dollar amount to be withheld per the time period (for example, week,
month) specified in the underlying support order.
6c. Arrears Greater Than 12 Weeks? The appropriate box (Yes/No) must be checked indicating
whether arrears are greater than 12 weeks.
7a-b. Current Cash Medical Support. Dollar amount to be withheld per the time period (for example,
week, month) specified in the underlying support order.
8a-b. Past-due Cash Medical Support. Dollar amount to be withheld per the time period (for example,
week, month) specified in the underlying support order.
9a-b. Current Spousal Support. (Alimony) Dollar amount to be withheld per the time period (for
example, week, month) specified in the underlying support order.
10a-b. Past-due Spousal Support. (Alimony) Dollar amount to be withheld per the time period (for
example, week, month) specified in the underlying order.
11a-c. Other. Miscellaneous obligations dollar amount to be withheld per the time period (for example,
week, month) specified in the underlying order. Must specify a description of the obligation (for example,
court fees).
12a-b. Total Amount to Withhold. The total amount of the deductions per the corresponding time
period. Fields 5a, 6a, 7a, 8a, 9a, 10a, and 11a should total the amount in 12a.
NOTE TO EMPLOYER/INCOME WITHHOLDER: An acceptable method of determining the amount to be
paid on a weekly or biweekly basis is to multiply the monthly amount due by 12 and divide that result by
the number of pay periods in a year. Additional information about this topic is available in Action
Transmittal 16-04, Correctly Withholding Child Support from Weekly and Biweekly Pay Cycles
(https://www.acf.hhs.gov/css/resource/correctly-withholding-child-support-from-weekly-and-biweekly-paycycles).

INCOME WITHHOLDING FOR SUPPORT – Instructions

Page 3 of 7

IV. Amounts to Withhold: (Completed by the Sender)

Fields 13a through 13d specify the dollar amount to be withheld for this IWO if the employer/income
withholder’s pay cycle does not correspond with field 12b.

13a. Per Weekly Pay Period. Total amount an employer/income withholder should withhold if the
employee/obligor is paid weekly.
13b. Per Semimonthly Pay Period. Total amount an employer/income withholder should withhold if the
employee/obligor is paid twice a month.
13c. Per Biweekly Pay Period. Total amount an employer/income withholder should withhold if the
employee/obligor is paid every two weeks.
13d. Per Monthly Pay Period. Total amount an employer/income withholder should withhold if the
employee/obligor is paid once a month.
14. Lump Sum Payment. Dollar amount withheld when the IWO is used to attach a lump sum payment.
This field should be used only when field 1c is checked.
15. Document Tracking ID. Optional unique identifier for this form assigned by the sender.
Please Note: Employer/Income Withholder’s Name, FEIN, Employee/Obligor’s Name and SSN, Case ID,
and Order ID must appear in the header on page two and subsequent pages.

V. Remittance Information: (Completed by the Sender except for the “Return to Sender”

check box, field 25. Fields 26-29 are completed only if required by state or tribal law.)
Payments are forwarded to the SDU in each state, unless the initial child support order was entered by a
state before January 1, 1994, and never modified, accrued arrears, or was enforced by a child support
agency or by a tribal CSA. If the order was issued by a tribal CSA, the employer/income withholder
must follow the remittance instructions on the form in the Supplemental Information Section.
16. State/Tribe. Name of the state or tribe sending this document.
17. Days. Number of days after the effective date noted in field 18 in which withholding must begin
according to the state or tribal laws/procedures for the employee/obligor’s principal place of employment.
18. Date. Implementation date of this IWO, expressed as date of “service,” “receipt,” or “mailing.” Only
one of the three choices is to be entered in the blank line.
19. Business Days. Number of business days within which an employer/income withholder must remit
amounts withheld pursuant to the state or tribal laws/procedures of the principal place of employment.
20. Percentage of Disposable Income. The percentage of disposable income that may be withheld
from the employee/obligor’s paycheck. It is the sender’s responsibility to determine the percentage an
employer/income withholder is required to withhold. Senders must enter a specific percentage and not a
range of percentages.

INCOME WITHHOLDING FOR SUPPORT – Instructions

Page 4 of 7

NOTE TO EMPLOYER/INCOME WITHHOLDER: The employer/income withholder may not withhold
more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act [15 USC
§1673(b)]; or 2) the amounts allowed by the jurisdiction of the employee/obligor’s principal place of
employment (i.e., the amounts allowed by state law if the employee/obligor’s principal place of
employment is in a state; or the amounts allowed by tribal law if the employee/obligor’s principal place of
employment is under tribal jurisdiction).
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 on the IWO.
State-specific withholding limitations, time requirements, and any allowable employer fees are available at
www.acf.hhs.gov/css/resource/state-income-withholding-contacts-and-program-requirements. For tribespecific contacts, payment addresses, and withholding limitations, please contact the tribe at
www.acf.hhs.gov/sites/default/files/programs/css/tribal_agency_contacts_printable_pdf.pdf or
https://www.bia.gov/tribalmap/DataDotGovSamples/tld_map.html.
Depending on applicable state or tribal law, you may need to consider amounts paid for health care
premiums to determine disposable income and apply appropriate withholding limits.
A federal government agency may withhold from a variety of incomes and forms of payment, including
voluntary separation incentive payments (buy-out payments), incentive pay, and cash awards. For a more
complete list, see 5 CFR 581.103.
21. State/Tribe. Name of the state or tribe sending this document.
NOTE TO SENDER: The Sender must designate the correct SDU. In certain cases, the Sender may be
required to designate an SDU (field 22), corresponding SDU Address (field 23), and if required Locator
Code (field 24) that is different than the Sender’s SDU (see OCSS’s AT-17-07: Interstate Child Support
Payment Processing, https://www.acf.hhs.gov/css/resource/interstate-child-support-payment-processing).
The Remittance ID in field 1h must correspond with the SDU identified in field 22.
22. SDU/Tribal Order Payee. Name of SDU (or payee specified in the underlying tribal support order) to
which payments must be sent.
23. SDU/Tribal Payee Address. Address of the SDU (or payee specified in the underlying tribal support
order) to which payments must be sent.
24. Locator Code. Optional code of the SDU payee state where payment is being remitted. Geographic
Locator Codes are standard codes for states, counties, cities, and territories issued by the National
Institute of Standards and Technology. These were formerly known as Federal Information Processing
Standards (FIPS) codes.
25. Return to Sender Checkbox. The employer/income withholder should check this box and return the
IWO to the sender if this IWO is not payable to an SDU or Tribal Payee or this IWO is not regular on its
face as indicated on page 1 of these instructions.
26. Signature of Judge/Issuing Official. Signature of the official authorizing this IWO if required by
state or tribal law.
27. Print Name of Judge/Issuing Official. Name of the official authorizing this IWO if required by state
or tribal law.
28. Title of Judge/Issuing Official. Title of the official authorizing this IWO if required by state or tribal
law.
29. Date of Signature. Date the judge/issuing official signs this IWO if required by state or tribal law.

INCOME WITHHOLDING FOR SUPPORT – Instructions

Page 5 of 7

30. Copy of IWO checkbox. Check this box for all intergovernmental IWOs. If checked, the
employer/income withholder is required to provide a copy of the IWO to the employee/obligor.

VI. Additional Information for Employers/Income Withholders: (Completed by the

Sender)
The following fields refer to federal, state, or tribal laws that apply to issuing an IWO to an
employer/income withholder. State- or tribal-specific information may be included only in the fields below.

31. Liability. Additional information on the penalty and/or citation of the penalty for an employer/income
withholder who fails to comply with the IWO. The state or tribal law/procedures of the employee/obligor’s
principal place of employment govern the penalty.
32. Anti-discrimination. Additional information on the penalty and/or citation of the penalty for an
employer/income withholder who discharges, refuses to employ, or disciplines an employee/obligor as a
result of the IWO. The state or tribal law/procedures of the employee/obligor’s principal place of
employment govern the penalty.
33. Supplemental Information. Any state-specific information needed, such as maximum withholding
percentage for nonemployees/independent contractors, fees the employer/income withholder may charge
the obligor for income withholding, or children’s names and DOBs if there are more than six children on
this IWO. Additional information must be consistent with the requirements of the form and the instructions.

VII. Notification of Employment Termination or Income Status: (Completed by the

Employer/Income Withholder)
The employer must complete this section when the employee/obligor’s employment is terminated, income
withholding ceases, or if the employee/obligor has never worked for the employer. The employer/income
withholder may report new payment sources such as workers’ compensation, if known.
34a-b. Employment/Income Status Checkbox. Check the employment/income status of the
employee/obligor.
35. Termination Date. If applicable, date employee/obligor was terminated.
36. Last Known Telephone Number. Last known (home/cell/other) telephone number of the
employee/obligor.
37. Last Known Address. Last known home/mailing address of the employee/obligor.
38. Final Payment Date. Date employer sent final payment to SDU/Tribal Payee.
39. Final Payment Amount. Amount of final payment sent to SDU/Tribal Payee.
40. New Employer’s or Income Withholder’s Name. Name of employee’s/obligor’s new employer or
income withholder (if known).
41. New Employer’s or Income Withholder’s Address. Address of employee’s/obligor’s new employer
or income withholder (if known).

VIII. Contact Information: (Completed by the Sender)
42. Sender Contact for Employer/Income Withholder. Name of the person that the employer/income
withholder can call for information regarding this IWO. If the sender is a victim of family or domestic
violence, rather than including direct contact information, enter contact information for someone else who
will communicate for you.
43. Sender Telephone Number. Telephone number of the contact person.

INCOME WITHHOLDING FOR SUPPORT – Instructions

Page 6 of 7

44. Sender Fax Number. Optional fax number of the contact person.
45. Sender Email/Website. Optional email or website of the contact person.
46. Sender Address (Termination/Income Status and Correspondence Address). Address to which
the employer should return the Employment Termination or Income Status notice. It is also the address
that the employer should use to correspond with the issuing entity.
47. Sender Contact for Employee/Obligor. Name of the person that the employee/obligor can call for
information.
48. Sender Telephone Number. Telephone number of the contact person.
49. Sender Fax Number. Optional fax number of the contact person.
50. Sender Email/Website. Optional email or website of the contact person.
Encryption Requirements: When communicating the Income Withholding for Support (IWO) through
electronic transmission, precautions must be taken to ensure the security of the data. Child support
agencies are encouraged to use the electronic applications provided by the federal Office of Child
Support Services. Other electronic means, such as encrypted attachments to emails, may be used if the
encryption method is compliant with Federal Information Processing Standard (FIPS) Publication 140-2
(FIPS PUB 140-2).

INCOME WITHHOLDING FOR SUPPORT – Instructions

Page 7 of 7

OMB 0970-0154
Expiration Date xx/xx/xxxx:

INCOME WITHHOLDING FOR SUPPORT
I. Sender Information: (Completed by the Sender)

1e

Date:

1a

INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT(IWO)

1b

AMENDED IWO

1c

ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT

1d

TERMINATION OF IWO

1f

Child Support Agency (CSA)

Court

Attorney

Private Individual/Entity (Check One)

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 www.acf.hhs.gov/css/resource/income-withholding-for-support-instructions). If you receive
this document from someone other than a state or tribal CSA or a court, a copy of the underlying support order must be
attached.
State/Tribe/Territory
City/County/Dist./Tribe
Private Individual Entity

1g

1i

Remittance ID (include w/payment)
1j
Order ID

1k

Case ID

1h

1l

II. Employer and Case Information: (Completed by the Sender)
2a
Employer/Income Withholder’s Name
2b
Employer/Income Withholder's Address

RE:

Employer/Income Withholder’s FEIN
Child(ren)’s Name(s) (Last, First, Middle)
3e

3a
Employee/Obligor’s Name (Last, First, Middle)
3b
Employee/Obligor's Social Security Number
3c
Employee/Obligor’s Date of Birth
3d
Custodial Party/Obligee’s Name (Last, First, Middle)

2c
Child(ren)’s Birth Date(s)
3f

3g

III. Order Information: (Completed by the Sender)
This document is based on the support order from
(State/Tribe).
4
You are required by law to deduct these amounts from the employee/obligor's income until further notice.
$
5b
current child support
5a
Per
past-due child support - Arrears greater than 12 weeks?
$
6b
Per
6a
Yes
No 6c
current cash medical support
Per
7b
7a
$
past-due cash medical support
8b
Per
8a
$
9b
current spousal support
Per
9a
$
10b
past-due spousal support
10a
Per
$
11b
11a
Per
$
for a Total Amount to Withhold of $

other (must specify)
per
12b
12a

11c
.

IV. Amounts to Withhold: (Completed by the Sender)
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:
13b
$
13a
$
per semimonthly pay period (twice a month)
per weekly pay period
$
13c
per biweekly pay period (every two weeks) $
13d
per monthly pay period
14
$
Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.
Income Withholding for Support (IWO)

Document Tracking ID

15

Page 1 of 4

Employer/Income Withholder’s Name:
Employee/Obligor’s Name:
Case ID:

2a

1l

Employer/Income Withholder’s FEIN:
SSN:

3a

3b

2c

1j

Order ID:

V. Remittance Information: (Completed by the Sender except for the “Return to Sender” check box.)
16
If the employee/obligor’s principal place of employment is
(State/Tribe), you must begin withholding no
18
later than the first pay period that occurs 17 days after the date of
of the order/notice. Send payment
within 19 business days of the pay date. If you cannot withhold the full amount of support for any or all orders for this
employee/obligor, withhold 20 % of disposable income for all orders. If the employee/obligor’s principal place of
21
employment is not
(State/Tribe), obtain withholding limitations, time requirements, the appropriate
method to allocate among multiple child support cases/orders and any allowable employer fees from the jurisdiction of
the employee/obligor’s principal place of employment.
State-specific withholding limit information is available at www.acf.hhs.gov/css/resource/state-income-withholdingcontacts-and-program-requirements. For tribe-specific contacts, payment addresses, and withholding limitations, please
contact the tribe at www.acf.hhs.gov/sites/default/files/programs/css/tribal_agency_contacts_printable_pdf.pdf or
www.bia.gov/tribalmap/DataDotGovSamples/tld_map.html.
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 law of the state of the employee/obligor’s principal place of
employment if the place of employment is in a state; or the tribal law of the employee/obligor’s principal place of
employment if the place of employment is under tribal jurisdiction. The CCPA is available at www.dol.gov/sites/dolgov/
files/WHD/legacy/files/garn01.pdf. If the Order Information section does not indicate that the arrears are greater than 12
weeks, then the employer should calculate the CCPA limit using the lower percentage.
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.
If the obligor is a nonemployee, obtain withholding limits from the Supplemental Information section in this IWO. This
information is also available at www.acf.hhs.gov/css/resource/state-income-withholding-contacts-and-programrequirements.
Remit payment to
at

23

22

(SDU/Tribal Order Payee)
(SDU/Tribal Payee Address)

Include the Remittance ID with the payment and if necessary this locator code of the SDU/Tribal

order payee

on the payment.

24

To set up electronic payments or to learn state requirements for checks, contact the State Disbursement Unit (SDU).
25

Return to Sender (Completed by Employer/Income Withholder). Payment must be
directed to an SDU in
accordance with sections 466(b)(5) and (6) of the Social Security Act or Tribal Payee (see Payments in Section VI). 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.
If Required by State or Tribal Law:
Signature of Judge/Issuing Official:
Print Name of Judge/Issuing Official:
Title of Judge/Issuing Official:
Date of Signature:

29

26
27
28

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.
30

If checked, the employer/income withholder must provide a copy of this form to the employee/obligor.

Income Withholding for Support (IWO)

Page 3 of 4

Employer/Income Withholder’s Name:

Employer/Income Withholder’s FEIN:
SSN:

3a

Employee/Obligor’s Name:
Case ID:

2a

1l

Order ID:

3b

2c

1j

VI. Additional Information for Employers/Income Withholders: (Completed by the Sender)
Priority: Withholding for support has priority over any other legal process under State law against the same income
(section 466(b)(7) of the Social Security Act). If a federal tax levy is in effect, please notify the sender.
Payments: You must send child support payments payable by income withholding to the appropriate State Disbursement
Unit or to a tribal CSA within 7 business days, or fewer if required by state law, after the date the income would have been
paid to the employee/obligor and include the date you withheld the support from his or her income. You may combine
withheld amounts from more than one employee/obligor’s income in a single payment as long as you separately identify
each employee/obligor’s portion of the payment. Child support payments may not be made through the federal Office of
Child Support Services (OCSS) Child Support Portal.
Lump Sum Payments: You may be required to notify a state or tribal CSA 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. Employers/income withholders may use OCSS’s Child Support Portal
(ocsp.acf.hhs.gov/csp/) to provide information about employees who are eligible to receive lump sum payments and to
provide contacts, addresses, and other information about their companies. Child support payments may not be made
through the federal OCSS Child Support Portal.
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.
31

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.
32

Supplemental Information:
33

Income Withholding for Support (IWO)

Page 4 of 4

2a

Employer/Income Withholder’s Name:

3a

Employee/Obligor’s Name:

1l

Case ID:

2c

Employer/Income Withholder’s FEIN:

3b

SSN:

1j

Order ID:

VII. Notification of Employment Termination or Income Status: (Completed by the Employer/Income Withholder)

34a
34b

If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor, you must
promptly notify the CSA and/or the sender by returning this form to the address listed in the Contact Information section
below or using OCSS’s Child Support Portal (ocsp.acf.hhs.gov/csp/). Please report the new employer or income
withholder, if known.
This person has never worked for this employer nor received periodic income.
This person no longer works for this employer nor receives periodic income.
Please provide the following information for the employee/obligor:
Termination date:

36

Last known telephone number:

35

Last known address:

37

Final payment date to SDU/Tribal Payee:

38

Final payment amount:

New employer’s or income withholder’s name:

39

40

New employer’s or income withholder’s address:

41

VIII. Contact Information: (Completed by the Sender)
To Employer/Income Withholder: If you have questions, contact
telephone:

43

, by fax:

44

(sender name) by

42

, by email or website:

.

45

Send termination/income status notice and other correspondence to:

46
(sender address).

To Employee/Obligor: If the employee/obligor hasquestions, contact
by telephone:

48

, by fax:

49

, by email or website:

47

(sender name)
.

50

IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor.

Encryption Requirements: When communicating this form through electronic transmission, precautions must be taken to
ensure the security of the data. Child support agencies are encouraged to use the electronic applications provided by the
federal Office of Child Support Services. Other electronic means, such as encrypted attachments to emails, may be used if
the encryption method is compliant with Federal Information Processing Standard (FIPS) Publication 140-2 (FIPS PUB
140-2).

The Paperwork Reduction Act of 1995 (Pub.L. 104-13): Public reporting burden for this mandatory [42 U.S.C. §§666(a)(1), (a)(8) and
666(b)(6)] collection of information is estimated to average two to five minutes per response. Information collected for this program is
subject to the federal confidentiality requirements [45 CFR 303.21]. A federal agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information, unless it displays a currently valid OMB control number. If you have any comments
on this collection of information, please contact OCSSFedSystems@acf.hhs.gov

Income Withholding for Support (IWO)

Page 4 of 4