ࡱ>  ?bjbj ض}g}gl2.  4***hL*Ar(("&"&"&$A&A&A&A&A&A&A$?DFJA"&&""&"&"&JA> _Ap*p*p*"&8$Ap*"&$Ap*p*:|&< &*;AuA0A<;I'BI$&<&<JIp<"&"&p*"&"&"&"&"&JAJA(r"&"&"&A"&"&"&"&I"&"&"&"&"&"&"&"&"& X l: INCOME WITHHOLDING FOR SUPPORT Sender Information: (Completed by the Sender) Service Date: 02/20/2021 ( INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) ( AMENDED IWO ( ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT ( TERMINATION OF IWO ( Child Support Enforcement (CSE) Agency (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 CSE agency or a court, a copy of the underlying support order must be attached. State/Tribe/Territory Michigan Remittance ID (include w/payment) 999999999 City/County/Dist./Tribe Saginaw County Friend of the Court Order ID 2021999999 Private Individual Entity Case ID 999999999 Employer and Case Information: (Completed by the Sender) EMPLOYERS R US INC/AKA ERU INC RE: DOE, JOHN, ANTHONY Employer/Income Withholders Name Employee/Obligors Name (Last, First, Middle) 100 WORKER WAY 888-88-8888 Employer/Income Withholders Address Employee/Obligors Social Security Number SUITE 100 12/01/1990 Employee/Obligors Date of Birth LANSING, MI 40000 DOE, JANE, TIBERIUS Custodial Party/Obligees Name (Last, First, Middle) Employer/Income Withholders FEIN 389999999 Child(ren)s Name(s) (Last, First, Middle) Child(ren)s Birth Date(s) DOE, JONATHAN, JAMESON 12/15/2010 DOE, JEANNIE, JO 12/14/2011 III. Order Information: (Completed by the Sender) This document is based on the support order from Michigan (State/Tribe). You are required by law to deduct these amounts from the employee/obligors income until further notice. $ 56.55 Per month current child support $ 56.55 Per month past-due child support - Arrears greater than 12 weeks? [X] Yes [ ] No $ 0.00 Per month current cash medical support $ 65.49 Per month past-due cash medical support $ 0.00 Per month current spousal support $ 0.00 Per month past-due spousal support $ 3.50 Per month other (must specify) Arrears and/or Fees . for a Total Amount to Withhold of $182.09 per MONTH. 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: $41.86 per weekly pay period $91.05 per semimonthly pay period (twice a month) $83.72 per biweekly pay period (every two weeks) $182.09 per monthly pay period $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to provide uniformity and standardization. Public reporting burden for this collection of information is estimated to average two to five minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information in accordance with 45 CFR 303.100 of the Child Support Enforcement Program. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information, please contact the Employer Services Team by email at employerservices@acf.hhs.gov. V. Remittance Information: (Completed by the Sender except for the Return to Sender check box.) If the employee/obligors principal place of employment is Michigan (State/Tribe), you must begin withholding no later than the first pay period that occurs 7 days after the date of service of the order/notice. Send payment within 3 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 50% of disposable income for all orders. If the employee/obligors principal place of employment is not Michigan (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/obligors principal place of employment. State-specific withholding limit information is available at www.acf.hhs.gov/css/resource/state-income-withholding-contacts-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/obligors principal place of employment if the place of employment is in a state; or the tribal law of the employee/obligors 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  HYPERLINK "https://www.acf.hhs.gov/css/resource/state-income-withholding-contacts-and-program-requirements" \h information is also available at www.acf.hhs.gov/css/resource/state-income-withholding-contacts-and-program- requirements. Remit payment to Michigan State Disbursement Unit (MiSDU) (SDU/Tribal Order Payee) at P.O. Box 30350, Lansing, MI 48909-7850 (SDU/Tribal Payee Address) Include the Remittance ID with the payment and if necessary this locator code of the SDU/Tribal order payee 2612500 on the payment. To set up electronic payments or to learn state requirements for checks, contact the State Disbursement Unit (SDU). Contacts and information are found at www.acf.hhs.gov/css/resource/sdu-eft-contacts-and-program-requirements. [ ] 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: Joe A. Friend Title of Judge/Issuing Official: Friend of the Court 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. 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 CSE agency 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/obligors income in a single payment as long as you separately identify each employee/obligors portion of the payment. Child support payments may not be made through the federal Office of Child Support Enforcement (OCSE) Child Support Portal. 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. Employers/income withholders may use OCSEs Child Support Portal ( HYPERLINK "https://ocsp.acf.hhs.gov/csp/" 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 OCSE 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/obligors 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. MCL 552.611a(2), 552.613, and 552.1501. 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. MCL 552.623. Supplemental Information: IMPORTANT: INCLUDE ORDER ID AND EMPLOYEE NAME WITH REMITTANCE. Remitters with payment questions including EFT/EDI/ACH may call MiSDU @ (800) 817-0805 or visit www.misdu.com. If a bonus or lump sum is payable to the employee/obligor, contact the OCS Central Operations at (866) 540-0008 (when prompted, say employer bonus) to be advised of the amount to remit. MI permits income withholders to charge support payers a fee up to $2 or $4/month for withholding: MCL 552.623. MI has no withholding limit for non-employee income/non-earnings: MCL 552.608, 552.611a. Report Lump-sum 866-540-0008;Payments www.misdu.com;No limit for non-employee income/non-earnings MCL 552.608, 611a;$2 or $4/month withholding fee MCL 552.623. Additional child(ren) this withholding order applies to: VII. Notification of Employment Termination or Income Status: (Completed by the Employer/Income Withholder) If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor, you must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information section below or using OCSEs 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: ___________________ Last known telephone number: Last known address: Final payment date to SDU/Tribal Payee: ________________ Final payment amount: New employers or income withholders name: New employers or income withholders address: VIII. Contact Information: (Completed by the Sender) To Employer/Income Withholder: If you have questions, contact Ima H. Worker (sender name) by telephone: 517-555-0000, by fax: 517-555-9999, by email or website: inghamfocemail.com. Send termination/income status notice and other correspondence to: Ingham County Friend of the Court 111 South Main, Lansing, MI 40000 (sender address). To Employee/Obligor: If the employee/obligor has questions, contact Ima H. Worker (sender name) by telephone: 517-555-0000, by fax: 517-555-9999, by email or website: inghamfocemail.com. 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 Enforcement. 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).     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