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Notice To Withhold Income For Child Support (Illinois)

This form is a supplement to the Legal Separation packet in Illinois. The form provided here is simply a sample of what the actual form looks like.

NOTICE TO WITHHOLD INCOME FOR CHILD SUPPORT

State of Illinois

County of: ____________________

Case Number: _________________

Date: ________________________

(___) Original Notice

(___) Amended Notice

(___) Terminate Notice


____________________________
Employer/Withholder's Fed. EIN No.

____________________________
Employee/Obligor's (Last, First, MI)

____________________________
Employer/Withholder's Name

____________________________
Employee/Obligor's Soc. Sec. No.

____________________________
Employer/Withholder's Address

____________________________
Court Case Number

____________________________
AND ANY SUBSEQUENT EMPLOYER

____________________________
Custodial Parent's (Last, First, MI)

____________________________
Custodial Parent's Social Security #

Child(ren)s name(s): ___________________

Date of birth: _______________


Child(ren)s name(s): ___________________

Date of birth: _______________


ORDER INFORMATION: This is a Notice to Withhold Income for Child Support based upon an order for support entered by the Honorable ___________________________,

Circuit Court of _________________ County, IL

on _____________________, 20 ___.

By law, you are required to deduct these amounts from the above -named employee or obligor's income until ________ , 20___ even if the Notice is not issued by your State.

(___) If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's obligator's employment.

$______ per _____ in current support

$______ per _____ in past due support totaling $______

Arrears 12 weeks or greater? (__) yes (__) no

$______ per _____ in medical support

$______ per _____ in ______

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 weekly pay period. $______ per semimonthly pay period (twice a month).

$_____ per monthly pay period. $______ per biweekly pay period (every two weeks).

REMITTANCE INFORMATION: Follow the laws and procedures of the employee's/obligor's principal place of employment even if such laws and procedures are different from this paragraph:

You must begin withholding no later than the first pay period occurring 14 working days after the date of this Notice. Send payment within 7 working days of the pay date/date of withholding. You are entitled to deduct a fee of your actual cost not to exceed $5 monthly to defray the cost of withholding. The total withheld amount, including your fee, cannot exceed FCCPA % of the employee/obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (see #9 below):

When remitting payment, provide the pay date that you withheld support and the case number: ________________.

Make it payable to: ___________________________________

Send check to: ______________________________________

ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS

(__) If checked, you are required to provide a copy of this form to your employee.

1. Priority: Withholding under this 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. If there are Federal tax levies in effect, please contact the requesting person/agency listed below.

2. 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/obligator.

3. Reporting the Date/Date of Withholding: You must report the date/date of withholding when sending the payment. The date/date of withholding is the date on which the employee is paid and controls the income, i.e., the date the income check or cash is given to the employee, or the date on which the income is deposited directly in his/her account.

4. Employee/Obligor with Multiple Support Withholdings: If you receive more than one Notice against this employee/obligor and you are unable to honor them all in full because together they exceed the withholding limit of the State of the employee's principal place of employment (see #9 below), you must allocate the withholding based on the law of the State of the employee's principal place of employment. If you are unsure of that State's allocation law, you must honor all Notices' current support withholdings before you withhold for any arrearages, to the greatest extent possible under the withholding limit. You should immediately contact the last agency that sent you a notice to find the allocation law of the state of the employee's principal place of employment.

5. Termination Notification: You must promptly notify the payee when the employee/obligor is no longer working for you. Please provide the information requested on the following page and return a copy of this order/notice to the person/agency.

Information Requested:

EMPLOYEE'S/OBLIGOR'S NAME: ________________________________

DATE OF SEPARATION/TERMINATION OF EMPLOYMENT: ___________________

LAST KNOWN HOME ADDRESS: ____________________________________

________________________________________________________________

NEW EMPLOYER'S NAME AND ADDRESS: ____________________________

______________________________________________________

Return Copy to: _________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below.

7. Liability: If you fail to withhold income as the 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. You may be found liable for the total amount which you fail to withhold or pay over and fines up to $100.00 per day for each day after the grace period. In Illinois, subsection (G) of 305 ILCS 5/10 - 16.2, 750 ILCS 5/706.1, 750 ILCS 15/4.1 or 750 ILCS 45/20.

8. 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.

9. Withholding Limits: You may not withhold more than the lesser 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/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 second family; and/or 2) 5% if arrears are more than 12 weeks old (see page 1).

10. The obligor's rights, remedies and duties: see Illinois Statutes 305 ILCS 5/10-16.2, 750 ILCS 5/706.1, 750 ILCS 15/4.1 and 750 ILCS 45/20.

Name and address of person preparing this Notice:

_______________________________________

_______________________________________

_______________________________________


-----------------------------
INSTRUCTIONS FOR FILLING OUT THIS FORM
-----------------------------

Check one of the following:

Original Notice: if this is the first notice you have sent to the person who will be paying child support.

Amended Notice: if you are changing the existing child support notice

Terminate Notice: if the child support order has been terminated by the court.

Employer/Withholder's Fed. EIN No.: the federal employer identification number of the employer of the person paying support in this section. To obtain this number, please contact the employer. If you are not able to get the number, continue to complete the form.

Employer/Withholder's Name: the name of the employer

Employer/Withholder's Address: the address of the employer

Employer/Obligor's (Last, First, MI): the name of the person who will pay/or is paying the support in this section.

Employer/Obligor's Soc. Sec. No.: the social security number of the person who will pay/or is paying the support in this section.

Employee Identification Number: the number assigned to the employee by the employer, if the employer uses a numbering system.

Custodial Parent (Last, First, MI): the name of the parent who is receiving the support in this section.

Custodial Parent's Social Security Number: The Social Security number of the parent who is receiving the support.

Child(ren) Name(s) : the names of all children receiving support in this section.

Date of birth: the date of birth (next to the child's name) of all children on whose behalf support is being paid.

ORDER INFORMATION:

1st Blank: the name of the judge who signed the most recent child support order

2nd Blank: the county that child support order is filed in

3rd Blank: the date that child support order was entered

4th Blank: the date on which the youngest child for which support is being paid turns 18.

5th Blank: Should be checked if children are to be enrolled in the insurance program of the person who will pay/or is paying child support.

6th and 7th Blanks: The amount of child support and the frequency (weekly, monthly, bi-weekly) that it is paid. For example $100 per month.

8th and 9th Blanks: The amount of past due child support and the frequency (weekly, bi-weekly, monthly) that it is paid.

10th Blank: Should be checked (yes) if the person paying support is more than 12 weeks behind in paying child support.

11th & 12th Blanks: The amount of medical support and the frequency (weekly, monthly, biweekly) that it is paid. For example $100 per month.

13th and 14th Blanks: Use these blanks for amounts paid that do not fit into either the current support, past due support, or medical support categories. Indicate the amount and the frequency (weekly, bi-weekly, monthly) that it is paid.

15th and 16th Blanks: The total amount of support and the frequency (weekly, monthly, biweekly) that it is paid.

17th through 20th Blanks: Using the total amount of support, calculate the amounts that an employer would pay in either a weekly, monthly, semimonthly, or biweekly pay cycle:

Example: If the total amount of support is $100 per month,

then the weekly pay period would be: $100 x 12 (12 months in a year) = 1200 - 52 (52 weeks in a year) = $23.07

the monthly pay period would be $100.00

the semimonthly pay period (twice a month) would be $100 ) 2 = $50.00

and the biweekly pay period (every two weeks) would be: $23.07(weekly pay period) x 2 = $46.15

REMITTANCE INFORMATION:

1st Blank: the case number.

2nd Blank: the name of the individual or agency receiving the payment of support. If you are receiving assistance for your children from the Illinois Department of Human Services, put the Illinois Department of Human Services here.

3rd Blank: Put the name and address of the Circuit Clerk where your case is filed.

ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS:

1st Blank: Check this box so that the employee/obligor will receive a copy.

2nd Blank: The name of the person paying support

3rd Blank: Leave blank, the employer will fill this blank out if the employee leaves his job

4th Blank: Leave blank, the employer will fill this blank out if the employee leaves his job

5th Blank: Leave blank, the employer will fill this blank out if the employee leaves his job Put your name, address, and telephone number as the person who is preparing this Notice on the last page.

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