INCOME WITHHOLDING FOR SUPPORT
`
`D INCOME WITHHOLDING ORDER-NOTICE FOR SUPPORT (IWO)
`AMENDED 1W0
`
`I:I ONE-TIME ORDERINOTICE FOR LUMP SUM PAYMENT
`I:I TERMINATION OF IWO
`
`Date:
`
`0710912020
`
`
`Child Support Enforcement (CSE) Agency
`E Court
`D Attorney
`I:I Private lndividuallEntity (Check One)
`
`
`
`
`
`
`NOTE: This two must be regular on its face. Under certain circumstances you must rejectthis two and return it to the
`sender (see 1W0 instructions www.acf.hhs.govlcsslres‘ourcefincome-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/1'ribefTerritory. ARKANSAS
`CityICountleistfl'ribe WHITE CO OCSE
`Private lndividualIEntity
`
`Remittance ID (include wlpayment) 137319862
`Order ID 73DR—11-1033
`Case ID
`137319862
`
`14 WHORFF JUNCTION RD
`Employerllncome Withholder's Address
`BATH, ME 04530—6388
`
`
`BRACKLEY ELECTRIC INC
`RE: RUCKER. REGGIE,.L
`Employerllncome Withholder‘s Name
`EmployeeIOingor's Name (Last. First, Middle)
`
`INFORMATION REDACTED
`EmployeeIObligor's Social Security Number
`
`0912211969
`EmployeeIObligor‘s Date of Birth.
`
`’
`PHILLIPS. AMANDA, M
`
`Custodial PartyIObligee's Name (Last First, Middle)
`
`
`
`
`Employerllncome ‘Mthholder’s FElN 464597173
`
`Child(ren)'5 Name(s) (Last, First. MI)
`
`ChiidtrenTs Birth Date(s)
`
`B,. E. J
`
`XXIXXIZO’IO
`
`
`
`ORDER INFORMATION: This document is based on the support order fromW (StatelTribe). You are required by law
`to deduct these amounts from the employeelobligor's incomeuntil further notice.
`$
`86.00 Per
`WEEK
`current child support
`$
`Per
`past-due child support - Arrears greater than 12 weeks? I: Yes
`$
`Per
`current cash medical support
`$
`Per
`past-due cash medical support
`$
`Per
`current spousal support
`3
`Per
`past~due spousal support
`$
`Per
`other (must specify)
`
`No
`
`for a Total Amount to Withheld of $
`
`86.00 per
`
`WEEK
`
`.
`
`AMOUNTS TO WITHH'OLD: You do not have to vary your pay cycle to be in compliance with the Order lnfonnation. If your pay
`cycle does not match the ordered payment cycle. withhold one of the following amounts:
`\
`$
`86.00 per weekly pay period
`$
`186.33 per semimonthly pay period (twice a month)
`$
`172.00 per biweekly pay period (every two Weeks)
`$ —372.67 per monthly pay period
`$
`Lump Sum'Payment: Do not stop any existing IWO unless you receive a termination order.
`
`Document Tracking ID
`
`fig OCSE - FEN31 03I2020
`Case Number(s): 137319862
`
`Page 8 of 10
`(3) COURT FILE
`
`Member Number: 09861045
`OMB 0970-0154
`EXP Date: 081'31/2020
`
`

`

`I
`
`
`Employer's Name: BRACKLEY ELECTRIC INC
`
`Employer FEIN: 464597173
`
`EmployeelObligor's Name: RUCKER, REGGIE. L
`Case Identifier: 137319862
`
`SSN: INFORMATION REDACTED
`Order Identifier: 73DR—11-1033
`
`REMITI'ANCE INFORMATION: If the employeelobligor's principal place of employment is ARKANSAS (State/Tribe), you must
`begin withholding no later than the first .pay period that occurs 15 days after the date of 9119312029.. Send payment within 1
`business days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employeelobiigor,
`withhold 593A; of disposable income for all orders. If the obtigor is a non-employee, obtain withholding limits from Supplemental
`Information.
`If the employeelobligor‘s principal place of employment
`is not ARKANSAS (State/Tribe), obtain withholding
`limitations, time reqUirements, 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/sfate-r'ncome-withhoiding-contacts—and—program-requirements.
`For
`tribe-specific
`contacts,
`payment
`addresses,
`and
`withholding
`limitations,
`please
`contact
`the
`tribe
`at
`www.acf.hhs.gov/sifes/defauif/flIeS/programs/css/trfbaLagency_contacts_printabie_pdf.pdf
`or
`hffsz/wwwbr‘a.gov/tribaimap/DataDofGovSampfes/tid_map.htmi.
`
`requirements and centralized payment collection and disbursement
`For electronic payment
`Disbursement Unit (SDU)], see www.acf.hhs.gov/css/empioyers/empioyer—responsfbiiities/payments.
`
`facility information [State
`
`include the Remittance ID with the payment and if necessary this locator code: 0500000
`
`Remit Payment to Office of Child Support Enforcement (SDUfI'ribal Order Payee)
`at AR OCSE Clearinghouse, P.O. Box 8125, Little Rock, AR 72203 (SDUITribaI Payee Address)
`
`I:I Return to Sender (Completed by Employerllncome 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 to SDU below). If payment is not
`directed to an SDUlTribal 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 Judgellssuing OffCIai
`Print Name of Judge/Issuing Official: REBECCA HAMMOND
`Title of Judge/Issuing Official: CS SPECIALIST |
`Date of Signature:
`
`2 f? ”.70
`
`If the employeelobligor 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 employeelobligor.
`
`D If checked, the employerfincome withholder must provide a copy of this form to the employee/obligor.
`
`ADDITIONAL INFORMATION FOR EMPLOYERSIINCOME WITHHOLDERS
`State-specific contact and withholding information can be found on the Federal Employer Services website located at
`www.acf.hhs.gov/css/resource/state-income-wr'thhoiding-confacts-and—program-requirements.
`
`Employers/income withholders may use OCSE's Child Support Portal (htipsy/ocsp.acf.hhs.gov/csp/) to provide information
`about employees who are eligible to receive a lump sum payment, have terminated employment, and to provide contacts,
`addresses, and other information about their company.
`
`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.
`
`Combining Payments: When remitting payments to an SDU or tribal CSE agency, you may combine withheld amounts from
`more than one employeelobiigor's income in a single payment. You must, however, separately identify each employeelobligor's
`portion of the payment.
`
`Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a tribal
`CSE agency. If this [W0 instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party,
`court. or-attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a
`court, attorney, or private individuallentity and the Initial order was entered before January 1. 1994 or the order was issued by a
`tribal CSE agency, you must follow the “Remit payment to” instructions on this form.
`
`OCSE - FEN31 03I2020
`Case Number(s): 137319852
`
`Page 9 of 10
`(3) COURT FILE
`
`Member Number: 09861045
`0MB 0970-0154 EXP Date: 08I3112020
`
`

`

`Employer's Name: BRACKLEY ELECTRIC INC
`
`Employer FEIN: 464597173
`
`EmployeefObligor‘s Name: RUCKER, REGGIE, L
`
`SSN: INFORMATION REDACTED
`
`Case Identifier: 137319862
`
`Order Identifier: 73DR—11-1033
`
`Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the
`amount was withheld from the employeefobligor‘s wages. You must comply with the law of the state (or tribal law if applicable) of
`the employeelobligor's principal place of employment regarding time periods within which you must implement the withholding
`and forward the support payments.
`
`Multiple lWOs: If there is more than one IWO against this employeefobligor and you are unable to fully honor all lWOs 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. Follow the state or tribal lawfprocedure of the employeelobligor‘s principal
`place of employment to determine the appropriate allocation method.
`
`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 andlor withhold lump sum payments.
`
`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 asthe IWO directs. you are liable for both the accumulated amount you should have withheld
`and any penalties set by state or tribal lawlprocedure.
`
`Anti-discrimination: You are subject to a fine determined under state or tribal law for discharging an employeelobligor from
`employment, refusing to employ, or taking disciplinary action against an employeelobligor because of this IWO.
`
`Withholding Limits: 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 employeelobligor‘s principal
`place of employment, if the place of employment is in a state; or the tribal
`law of the employeelobligor‘s principal place of
`employment if the place of employment is under tribal jurisdiction. Disposable income is the net income after mandatory
`deductions such as: state. federal. local taxes; Social Security taxes: statutory pension contributions; and Medicare taxes. The
`federal limit'Is 50% of the disposable'Income if the obligorIs supporting another family and 60% of the disposable'Inseme if the
`obligor'Is not supporting another family. However those limitsIncrease 5% --to 55% and 65% —if the arrears are greater than 12
`weeks. 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 indicated in this section.
`
`Depending upon applicable state or‘tribal law, you may needto consider amounts paid for health care premiums in determining
`disposable income and applying appropriate withholding limits.
`
`Arrears greater than 12 weeks? 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.
`r
`
`Supplemental Information:
`
`For employee bonuses or other lump sum payments as defined by Ark. Code Ann. § 53-14—201, call 1-800-216-0224 for
`instruction. You me be re uired to withhold from an lum sum a ments the full amount-of an
`ast due child su
`ort owed b .
`
`this em lo ee but not exceedin 50% of the net lum sum a ment.
`
`
`
`
`.J'E OCSE - FEN31 0312020
`" Case Number(s): 137319862
`
`Page 10 of 10
`(3) COURT FILE
`
`Member Number: 09861045
`OMB 0970-0154 EXP Date: 08l31l2020
`
`