NOTICE TO EMPLOYER OR OTHER INCOME PAYOR TO: RE: DATE: Employee/Obligor: Social Security #: Birthdate: Enclosed you will find an Income Deduction Order. This is your notice under OCGA § 19-6-33(e), explaining your duties, penalties and rights concerning the Income Deduction Order. Please read this notice and the court order carefully and follow their instructions. If you have any questions, please call me at the number below, or call the Family Support Registry (FSR) at 678305-0723 or toll-free at 1-877-231-8573. Definitions - Throughout this notice, the term “Employer” also includes any person, private entity or unit of government that provides or administers any kind of income due the Obligor. The term “Employee” refers to the support Obligor, whether or not the income is earned by the Obligor as an employee. “Income” includes wages, salary, bonuses, commissions, compensation as an independent contractor, worker’s compensation, payments under a disability, pension or retirement program, interest, or any other periodic form of payments, regardless of source. Basic Requirements and Penalty - You are required by law to deduct from an Employee’s income the amount specified by the court in the Income Deduction Order. IF YOU WILLFULLY FAIL TO DEDUCT THE PROPER AMOUNT, YOU ARE LIABLE FOR THE AMOUNT THAT SHOULD HAVE BEEN DEDUCTED PLUS COSTS, INTEREST, AND REASONABLE ATTORNEY FEES. Along with the deducted amount, you are required to note the names of the parties, the case number, and the Employee’s Social Security Number on the payment, and to send a statement about whether the amount being sent totally or partially satisfies the periodic amount specified in the Order. Deadlines and Where to Send - Payment must begin no later than the first pay period after 14 days following the postmark of this notice. You must forward the deducted amount within 2 days after each pay day, to Child Support Enforcement, Family Support Registry (FSR), P.O. Box 1800, Carrollton, GA 30112-1800. Priority Over Other Collection Processes - The Income Deduction Order has priority over all other legal processes under Georgia law pertaining to the same income, and the payment required by the Income Deduction Order is a complete defense against any claims of the Employee or the Employee’s creditors as to the sum paid. Administrative Fees You May Charge - You may collect up to $25.00 against the Employee’s income to reimburse for the administrative costs of the first income deduction, and up to $3.00 for each subsequent deduction. IDO Notice to Employer — rev. August 19, 2008 Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Maximum Deduction Amount - The amount actually deducted plus all administrative charges shall not be in excess of the amount allowed under Section 303(b) of the federal Consumer Credit Protection Act, 15 USCA §1673(b). Conflicting Orders - If you get more than one Income Deduction Order against the same Employee, you are required to contact the issuing court for further instructions. Upon being contacted, OCGA § 19-6-33(e)(11) requires the court to allocate the amounts available for income deduction. Continuing Duty - You must continue to deduct and send the child support until further notice is given by the court, the undersigned Obligee, or the Office of Child Support Enforcement, or until you are no longer providing income to the Employee. Even if the Employee contests enforcement of the Income Deduction Order, you must continue to enforce the order, until the court or administrative agency issues an order granting relief to the Employee. Prohibition Against Firing Employee - You may not discharge an Employee because you receive an Income Deduction Order. If an Employee is discharged for this reason, a penalty of up to $250.00 for the first violation and $500.00 for a subsequent violation may be imposed against you. When Employee Leaves - When you no longer provide income to the Employee, you are required to notify the Obligee and the Family Support Registry (FSR) within 7 days and provide the Employee’s new Employer (or other payor), if known. If the IV-D agency is enforcing the order you must make these notifications to the agency instead of to the Obligee and FSR. If you willfully fail to do this, you are subject to a civil penalty not to exceed $250.00 for the first violation and $500.00 for a subsequent violation. Combining Payment on Multiple Orders - If you get Income Deduction Orders requiring you to deduct income of two or more Employees to pay to the same agency, you may combine the amounts paid in a single payment, so long as you identify the amount attributable to each Employee. Obligee/Recipient (Signature) Name: Address: Telephone: IDO Notice to Employer — rev. August 19, 2008 Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com