Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 1 of 9en-USNOTICE OF INCOME WITHHOLDING FOR SUPPORT en-USOriginal Income Withholding Order/Notice for Support (IWO) en-USAmended IWO en-USOne Time Ordered/Notice for Lump Sum Payment Termination of IWO þ Date: þ en-US Child Support Enforcement (CSE) Agency þ þ Court þ þ Attorney þ Private Individual/Entity NOTE: þ This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return en-USit to the sender (see IWO instructions en-UShttp://www.acf.hhs.gov/css/resource/income-withholding-for-en-USsupport-formen-US). If you receive this document from someone other than a State or Tribal CSE agency or a en-USCourt, a copy of the underlying order must be attached. 3285 Notice of Income Withholding for Support þ (02/25/19) CCDR 0556 A en-USIN THE CIRCUIT COURT OF COOK COUNTY, ILLINOISen-USCOUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION en-USPetitioneren-USand en-USRespondent Case No. þ en-USen-USPAYOR/EMPLOYER Name/Company: þ þ Address: þ þ City: þ þ County: þ þ State: þ þ Zip: þ en-US Phone: þ en-USDorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 2 of 9 3285 Notice of Income Withholding for Support þ (02/25/19) CCDR 0556 B en-USORDER INFORMATION: This document is based on the support or withholding order from Illinois (State/en-USTribe). You are required by law to deduct these amounts from the employee/obligor222s income until further notice. $ þ Per þ en-US current child support $ þ Per þ en-US past-due child support - Arrears greater than 12 weeks? $ þ Per þ en-US current cash medical support $ þ Per þ en-US past-due cash medical support $ þ Per þ en-US current spousal support $ þ Per þ en-US past-due spousal support $ þ Per þ delinquency, totaling $ þ as of þ $ þ Per þ other (must specify) þ en-US for a Total Amount to Withhold of $ þ en-US per en-US State/Tribe/Territory þ þ City/County/Dist./Tribe þ Private Individual/Entity þ en-USEmployer/Income Withholder222s Name en-USEmployer/Income Withholder222s Address Employer/Income Withholder222s FEIN þ þ þ þ þ Re: þ þ en-USEmployer/Obligor222s Name (Last, First, MI) en-USEmployer/Obligor222s Social Security Number en-USCustodial Party/Obligor222s Name (Last, First, MI) Child(ren222s) Child(ren222s) Name(s) (Last, First, MI) þ Birth Date(s) þ þ þ þ þ þ þ en-USEntry Date of Order of Supporten-US Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 3 of 9 en-USAMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order en-USInformation. If your pay cycle does not match the ordered payment cycle, withhold one of the following amounts: $ þ en-US per weekly pay period $ þ en-US per semimonthly pay period (twice a month) $ þ en-US per biweekly pay period (every two weeks) $ þ en-US per monthly pay period $ þ en-US LUMP SUM PAYMENT: Do not stop any existing IWO unless you receive a terminationen-USorder.en-USREMITTANCE INFORMATION: If the employee/obligor222s principal place of employment is Illinois (State/en-USen-US. Send payment within 7 working days of the pay date. If you cannot withhold the full amount ofen-USsupport for any or all orders for this employee/obligor, withhold up to en-US% of disposable income for all orders. en-USIf the employee/obligor222s principal place of employment is not Illinois (State/Tribe), obtain withholding limitations, en-UStime requirements, and any allowable employer fees at en-UShttp://www.acf.hhs.gov/css/resource/state-income-en-USwithholding-contacts-and-program-requirementsen-US for the employee/obligor222s principal place of employment.en-USFor electronic payment requirements and centralized payment collection and disbursement facility information en-US(State Disbursement Unit (SDU)), see http://www.acf.hhs.gov/css/employers/employer-responsibilities/payments þ en-US Remit payment to: þ þ SDU/Tribal Order Payee at: þ SDU/Tribal Order Payee Address en-USReturn to Sender (Completed by Employer/Income Withholder). Payment must be directed to an SDU inen-USen-USdirected to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the en-USIWO to the sender. þ en-USORDER IS ATTACHED. þ þ þ þ Date of Signature: þ en-USen-USIf the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this en-USorder, a copy of this IWO must be provided to the employee/obligor. en-USIf checked, the employer/income withholder must provide a copy of this form to the employee/obligor. 3285 Notice of Income Withholding for Support þ (02/25/19) CCDR 0556 C Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.org 3285 Notice of Income Withholding for Support þ (02/25/19) CCDR 0556 D en-USen-USat: en-UShttp://www.acf.hhs.gov/css/resource/state-income-withholding-contacts-and-program-requirementsen-USPriority:en-USen-USen-USCombining Payments:en-USWhen remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than en-USone employee/obligor222s income in a single payment. You must, however, separately identify each employee/en-USobligor222s portion of the payment.en-USPayments to SDU:en-USYou must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE en-USagency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial en-USparty, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this en-USIWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, en-USen-USform.en-USReporting the Pay Date:en-USYou must report the pay date when sending the payment. The pay date is the date on which the amount was en-USwithheld from the employee/obligor222s wages. You must comply with the law of the State (or Tribal law if en-USapplicable) of the employee/obligor222s principal place of employment regarding time periods within which you must en-USimplement the withholding and forward the support payments.en-USMultiple IWOs:en-USIf there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to en-USFederal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority en-USto current support before payment of any past-due support. Follow the State or Tribal law/procedure of the en-USemployee/obligor222s principal place of employment to determine the appropriate allocation method.en-USLump Sum Payments:en-USYou may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/en-USobligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to en-USreport and/or withhold lump sum payments.en-USLiability:en-USIf you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from en-USthe employee/obligor222s income as the IWO directs, you are liable for both the accumulated amount you should en-UShave withheld and any penalties set by State or Tribal law/procedure. See attached supplemental sheet for details en-USen-USADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERSDorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.org 3285 Notice of Income Withholding for Support þ (02/25/19) CCDR 0556 E en-USAnti-discrimination:en-USen-USemployment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. en-USen-USLaw. Employer222s Name: þ þ Employer FEIN: þ en-US Employee/Obligor222s Name: þ þ þ þ þ en-USen-USWithholding Limits:en-US You may not withhold more than the lesser of: 1) the amounts allowed by the Federal en-USen-USof the employee/obligor222s principal place of employment (see REMITTANCE INFORMATION). Disposable en-USincome is the net income left after making mandatory deductions such as: State, Federal, local taxe