A-2B Income Withholding Order/Notice for Support Numbered Reference Copy (IWO Form Non-IV-D b)

(Important Note: Do not complete this form. Use it as a guide when filling out the actual Forms)

Instructions for IWO Non-IV-D (CHILD SUPPORT AND COMBINED CHILD AND SPOUSAL SUPPORT ) and
IWO Non-IV-D a (SPOUSAL SUPPORT ONLY)

Fields 1a-1d: Check the applicable box, depending on your situation.

Field 1e: Leave this field blank. The Court will fill in the date when the Income Withholding
Order/Notice for Support is signed.

Field 1f: Check the box for “Court.”

Field 1g: Write in “New York.”

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Field 1h: Leave this field blank.

Field 1i: Write in the name of the county where your divorce action was filed.

Field 1j: Fill in the Index number of your Supreme Court divorce action.

Field 1k: Leave this field blank.

Field 1l: Leave this field blank

Field 2a: Fill in the Name of the employer to whom the IWO will be sent and who will be directed to withhold income

Field 2b: Fill in the mailing address of the employer, including the street, PO Box, city, state and zip
code. (This may differ from the employee’s worksite). If the employer is a federal
government agency, fill in the address listed under Federal Agencies - Addresses for
Income Withholding Purposes at:
http://www.acf.hhs.gov/programs/cse/newhire/contacts/iw_fedcontacts.htm

Field 2c: Fill in the employer’s nine digit Federal Employer Identification Number (FEIN) if available.

Field 3a: Fill in the employee’s/obligor’s last name, first name, middle name.

Field 3b: Fill in the social security number or other taxpayer identification number of the employee/obligor.

Field 3c: Fill in the name of the custodial party/obligee
(or obligee on the Spousal Support Only IWO) (last name, first name, middle name)

Field 3d: Fill in the child(ren)’s last name(s), first name(s), and middle name(s). Note if there are more
than six children, attach an additional page. (Or you could utilize the blank space above the
lines provided for the first 6 children.)

Note: For Spousal Support Only orders field 3d is not applicable.
Field 3e: Fill in the child(ren)’s birth date(s) each child named.

Note: For Spousal Support Only orders field 3e is not applicable.

Field 3f: Write in, “Supreme Court of _________County.” Then fill in County where the divorce
action was filed.

Field 4: Fill in the county where the divorce action was filed.

Fields 5a- 11c: Fill in the applicable dollar amounts for a specific time period for each type of support.

Copy this information from Fields 22 through 27 of the Judgment of Divorce (Form UD-11)

For Field 6c, check the appropriate box to indicate whether arrears have accrued for more than
12 weeks.

NOTE: For Spousal Support Only orders fields 5a, 5b, 6a, 6b, 7a, 7b, 8a and 8b are not applicable.
Field 12a: Enter the total of the amounts in Fields 5a-11a on Line 12a. This is the total amount to
withhold.

Field 12b: Enter the time period (e.g. week, month) specified in the underlying order for the
obligations contained in 5a - 11a.

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Fields 13a - 13d:

If you are certain of the employer’s pay cycle, enter the value of the obligation in the
appropriate field. Only one field need be filled in.

If you are not certain of the employer’s pay cycle, you must enter a value in each of these
fields. To do this, follow these instructions:

First calculate the amount of the obligation on a yearly basis (i.e., if the amount of the
obligation is weekly, multiply it by 52; if biweekly, multiply it by 26; if semimonthly multiply
it by 24; or if monthly, multiply it by 12); then take the yearly amount and divide it by the
appropriate pay cycle (i.e., if weekly, by 52; if biweekly, by 26; if semimonthly, by 24; and if
monthly, by 12). Then enter the recalculated amount in the proper field.

Example 1: Assume the support obligation is $100.00 biweekly. You know that the employer’s
pay cycle is monthly. Then you should multiply $100.00 by 26 to get the yearly obligation
($2,600.00). Then divide that by 12 to get the monthly obligation ($216.67). You would then
enter that value in field 13d.

Example 2: Maybe you’re not sure of the employer’s pay cycle. Then you should again
multiply $100.00 by 26 to get the yearly obligation ($2,600.00). Then divide $2,600.00 by 52 to
get the value for the weekly value ($50.00); divide $ 2,600.00 by 26 to get the biweekly value
($100.00.); divide $2,600.00 by 24 to get the semimonthly value ($108.33); and divide $2,600.00
by 12 to get the monthly value ($216.67). You should enter these values in fields 13a - 13d.

Field 13a: If the employer’s pay cycle does not correspond with Field 12b, enter the total amount the
employer should withhold if the employee is paid weekly

Field 13b: If the employer’s pay cycle does not correspond with Field 12b, enter the total amount the
employer should withhold if the employee is paid twice a month

Field 13c: If the employer’s pay cycle does not correspond with Field 12b, enter the total amount the
employer should withhold if the employee is paid every two weeks.

Field 13d: If the employer’s pay cycle does not correspond with Field 12b, enter the total amount the
employer should withhold if the employee is paid once a month.

Field 14: Complete if 1c, above, has been selected.

Fields 15- 24: These Fields have been pre-filled to make it easier for you. For this reason, Fields 15-24
have no numbers. Go to Field 21.

Field 21: “Document Tracking Identifier”: Leave the line at the bottom of page 1 blank.

Field 25: Leave this field blank. It is to be filled in by the Employer if applicable.

Note: For Spousal Support Only orders Field 25 is not applicable.

Fields 26- 29 Leave these spaces blank. The Court will fill in this information when the IWO is signed by
the Judge.

Field 30: If the employee works in a state different from New York, check this box.

Fields 34a -41: Leave these spaces blank. These are to be filled in by the Employer, if applicable.

Fields 42 -50: Leave this section blank so that it can be filled in by the Court.

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Top of Page 3: Copy the information from Fields 2a, 2c, 3a and 1j. Leave the NY Case Identifier field blank.

Now that you have finished completing the Income Withholding Order/Notice for Support, you should submit it to
the Supreme Court Clerk for signature by the Judge. After it is signed by the Judge, you must serve a certified
copy of the Income Withholding Order/Notice for Support on the employer and the Defendant.
A certified copy of the Child Support and Combined Child and Spousal Support orders (IWO Form Non-IVD)
must also be served on the New York State Child Support Processing Center, PO Box 15365, Albany, N.Y.
12212-5365. You may use regular mail, but it is suggested that you file an Affidavit of Service of the IWO
order with the Clerk of the Court. Spousal Support Only IWO orders (IWO Form Non-IV-D a) should NOT
be served on the New York State Child Support Processing Center.

Important Note: The NYS Office of Temporary and Disability Assistance advises that the Federal Office of
Child Support Enforcement has confirmed that if the IWO is issued by a Court, a copy of the underlying order
need not be attached to the IWO even in instances where the IWO is served by a litigant or his/her
representative acting on the Court’s instructions. See Field 1(f) on the first page of the IWO and Fields 26-29
on the second page of the IWO which identify the Issuer. If you have continuing questions about this
instruction, you may contact the New York State Child Support Customer Service Helpline at 1-888-208-4485
(TTY: 1-866-875-9975) Monday through Friday 8:00 a.m. - 7:00 p.m.