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Florida Family Law Rules of Procedure Form 12.006(d)

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INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF
PROCEDURE FORM 12.996(d), FLORIDA ADDENDUM TO
INCOME WITHHOLDING ORDER (06/12)
When should this form be used?
This form should be used when the court has ordered that support be paid by income deduction and
OMB Form 0970-0154, Income Withholding for Support, has been used. This form must be added to the
OMB form to provide provisions required for income deduction orders by Florida law.
This form should be typed or printed in black ink. It should be attached to the OMB form and filed with
the clerk of the circuit court in the county in which your action is pending.
What should I do next?
A copy of this form and a copy of the OMB Income Withholding for Support form, signed by the judge,
should be sent to the obligor’s payor by certified mail, return receipt requested. The return receipt
should be sent to the person who prepared this form, so that it can be filed with the court with Florida
Family Law Rules of Procedure Form 12.996(c), Notice of Filing Return Receipt.
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. The words that are in “bold underline” in these instructions are defined
there. For further information see sections 61.13 and 61.1301, Florida Statutes.
Special Instructions...
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last page of every
form he or she helps you complete.
Instructions for Florida Family Law Rules of Procedure Form 12.996(d), Florida Addendum to Income Withholding
Order (06/12)
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA
Case No: ________________________
Division: ________________________
_________________________________,
Petitioner,
and
_________________________________,
Respondent.
FLORIDA ADDENDUM TO INCOME WITHHOLDING ORDER
THE PAYOR, {name}__________________________, IS HEREBY NOTIFIED that, under sections 61.13
and 61.1301, Florida Statutes, you have the responsibilities and rights set forth below with regard to the
Income Withholding Order/Notice for Support.
1. The Income Withholding Order/Notice for Support is enforceable against employers specifically
listed upon the form as well as all subsequent employers/payors of Obligor,
{name}____________________________, {address}__________________________________.
2. You are required to deduct from the obligor’s income the amount specified in the income
withholding order, and in the case of a delinquency the amount specified in the notice of
delinquency, and to pay that amount to the State of Florida Disbursement Unit. The amount
actually deducted plus all administrative charges shall not be in excess of the amount allowed under
section 303(b) of the Consumer Credit Protection Act, 15 U.S.C. Section 1673(b), as amended.
3. You must implement the income deduction no later than the first payment date which occurs more
than 14 days after the date the income deduction order was served on you, and you shall conform
the amount specified in the income withholding order to the obligor’s pay cycle. The court should
request at the time of the order that the payment cycle will reflect that of the obligor.
4. You must forward, within 2 days after each date the obligor is entitled to payment from you, to the
State of Florida Disbursement Unit, the amount deducted from the obligor’s income, a statement as
to whether the amount totally or partially satisfies the periodic amount specified in the income
withholding order, and the specific date each deduction is made. If the IV-D agency is enforcing the
order, you shall make these notifications to the agency.
5. If you fail to deduct the proper amount from the obligor’s income, you are liable for the amount you
should have deducted, plus costs, interest, and reasonable attorneys’ fees.
Florida Family Law Rules of Procedure Form 12.996(d), Florida Addendum to Income Withholding Order (06/12)
6. You may collect up to $5 against the obligor’s income to reimburse you for the administrative costs
for the first income deduction and up to $2 for each deduction thereafter.
7. The Income Withholding Order/Notice for Support is binding on you until further notice by court
order or until you no longer provide income to the obligor.
8. When you no longer provide income to the obligor, you shall notify the obligee,
{name}_________________________, {address}__________________________________________,
and provide the obligor’s last known address and the name and address of the obligor’s new payor,
if known, utilizing the form contained within the Income Withholding Order/Notice for Support. If
you violate this provision, you are subject to a civil penalty not to exceed $250 for the first violation
or $500 for any subsequent violation. If the IV-D agency is enforcing the order, you shall make these
notifications to the agency instead of the obligee. Penalties shall be paid to the obligee or the IV-D
agency, whichever is enforcing the income deduction order.
9. You shall not discharge, refuse to employ, or take disciplinary action against an obligor because of
the requirement for income deduction. A violation of this provision subjects you to a civil penalty
not to exceed $250 for the first violation or $500 for any subsequent violation. Penalties shall be
paid to the obligee or the IV-D agency, whichever is enforcing the income deduction, if any alimony
or child support obligation is owing. If no alimony or child support obligation is owing, the penalty
shall be paid to the obligor.
10. The obligor may bring a civil action in the courts of this state against a payor who refuses to employ,
discharges, or otherwise disciplines an obligor because of income deduction. The obligor is entitled
to reinstatement of all wages and benefits lost, plus reasonable attorneys’ fees and costs incurred.
11. In a Title IV-D case, if an obligation to pay current support is reduced or terminated due to the
emancipation of a child and the obligor owes an arrearage, retroactive support, delinquency, or
costs, income deduction continues at the rate in effect immediately prior to emancipation until all
arrearages, retroactive support, delinquencies, and costs are paid in full or until the amount of
withholding is modified.
12. All notices to the obligee shall be sent to the address provided in this notice to payor, or any place
thereafter the obligee requests in writing.
13. An employer who employed 10 or more employees in any quarter during the preceding state fiscal
year or who was subject to and paid tax to the Department of Revenue in an amount of $20,000 or
more shall remit support payments deducted pursuant to an income deduction order or income
deduction notice and provide associated case data to the State Disbursement Unit by electronic
means approved by the department. Payors who are required to remit support payments
electronically can find more information on how to do so by accessing the State Disbursement Unit’s
website at www.floridasdu.com and clicking on “Payments.” Payment options include Expert Pay,
Automated Clearing House (ACH) credit through your financial institution,
www.myfloridacounty.com , or Western Union. Payors may contact the SDU Customer Service
Employer telephone line at
1-888-883-0743.
Florida Family Law Rules of Procedure Form 12.996(d), Florida Addendum to Income Withholding Order (06/12)
14. The amount of arrears owed, if any, is $____________. You must withhold an additional twenty
percent (20%) or more of the ongoing periodic obligation towards same at the rate of $________
per ____________ until full payment is made of any arrearage, attorneys’ fees and costs—provided
that no deduction shall be applied to attorneys’ fees and costs until the full amount of any arrearage
is paid. If a delinquency accrues after the order establishing, modifying, or enforcing support has
been entered and there is no existing order for repayment of the delinquency or a pre-existing
arrearage, a payor shall deduct $________per _____________ (which represents an additional
twenty percent (20%) of the current support obligation, or other amount agreed to by the parties)
until the delinquency and any attorneys’ fees and costs are paid in full. No deduction may be
applied to attorneys’ fees and costs until the delinquency is paid in full.
15. Pursuant to sections 61.13 and 61.1301, Florida Statutes, the amounts listed for payment on the
Income Withholding Order must be varied by the employer/payor for bonus income, or similar onetime payment:
You shall deduct [Choose only one] ( ) the full amount, ( ) _______%, or (
) none of the
income which is payable to the obligor in the form of a bonus or other similar one-time
payment, up to the amount of arrearage reported in the Income Deduction Order or the
remaining balance thereof, and forward the payment to the State of Florida Disbursement Unit.
For purposes of this subparagraph, “bonus” means a payment in addition to an obligor’s usual
compensation and which is in addition to any amounts contracted for or otherwise legally due
and shall not include any commission payments due an obligor.
16. Child Support Reduction/Termination Schedule. Child support amount listed on the IWO shall be
automatically reduced or terminated as set forth in the following schedule:
Please list
children
by initials
from eldest to
youngest
Child 1
(Eldest)
Initials & year
of birth:
Insert in this
column the
day, month,
and year the
child support
obligation
terminates for
each
designated
child (see
instructions)
From the effective
date of this Income
Deduction Order
until the following
date:
Insert in
this column
the amount
of child
support for
all minor
children
remaining
(including
designated
child).
child support for Child 1 and
all other younger child(ren)
should be paid in the
following monthly amount:
Florida Family Law Rules of Procedure Form 12.996(d), Florida Addendum to Income Withholding Order (06/12)
Child 2
Initials & year
of birth:
After the date set
forth in the row
above until the
following date:
child support for Child 2 and
all other younger child(ren)
should be paid in the
following monthly amount:
Child 3
Initials & year
of birth:
After the date set
forth in the row
above until the
following date:
child support for Child 3 and
all other younger child(ren)
should be paid in the
following monthly amount:
Child 4
Initials & year
of birth:
After the date set
forth in the row
above until the
following date:
child support for Child 4 and
all other younger child(ren)
should be paid in the
following monthly amount:
Child 5
Initials & year
of birth:
After the date set
forth in the row
above until the
following date:
child support for Child 5 and
all other younger child(ren)
should be paid in the
following monthly amount:
(Continue on additional pages for additional children)
NOTE: This change only relates to the amount of the child support obligation portion of
the payments listed in the first pay of the Income Withholding Order. If there is a child
support arrearage in a Title IV-D case, the amount will not be reduced due to the child
no longer being eligible for support pursuant to paragraph 11 above.
17. Additional information regarding the implementation of income deduction may be found at
www.floridasdu.com.
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW
[fill in all blanks] This form was prepared for the: {choose only one} ( ) Petitioner ( ) Respondent
This form was completed with the assistance of:
{name of individual}_____________________________________________________________,
{name of business}_______________________________________________________________,
{address}_______________________________________________________________________,
{city}_____________________, {state}________, {telephone number}______________________.
Florida Family Law Rules of Procedure Form 12.996(d), Florida Addendum to Income Withholding Order (06/12)
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