Florida Addendum To Income Form – Fill Out and Use This PDF

INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.996(d), FLORIDA ADDENDUM TO INCOME WITHHOLDING ORDER (07/13)

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 o ligor’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 pro eedi g, you should read Ge eral I for atio for “elf-Represe ted Litiga ts fou d 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...

When filling out an Income Withholding for Support form, please note the following additional instructions for that form:

1.The Remittance Identifier is the County Code for the county the case was heard in followed by the Case Number. A list of county codes is included with these instructions.

2.The FIPS code may be found on the attached list. Use the code for the County in which the case is pending.

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

Instructions for Florida Family Law Rules of Procedure Form 12.996(d), Florida Addendum to Income Withholding Order (07/13)

6. You ay olle t up to $5 agai st the o ligor’s i o e to rei urse 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}__________________________________________,

a d pro ide the o ligor’s last k o address a d the a e a d address of the o ligor’s ew 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

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 (07/13)

(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 page 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 (07/13)