Get Florida Addendum To Income Form

The Florida Addendum To Income form is a legal document used in conjunction with an income withholding order for child support. This form ensures compliance with Florida law by detailing the responsibilities of the payor regarding income deductions. If you need to fill out this important form, click the button below to get started.

Structure

The Florida Addendum to Income form plays a crucial role in the enforcement of income withholding orders for child support and alimony. This form is specifically used when a court mandates that support payments be made through income deduction. It complements the OMB Form 0970-0154, which is the standard Income Withholding for Support form. By attaching the Florida Addendum, you ensure compliance with state laws that outline the necessary provisions for income deduction orders. Proper completion of this form requires clear typing or printing in black ink, and it must be filed with the circuit court clerk in the relevant county. Once the form is prepared, a copy, along with the signed OMB form, must be sent via certified mail to the obligor’s payor. This step is vital for documenting the process and ensuring that all parties are informed. Additionally, the form includes important instructions and codes, such as the Remittance Identifier and FIPS code, which help identify the specific county and case involved. Understanding these details is essential for anyone navigating the complexities of family law in Florida.

Florida Addendum To Income Preview

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)

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.

		FIPS and County Codes
COUNTY	FIPS	COUNTY CODE	COUNTY	FIPS	COUNTY CODE
ALACHUA	12001	01	LAKE	12069	35
BAKER	12003	02	LEE	12071	36
BAY	12005	03	LEON	12073	37
BRADFORD	12007	04	LEVY	12075	38
BREVARD	12009	05	LIBERTY	12077	39
BROWARD	12011	06	MADISON	12079	40
CALHOUN	12013	07	MANATEE	12081	41
CHARLOTTE	12015	08	MARION	12083	42
CITRUS	12017	09	MARTIN	12085	43
CLAY	12019	10	MONROE	12087	44
COLLIER	12021	11	NASSAU	12089	45
COLUMBIA	12023	12	OKALOOSA	12091	46
DADE	12025	13	OKEECHOBEE	12093	47
DESOTO	12027	14	ORANGE	12095	48
DIXIE	12029	15	OSCEOLA	12097	49
DUVAL	12031	16	PALM BEACH	12099	50
ESCAMBIA	12033	17	PASCO	12101	51
FLAGER	12035	18	PINELLAS	12103	52
FRANKLIN	12037	19	POLK	12105	53
GADSDEN	12039	20	PUTNAM	12107	54
GILCHRIST	12041	21	ST. JOHNS	12109	55
GLADES	12043	22	ST. LUCIE	12111	56
GULF	12045	23	SANTA ROSA	12113	57
HAMILTON	12047	24	SARASOTA	12115	58
HARDEE	12049	25	SEMINOLE	12117	59
HENDRY	12051	26	SUMTER	12119	60
HERNANDO	12053	27	SUWANNEE	12121	61
HIGHLANDS	12055	28	TAYLOR	12123	62
HILLSBOROUGH	12057	29	UNION	12125	63
HOLMES	12059	30	VOLUSIA	12127	64
INDIAN RIVER	12061	31	WAKULLA	12129	65
JACKSON	12063	32	WALTON	12131	66
JEFFERSON	12065	33	WASHINGTON	12133	67
LAFAYETTE	12067	34

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

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 dedu t fro the o ligor’s i o e the a ou t spe ified i the i o e 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 a ou t spe ified i the i o e ithholdi g order to the o ligor’s pay y le. The ourt 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

“tate of Florida Dis urse e t U it, the a ou t dedu ted fro the o ligor’s i o e, a state e t 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 dedu t the proper a ou t fro the o ligor’s i o e, you are lia le for the a ou t 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 (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

ele tro i ally a fi d ore i for	atio	o	ho	to do so y a essi g the “tate Dis urse e t U it’s
website at www.floridasdu.com a	d li	ki	g o	Pay e ts. Pay ent 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 (07/13)

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 one- time 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, o us ea s a pay e t i additio to a o ligor’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		Insert in this		Insert in
children		column the		this column
by initials		day, month,		the amount
from eldest to		and year the		of child
youngest		child support		support for
		obligation		all minor
		terminates for		children
		each		remaining
		designated		(including
		child (see		designated
		instructions)		child).
Child 1	From the effective		child support for Child 1 and
(Eldest)	date of this Income		all other younger child(ren)
Initials & year
Initials & year	Deduction Order		should be paid in the
of birth:	UNTIL the following		following monthly amount:
	date:

Child 2	After the date set		child support for Child 2 and
Child 2	After the date set		child support for Child 2 and

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

Initials & year	forth in the row	all other younger child(ren)
Initials & year	forth in the row	all other younger child(ren)
of birth:	above until the	should be paid in the

	following date:	following monthly amount:


Child 3
Child 3	After the date set	child support for Child 3 and
Initials & year
Initials & year	forth in the row	all other younger child(ren)
of birth:
of birth:	above until the	should be paid in the
	following date:	following monthly amount:

Child 4	After the date set	child support for Child 4 and
Initials & year	forth in the row	all other younger child(ren)
of birth:
of birth:	above until the	should be paid in the

	following date:	following monthly amount:


Child 5	After the date set	child support for Child 5 and
Child 5	After the date set	child support for Child 5 and
Initials & year
Initials & year	forth in the row	all other younger child(ren)
of birth:
of birth:	above until the	should be paid in the
	following date:	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 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)

➤ PDF File

Document Data

Fact Name	Description
Form Purpose	This addendum is used when a court mandates income deduction for support payments.
Governing Laws	Sections 61.13 and 61.1301 of the Florida Statutes govern this form.
Filing Requirement	Attach this form to the OMB Income Withholding for Support form before filing with the circuit court clerk.
Mailing Instructions	Send a signed copy of both forms to the obligor's payor via certified mail.
Income Deduction Timeline	The payor must implement deductions within 14 days of receiving the order.
Notification Duties	Payors must notify the State Disbursement Unit of deductions within 2 days of payment dates.
Employer Penalties	Employers face penalties for failing to deduct the correct amount from the obligor's income.
Electronic Remittance	Employers with 10+ employees must remit payments electronically to the State Disbursement Unit.
Obligor Protections	Employers cannot discharge or discipline obligors due to income deduction requirements.

How to Use Florida Addendum To Income

After completing the Florida Addendum to Income form, it is essential to send a copy along with the OMB Income Withholding for Support form, signed by the judge, to the obligor’s payor via certified mail. Ensure to keep the return receipt for filing with the court.

Obtain the Florida Addendum to Income form and the OMB Income Withholding for Support form.
Fill in the case details at the top of the form, including the judicial circuit and county.
Enter the case number and division information.
Provide the names of the petitioner and respondent in the designated spaces.
Identify the payor by writing their name in the appropriate section.
List the obligor’s name and address accurately.
Complete the sections regarding the responsibilities and rights of the payor as outlined in the form.
Include the amounts for any arrears owed, if applicable, and specify any additional amounts to be withheld.
Sign and date the form where indicated.
Attach the completed form to the OMB Income Withholding for Support form.
File the forms with the clerk of the circuit court in the appropriate county.
Send a copy of the filed forms to the obligor’s payor via certified mail, return receipt requested.
Keep the return receipt for your records and for filing with the court using the Notice of Filing Return Receipt form.

Key Facts about Florida Addendum To Income

What is the purpose of the Florida Addendum To Income form?

This form is used when a court orders that support payments be made through income deduction. It must be attached to the OMB Income Withholding for Support form to comply with Florida law. The addendum provides specific provisions required for income deduction orders.

When should I use this form?

You should use this form when the court has mandated income deductions for support payments. It is essential to include this addendum with the OMB form to ensure all legal requirements are met.

How do I submit the Florida Addendum To Income form?

After completing the form, you must file it with the clerk of the circuit court in the relevant county. Make sure to send a copy of both the addendum and the OMB form, signed by the judge, to the obligor’s payor via certified mail. Keep the return receipt for your records.

What information do I need to include in the form?

You'll need to provide the obligor's name and address, the case number, and the county where the case is being heard. Additionally, you must include the Remittance Identifier and FIPS code, which are crucial for processing the income deduction correctly.

What happens if the payor fails to deduct the correct amount?

If the payor does not deduct the correct amount from the obligor’s income, they may be held liable for the amount that should have been deducted. This includes any associated costs, interest, and reasonable attorney's fees.

Are there penalties for non-compliance with the income deduction order?

Yes, payors can face civil penalties for failing to comply with the income deduction order. The penalties can reach up to $250 for the first violation and $500 for any subsequent violations. These penalties are payable to the obligee or the IV-D agency enforcing the order.

Can the obligor take legal action if the payor does not comply?

Yes, the obligor has the right to bring a civil action against a payor who refuses to comply with the income deduction order. This includes cases of employment discrimination due to the income deduction requirement.

What should I do if the obligor's employment situation changes?

If the obligor no longer receives income from the payor, the payor must notify the obligee and provide the obligor's last known address and any new payor's information if available. Failure to do so may result in civil penalties.

Common mistakes

Filling out the Florida Addendum to Income form can be a daunting task, and mistakes can lead to significant delays or complications in the income withholding process. One common mistake is not including the correct Remittance Identifier. This identifier is crucial as it combines the county code with the case number. Omitting or miswriting this information can result in payments being misdirected, causing unnecessary confusion and potential legal issues.

Another frequent error involves the FIPS code. This code must be accurately listed to ensure that the income withholding order is enforced correctly. Individuals often overlook this detail or use an outdated code, which can lead to complications in processing payments. It’s essential to refer to the attached list of FIPS codes and double-check that the correct code for the county is being used.

Many people also fail to attach the necessary documents when submitting the form. A copy of the OMB Income Withholding for Support form, signed by the judge, must accompany the Florida Addendum to Income form. Neglecting to include this document can result in the court rejecting the filing, leading to delays in the support payments that are intended to help those in need.

Lastly, individuals sometimes forget to send a copy of the completed form via certified mail to the obligor’s payor. This step is critical because it ensures that the payor is officially notified of their responsibilities under the income withholding order. Failing to do so can create confusion about payment obligations and could ultimately lead to enforcement issues down the line.

Documents used along the form

The Florida Addendum to Income form is often used in conjunction with several other documents. Each of these forms plays a critical role in the income deduction process mandated by the court. Below are four commonly associated documents.

OMB Form 0970-0154, Income Withholding for Support: This is the primary form used to initiate income withholding for child support or alimony. It specifies the amount to be deducted from the obligor's income and must be completed and signed by the court.
Florida Family Law Rules of Procedure Form 12.996(c), Notice of Filing Return Receipt: This form is used to notify the court that the obligor's payor has received the income withholding order. It includes proof of delivery, which is essential for compliance with court requirements.
Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a): If a nonlawyer assists in filling out the forms, this document must be provided. It outlines the nonlawyer's role and responsibilities in the process, ensuring transparency and compliance with legal standards.
State Disbursement Unit (SDU) Payment Options Documentation: This document provides information on how payors can remit support payments electronically. It includes details on acceptable payment methods and contact information for assistance, ensuring timely and accurate payment processing.

Using these documents together ensures that the income withholding process runs smoothly and complies with Florida law. Proper completion and filing of each form are crucial for effective enforcement of support obligations.

Similar forms

Income Withholding for Support (OMB Form 0970-0154): This form is used to officially notify employers to withhold income for child support payments. Like the Florida Addendum To Income form, it outlines the obligations of the payor regarding income deductions.
Notice of Filing Return Receipt (Form 12.996(c)): This document is filed to confirm that the payor has received the income withholding order. It serves a similar purpose of ensuring proper communication and compliance with court orders.
Disclosure from Nonlawyer (Form 12.900(a)): This form is provided by nonlawyers assisting individuals in completing legal forms. It ensures transparency about the nonlawyer's role, akin to how the Florida Addendum To Income form requires clarity in the income withholding process.
Child Support Guidelines Worksheet: This document is used to calculate the appropriate amount of child support. It is similar in that it provides a structured approach to determining financial obligations, just as the Florida Addendum does for income withholding.
Income Deduction Order: This order specifies the amount to be deducted from an obligor's income for support payments. Both the Income Deduction Order and the Florida Addendum To Income form detail the financial responsibilities of the payor.
Final Judgment of Dissolution of Marriage: This document outlines the final terms of a divorce, including support obligations. Like the Florida Addendum, it formalizes financial responsibilities as determined by the court.
Petition for Modification of Child Support: This form is used to request changes to existing child support orders. It is similar in that it addresses the financial obligations of the parties involved, similar to the income withholding process outlined in the Florida Addendum.
Child Support Enforcement Notice: This notice informs parties of enforcement actions regarding unpaid child support. It shares a common goal with the Florida Addendum, which is to ensure compliance with financial obligations established by the court.

Dos and Don'ts

When filling out the Florida Addendum to Income form, it is important to follow certain guidelines to ensure accuracy and compliance. Below is a list of things you should and shouldn't do.

Do type or print the form in black ink.
Do attach this form to the OMB Income Withholding for Support form.
Do send a copy of the completed forms to the obligor's payor by certified mail.
Do include the Remittance Identifier and FIPS code accurately.
Do ensure that a nonlawyer assisting you provides a Disclosure from Nonlawyer.

Don't forget to file the forms with the clerk of the circuit court.
Don't neglect to notify the obligee if the payor no longer provides income to the obligor.
Don't fail to deduct the correct amount from the obligor's income.
Don't discharge or take disciplinary action against an obligor because of income deduction requirements.

Misconceptions

Misconception 1: The Florida Addendum To Income form is optional.

This form is required when the court orders income deduction for support. It must be attached to the OMB Income Withholding for Support form.

Misconception 2: Only attorneys can assist with filling out this form.

A nonlawyer can help, but they must provide a Disclosure from Nonlawyer and include their contact information on the form.

Misconception 3: The form can be completed in any ink color.

This form must be typed or printed in black ink only to ensure clarity and legibility.

Misconception 4: The payor has unlimited time to implement income deductions.

The payor must begin deductions no later than the first payment date that occurs more than 14 days after receiving the order.

Misconception 5: The income withholding order is temporary and can be ignored after a certain period.

This order remains binding until the court issues a further notice or the payor stops providing income to the obligor.

Misconception 6: Employers can refuse to comply with income deductions.

Employers are legally obligated to comply with the order. Failing to do so can result in civil penalties.

Key takeaways

When filling out and using the Florida Addendum To Income form, it is essential to follow specific guidelines to ensure compliance with state laws. Here are some key takeaways:

Purpose of the Form: This form is required when a court orders support to be paid through income deduction. It must accompany the OMB Form 0970-0154.
Filing Requirements: Ensure the form is typed or printed in black ink. Attach it to the OMB form and file it with the clerk of the circuit court in the appropriate county.
Mailing Instructions: Send a copy of the completed form and the OMB form, signed by the judge, to the obligor's payor via certified mail. Keep the return receipt for court records.
Income Deduction Implementation: The payor must begin deducting the specified amount from the obligor's income within 14 days of receiving the order.
Notification Obligations: If the payor stops providing income to the obligor, they must notify the obligee and provide the obligor's new payor information, if known.
Penalties for Non-Compliance: Failure to adhere to the income deduction requirements can result in civil penalties for the payor, including fines for wrongful discharge or refusal to employ the obligor.

By following these guidelines, individuals can navigate the process more effectively and ensure compliance with Florida law.