Information Collection

Income withholding orders/termination of employment/income status

IC 227080 under ICR 201706-0970-001 · OMB 0970-0154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Income withholding orders/termination of employment/income status	Form
IWO_Instructions.doc	Instruction
1 IWO Form IWO Form.docx	Form

IC Title:

Income withholding orders/termination of employment/income status

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	IWO Form	IWO Form.docx		Yes	Yes	Fillable Printable
Instruction			IWO_Instructions.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,228,320

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11,472,509	11,472,509
Annual IC Time Burden (Hours)	382,417	382,417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.