Information Collection

Income withholding orders/termination of employment/income status (Employers and other income withholders)

IC 227080 under ICR 202309-0970-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 (Employers and other income withholders)	Form
0970_0154_Instructions_OCSS_091523.docx	Instruction
0970_0154_Instructions_OCSS_091523.docx	Instruction
0970-0154_IWO Sample Form_091523.docx	Instruction
0970-0154_IWO Sample Form_091523.docx	Instruction
1 IWO Form 0970_0154_IWO_Form_OCSS_062123.docx	Form
1 IWO Form 0970_0154_IWO_Form_OCSS_062123.docx	Form

IC Title:

Income withholding orders/termination of employment/income status (Employers and other income withholders)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	IWO Form	0970_0154_IWO_Form_OCSS_062123.docx	Yes	Yes	Fillable Printable
Instruction			0970_0154_Instructions_OCSS_091523.docx	Yes	Yes	Fillable Printable
Instruction			0970-0154_IWO Sample Form_091523.docx	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: 1,277,952

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	10,236,396	10,236,396
Annual IC Time Burden (Hours)	341,213	341,213
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.