Fill and Sign the Oklahoma Support Form

*03EN006E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES [Sender name and address]                   Initial Notice to Employers [Recipient name and address]                   Attention: PAYROLL RE: Oklahoma Centralized Support Registry Non-IV-D Child Support Payments Dear Employer: Under Section 413 of Title 43 of the Oklahoma Statutes, the Oklahoma Department of Human Services (hereinafter referred to as Department), Child Support Enforcement Division (CSED), centrally processes child support payments that meet the conditions below. Currently, you are not sending these payments to the Oklahoma Centralized Support Registry. This notice provides you with the steps to prepare new accounts for these payments. Step 1. Review child support deductions that do not now go to the Oklahoma Centralized Support Registry and answer these questions. If the answers to both questions are yes, then go to Step 2.  Question 1: Are these deductions from wages or compensation for child support payments now paid to a payee other than the Oklahoma Centralized Support Registry or another state's child support agency?  Question 2: Are these deductions from wages or compensation for child support payments made according to an Oklahoma court order or notice to deduct child support by income assignment? If the answers to both questions are yes, then: Step 2. Complete the Oklahoma Centralized Support Registry Data Sheet on the next page. A copy of the court order or notice is required for each payee receiving child support payments from your employee. Step 3. Make a copy of the court order or notice requiring deductions for child support. Step 4. Mail the Oklahoma Centralized Support Registry Data Sheet and a copy of the court order or notice to: Oklahoma Centralized Support Registry P. O. Box 268809 Oklahoma City, OK 73126-8809 Do not interrupt or redirect payments at Step 4. OKDHS issued 5-17-2007 03EN006E Page 1 of 4 03EN006E Initial Notice to Employers Step 5. The Oklahoma Centralized Support Registry will establish an account number (Family Group Number or FGN) for processing payments from the Oklahoma Centralized Support Registry Data Sheet and court order information. Step 6. You will receive a notice from the Department with the FGN account number for your employee and each payee receiving child support. In some instances, your employee will be paying more than one payee. Therefore, the employee will have an FGN for each payee and you will receive more than one notice. It is very important, for the timely processing of payments, that we receive the appropriate account number with all future payments. NOTE: When your notice with the FGN account number is mailed, the Department sends notices to your employee and payees, explaining the changes and providing our telephone numbers for questions. Step 7. Send payments from the next payroll with employee identification and FGN to: Oklahoma Centralized Support Registry P. O. Box 268809 Oklahoma City, OK 73126-8809 Please note that you are required to use this process for any new employee or existing employee with a child support order for whom you can answer yes to both questions in Step 1 above. Therefore, you should retain a copy of this notice for future use and reference. Thank you for your cooperation. If you have questions, contact CSED at 405-522-2273 or TTY at 405-522-3792 in the Oklahoma City area, or toll free at 1-800-522-2922 or TTY at 1-866-264-4767. Oklahoma Department of Human Services Child Support Enforcement Division Page 2 of 4 OKDHS issued 5-17-2007 Initial Notice to Employers 03EN006E Oklahoma Centralized Support Registry Data Sheet Attention Employer: Attach to this notice a copy of the court order or notice for income withholding and mail to: Oklahoma Centralized Support Registry P. O. Box 268809 Oklahoma City, OK 73126-8809 If you received this Oklahoma Centralized Support Registry Data Sheet by fax, please fax completed notice with a copy of the court order or notice for income withholding to 405 - 600-0018. This is confidential information protected at CSED by 56 O.S. § 183 and 56 O.S. § 237(h). Payor data (your employee): Employee name       Social Security number       Date of birth       Sex Male Female Street address       City       State       Zip       Check one. Current frequency of withholding: Weekly Bi-weekly Semi-monthly Monthly Payee data: Receives the payments - NOT Oklahoma Centralized Support Registry Payee name       Street address       City       State       Zip       Employer data: Employer name       Federal Identification number       Payroll contact person       Area code       Phone       Payroll address, if different from cover letter: Street address       City       State       Zip       EMPLOYER ALERT Are you aware of any restricted contact between the payor and payee, such as a legal protective order or restraining order? Yes No If yes, please explain:       OKDHS issued 5-17-2007 Page 3 of 4 03EN006E Initial Notice to Employers Employer : The data below is not mandatory but will assist our efforts in making sure the withholdings sent to us are processed in a correct and efficient manner. Additional payee data: Social Security number       Date of birth       Sex Male Female Area code       Phone       Children data: If more than three children, please use back of page. Child 1 name       Social Security number       Date of birth       Sex Male Female Child 2 name       Social Security number       Date of birth       Sex Male Female Child 3 name       Social Security number       Date of birth       Sex Male Female Additional employer data: Do you have child support withholdings from this employee's earnings for another payee that are currently being submitted to our agency? Yes No If yes, what is the Oklahoma Child Support Identification number you use to identify this payment?       Are you interested in sending these withholdings by electronic funds transfer process? Yes No If yes, name and telephone number of person we should contact: Name       Area code       Phone       You may call 405-600-0014 for more information concerning electronic funds transfer. To obtain additional information about other methods of electronic payments, visit CSED on the Internet at http://www.okdhs.org/onlineservices/cspay/default.htm . For questions concerning all other issues, contact CSED at 405 - 522 - 2273 or TTY at 405 - 522-3792 in the Oklahoma City area, or toll free at 1-800-522-2922 or TTY at 1 - 866-264 - 4767. Page 4 of 4 OKDHS issued 5-17-2007