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Here is the text we could read:

INCOME WITHHOLDING FOR SUPPORT

FL-195
OMB 0970-0154
Expiration Date: 09/30/2023

I. Sender Information: (Completed by the Sender)

Date:

INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO)
ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT

AMENDED IWO
TERMINATION OF IWO

Child Support Enforcement (CSE) Agency

Court

Attorney

Private Individual/Entity (Check One)

NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the
sender (see IWO instructions
). If you receive
this document from someone other than a state or tribal CSE agency or a court, a copy of the underlying support order
must be attached.

State/Tribe/Territory
City/County/Dist./Tribe
Private Individual/Entity

Remittance ID (include w/payment)
Order ID
Case ID

II. Employer and Case Information: (Completed by the Sender)

RE:

Employer/Income Withholder's Name

Employee/Obligor's Name (Last, First, Middle)

Employer/Income Withholder's Address

Employee/Obligor's Social Security Number

Employee/Obligor's Date of Birth

Custodial Party/Obligee’s Name (Last, First, Middle)

Employer/Income Withholder's FEIN
Child(ren)'s Name(s) (Last, First, Middle)

Child(ren)'s Birth Date(s)

III. Order Information: (Completed by the Sender)
This document is based on the support order from
You are required by law to deduct these amounts from the employee/obligor's income until further notice.
$
$
$
$
$
$
$
for a Total Amount to Withhold of $

current child support
past-due child support - Arrears greater than 12 weeks?
current cash medical support
past-due cash medical support
current spousal support
past-due spousal support
other (must specify)

Per
Per
Per
Per
Per
Per
Per

per

(State/Tribe).

Yes

IV. Amounts to Withhold: (Completed by the Sender)
You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match
the ordered payment cycle, withhold one of the following amounts:
$
$
$
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to provide uniformity and standardization. Public reporting
burden for this collection of information is estimated to average two to five minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing
the collection of information. This is a mandatory collection of information in accordance with 45 CFR 303.100 of the Child Support Enforcement Program. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have
any comments on this collection of information, please contact the Employer Services Team by email at

$
per weekly pay period
per biweekly pay period (every two weeks)$
Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.

per semimonthly pay period (twice a month)
per monthly pay period

Income Withholding for Support (IWO)

Document Tracking ID

Page 1 of 4

Employer/Income Withholder's Name:

Employee/Obligor's Name:

Employer/Income Withholder's FEIN:

SSN:

Case ID:

Order ID:

FL-195

V. Remittance Information: (Completed by the Sender except for the "Return to Sender" check box.)

business days of the pay date. If you cannot withhold the full amount of support for any or all orders for this

If the employee/obligor’s principal place of employment is
later than the first pay period that occurs
within
employee/obligor, withhold
employment is not
method to allocate among multiple child support cases/orders and any allowable employer fees from the jurisdiction of
the employee/obligor’s principal place of employment.

(State/Tribe), you must begin withholding no
of the order/notice. Send payment

% of disposable income for all orders. If the employee/obligor’s principal place of

(State/Tribe), obtain withholding limitations, time requirements, the appropriate

days after the date of

State-specific withholding limit information is available at

contact the tribe at

. For tribe-specific contacts, payment addresses, and withholding limitations, please

You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act
(CCPA) [15 USC §1673 (b)]; or 2) the amounts allowed by the law of the state of the employee/obligor’s principal place of
employment if the place of employment is in a state; or the tribal law of the employee/obligor’s principal place of
employment if the place of employment is under tribal jurisdiction. The CCPA is available at

. If the Order Information section does not indicate that the arrears are greater than 12

weeks, then the employer should calculate the CCPA limit using the lower percentage.

If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to federal,
state, or tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support
before payment of any past-due support.

If the obligor is a nonemployee, obtain withholding limits from the Supplemental Information section in this IWO. This
information is also available at

Remit payment to
at

California State Disbursement Unit
P.O. Box 989067, West Sacramento, CA 95798-9067

(SDU/Tribal Order Payee)
(SDU/Tribal Payee Address)

Include the Remittance ID with the payment and if necessary this locator code of the SDU/Tribal order payee
on the payment.

To set up electronic payments or to learn state requirements for checks, contact the State Disbursement Unit (SDU).
Contacts and information are found at

Return to Sender (Completed by Employer/Income Withholder). Payment must be directed to an SDU in
accordance with sections 466(b)(5) and (6) of the Social Security Act or Tribal Payee (see Payments in Section VI). If
payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return
the IWO to the sender.

If Required by State or Tribal Law:
Signature of Judge/Issuing Official:
Print Name of Judge/Issuing Official:
Title of Judge/Issuing Official:
Date of Signature:

If the employee/obligor works in a state or for a tribe that is different from the state or tribe that issued this order, a copy of
this IWO must be provided to the employee/obligor.

If checked, the employer/income withholder must provide a copy of this form to the employee/obligor.

Income Withholding for Support (IWO)

Page 2 of 4

Employer/Income Withholder's Name:

Employee/Obligor's Name:

Employer/Income Withholder's FEIN:

SSN:

Case ID:

Order ID:

FL-195

VI. Additional Information for Employers/Income Withholders: (Completed by the Sender)

Priority: Withholding for support has priority over any other legal process under State law against the same income
(section 466(b)(7) of the Social Security Act). If a federal tax levy is in effect, please notify the sender.

Payments: You must send child support payments payable by income withholding to the appropriate State Disbursement
Unit or to a tribal CSE agency within 7 business days, or fewer if required by state law, after the date the income would
have been paid to the employee/obligor and include the date you withheld the support from his or her income. You may
combine withheld amounts from more than one employee/obligor’s income in a single payment as long as you separately
identify each employee/obligor’s portion of the payment. Child support payments may not be made through the federal
Office of Child Support Enforcement (OCSE) Child Support Portal.

Lump Sum Payments: You may be required to notify a state or tribal CSE agency of upcoming lump sum payments to
this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are
required to report and/or withhold lump sum payments. Employers/income withholders may use OCSE’s Child Support
Portal
to provide contacts, addresses, and other information about their companies. Child support payments may not be made
through the federal OCSE Child Support Portal.

to provide information about employees who are eligible to receive lump sum payments and

Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the
employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld
and any penalties set by state or tribal law/procedure.

Anti-discrimination: You are subject to a fine determined under state or tribal law for discharging an employee/obligor
from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.

Supplemental Information:

Income Withholding for Support (IWO)

Page 3 of 4

Employer/Income Withholder's Name:

Employee/Obligor's Name:

Employer/Income Withholder's FEIN:

SSN:

Case ID:

Order ID:

FL-195

VII. Notification of Employment Termination or Income Status: (Completed by the Employer/Income Withholder)

If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor, you must
promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information
section below or using OCSE’s Child Support Portal
withholder, if known.

Please report the new employer or income

This person has never worked for this employer nor received periodic income.

This person no longer works for this employer nor receives periodic income.

Please provide the following information for the employee/obligor:

Last known telephone number:

Termination date:

Last known address:

Final payment date to SDU/Tribal Payee:

Final payment amount:

New employer's or income withholder's name:

New employer's or income withholder's address:

VIII. Contact Information: (Completed by the Sender)

To Employer/Income Withholder: If you have questions, contact

(sender name) by

telephone:

, by fax:

, by email or website:

Send termination/income status notice and other correspondence to:

To Employee/Obligor: If the employee/obligor has questions, contact

by telephone:

, by fax:

, by email or website:

IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor.

Encryption Requirements:
When communicating this form through electronic transmission, precautions must be taken to ensure the security of the
data. Child support agencies are encouraged to use the electronic applications provided by the federal Office of Child
Support Enforcement. Other electronic means, such as encrypted attachments to emails, may be used if the encryption
method is compliant with Federal Information Processing Standard (FIPS) Publication 140-2 (FIPS PUB 140-2).

(sender address).

(sender name)

Income Withholding for Support (IWO)

Page 4 of 4

Income Withholding for Support

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 4
Fields(s): 117
Average fields per page: 29
Reading Level: Grade 9
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

f_l_page_list_document_date was FL-195[0].Page1[0].List1[0].Li1[0].DocumentDate[0] (0.47 conf)
f_l_page_list_li_check_box__1 was FL-195[0].Page1[0].List1[0].Li1[0].CheckBox1[0] (0.40 conf)
f_l_page_list_li_check_box__2 was FL-195[0].Page1[0].List1[0].Li1[0].CheckBox1[1] (0.40 conf)
f_l_page_list_li_check_box__3 was FL-195[0].Page1[0].List1[0].Li1[0].CheckBox1[2] (0.40 conf)
f_l_page_list_li_check_box__4 was FL-195[0].Page1[0].List1[0].Li1[0].CheckBox1[3] (0.40 conf)
f_l_page_list_li_check_box__5 was FL-195[0].Page1[0].List1[0].Li1[0].CheckBox5[0] (0.40 conf)
f_l_page_list_li_check_box__6 was FL-195[0].Page1[0].List1[0].Li1[0].CheckBox5[1] (0.40 conf)
f_l_page_list_li_check_box__7 was FL-195[0].Page1[0].List1[0].Li1[0].CheckBox5[2] (0.40 conf)
f_l_page_list_li_check_box__8 was FL-195[0].Page1[0].List1[0].Li1[0].CheckBox5[3] (0.40 conf)
l_page_state_tribe_name was FL-195[0].Page1[0].List1[0].Li1[0].IssuingState-Tribe-TerritoryName[0] (0.37 conf)
f_l_list_remittance_identifier was FL-195[0].Page1[0].List1[0].Li1[0].RemittanceIdentifier[0] (0.42 conf)
l_page_list_issuing_name was FL-195[0].Page1[0].List1[0].Li1[0].IssuingJurisdictionName[0] (0.39 conf)
f_l_page_list_order_identifier was FL-195[0].Page1[0].List1[0].Li1[0].OrderIdentifierA[0] (0.40 conf)
l_private_individual_entity_name was FL-195[0].Page1[0].List1[0].Li1[0].PrivateIndividualEntityName[0] (0.43 conf)
f_l_page_list_case_identifier was FL-195[0].Page1[0].List1[0].Li1[0].CaseIdentifierA[0] (0.39 conf)
f_l_page_list_employer_name was FL-195[0].Page1[0].List2[0].Li1[0].EmployerNameA[0] (0.40 conf)
f_l_page_list_employer_address__1 was FL-195[0].Page1[0].List2[0].Li1[0].EmployerAddress1[0] (0.36 conf)
f_l_page_list_employer_address__2 was FL-195[0].Page1[0].List2[0].Li1[0].EmployerAddress2[0] (0.36 conf)
f_l_page_list_employer_address__3 was FL-195[0].Page1[0].List2[0].Li1[0].EmployerAddress3[0] (0.36 conf)
f_l_page_list_li_text_field__1 was FL-195[0].Page1[0].List2[0].Li1[0].TextField[0] (0.39 conf)
f_l_page_list_employee_name was FL-195[0].Page1[0].List2[0].Li1[0].EmployeeNameA[0] (0.40 conf)
f_l_page_list_li_ss_n was FL-195[0].Page1[0].List2[0].Li1[0].EmployeeSSN[0] (0.36 conf)
f_l_page_list_li_employee_b was FL-195[0].Page1[0].List2[0].Li1[0].EmployeeDOB[0] (0.35 conf)
f_l_page_list_li_name was FL-195[0].Page1[0].List2[0].Li1[0].ObligeeName[0] (0.36 conf)
f_l_page_list_li_child_name__1 was FL-195[0].Page1[0].List2[0].Li1[0].Child1Name[0] (0.36 conf)
f_l_page_list_child_date__1 was FL-195[0].Page1[0].List2[0].Li1[0].Child1BirthDate[0] (0.41 conf)
f_l_page_list_li_child_name__2 was FL-195[0].Page1[0].List2[0].Li1[0].Child2Name[0] (0.36 conf)
f_l_page_list_child_date__2 was FL-195[0].Page1[0].List2[0].Li1[0].Child2BirthDate[0] (0.41 conf)
f_l_page_list_li_child_name__3 was FL-195[0].Page1[0].List2[0].Li1[0].Child3Name[0] (0.36 conf)
f_l_page_list_child_date__3 was FL-195[0].Page1[0].List2[0].Li1[0].Child3BirthDate[0] (0.41 conf)
f_l_page_list_li_child_name__4 was FL-195[0].Page1[0].List2[0].Li1[0].Child4Name[0] (0.36 conf)
f_l_page_list_child_date__4 was FL-195[0].Page1[0].List2[0].Li1[0].Child4BirthDate[0] (0.41 conf)
f_l_page_list_li_child_name__5 was FL-195[0].Page1[0].List2[0].Li1[0].Child5Name[0] (0.36 conf)
f_l_page_list_child_date__5 was FL-195[0].Page1[0].List2[0].Li1[0].Child5BirthDate[0] (0.41 conf)
f_l_page_list_li_child_name__6 was FL-195[0].Page1[0].List2[0].Li1[0].Child6Name[0] (0.36 conf)
f_l_page_list_child_date__6 was FL-195[0].Page1[0].List2[0].Li1[0].Child6BirthDate[0] (0.41 conf)
l_page_list_issuing_tribunal_name was FL-195[0].Page1[0].List3[0].Li1[0].IssuingTribunalName[0] (0.38 conf)
l_list_support_current_child_amount was FL-195[0].Page1[0].List3[0].Li1[0].SupportCurrentChildAmount[0] (0.40 conf)
l_page_list_support_current was FL-195[0].Page1[0].List3[0].Li1[0].SupportCurrentChildFrequencyCode[0] (0.38 conf)
l_support_past_due_child_amount was FL-195[0].Page1[0].List3[0].Li1[0].SupportPastDueChildAmount[0] (0.35 conf)
l_list_support_past_due_child was FL-195[0].Page1[0].List3[0].Li1[0].SupportPastDueChildFrequencyCode[0] (0.36 conf)
l_support_current_medical_amount was FL-195[0].Page1[0].List3[0].Li1[0].SupportCurrentMedicalAmount[0] (0.42 conf)
l_list_support_current_medical was FL-195[0].Page1[0].List3[0].Li1[0].SupportCurrentMedicalFrequencyCode[0] (0.39 conf)
l_support_past_due_medical_amount was FL-195[0].Page1[0].List3[0].Li1[0].SupportPastDueMedicalAmount[0] (0.41 conf)
l_list_support_past_due__1 was FL-195[0].Page1[0].List3[0].Li1[0].SupportPastDueMedicalFrequencyCode[0] (0.40 conf)
l_list_support_current_amount was FL-195[0].Page1[0].List3[0].Li1[0].SupportCurrentSpousalAmount[0] (0.37 conf)
l_list_support_current_spousal was FL-195[0].Page1[0].List3[0].Li1[0].SupportCurrentSpousalFrequencyCode[0] (0.37 conf)
l_list_support_past_due_amount was FL-195[0].Page1[0].List3[0].Li1[0].SupportPastDueSpousalAmount[0] (0.40 conf)
l_list_support_past_due__2 was FL-195[0].Page1[0].List3[0].Li1[0].SupportPastDueSpousalFrequencyCode[0] (0.38 conf)
f_l_page_list_obligation_amount was FL-195[0].Page1[0].List3[0].Li1[0].ObligationOtherAmount[0] (0.38 conf)
f_l_page_list_obligation was FL-195[0].Page1[0].List3[0].Li1[0].ObligationOtherFrequencyCode[0] (0.38 conf)
l_page_list_obligation_description was FL-195[0].Page1[0].List3[0].Li1[0].ObligationOtherDescriptionText[0] (0.36 conf)
f_l_list_obligation_total_amount was FL-195[0].Page1[0].List3[0].Li1[0].ObligationTotalAmount[0] (0.39 conf)
f_l_list_obligation_total was FL-195[0].Page1[0].List3[0].Li1[0].ObligationTotalFrequencyCode[0] (0.39 conf)
f_l_page_list_li_yes__1 was FL-195[0].Page1[0].List3[0].Li1[0].YesNo[0] (0.36 conf)
f_l_page_list_li_yes__2 was FL-195[0].Page1[0].List3[0].Li1[0].YesNo[1] (0.36 conf)
income_withholding_deduction_weekly_amount__1 was FL-195[0].Page1[0].List4[0].Li1[0].IncomeWithholdingDeductionWeeklyAmount[0] (0.35 conf)
l_list_income_withholding_amount was FL-195[0].Page1[0].List4[0].Li1[0].IncomeWithholdingSemimonthlyAmount[0] (0.39 conf)
income_withholding_deduction_weekly_amount__2 was FL-195[0].Page1[0].List4[0].Li1[0].IncomeWithholdingDeductionBi-WeeklyAmount[0] (0.36 conf)
l_income_withholding_monthly_amount was FL-195[0].Page1[0].List4[0].Li1[0].IncomeWithholdingMonthlyAmount[0] (0.37 conf)
f_l_li_sum_payment_amount was FL-195[0].Page1[0].List4[0].Li1[0].LumpSumPaymentAmount[0] (0.41 conf)
f_page_document_tracking_number was FL-195[0].Page1[0].DocumentTrackingNumber[0] (0.32 conf)
f_l_page_employer_name__1 was FL-195[0].Page2[0].EmployerNameA[0] (0.38 conf)
f_l_page_text_field__1 was FL-195[0].Page2[0].TextField[0] (0.34 conf)
f_l_page_employee_name__1 was FL-195[0].Page2[0].EmployeeNameA[0] (0.37 conf)
f_l_page_employee_ss_n__1 was FL-195[0].Page2[0].EmployeeSSN[0] (0.38 conf)
f_l_page_case_identifier__1 was FL-195[0].Page2[0].CaseIdentifierA[0] (0.39 conf)
f_l_page_order_identifier__1 was FL-195[0].Page2[0].OrderIdentifierA[0] (0.41 conf)
f_l_page_list_li_text_field__2 was FL-195[0].Page2[0].List5[0].Li1[0].TextField1[0] (0.39 conf)
f_l_page_list_li_text_field__3 was FL-195[0].Page2[0].List5[0].Li1[0].TextField2[0] (0.39 conf)
l_income_withholding_start_date was FL-195[0].Page2[0].List5[0].Li1[0].IncomeWithholdingStartDate[0] (0.39 conf)
f_l_page_list_li_send_payment_within_days_number was FL-195[0].Page2[0].List5[0].Li1[0].SendPaymentWithinDaysNumber[0] (0.37 conf)
f_l_list_income_withholding_rate was FL-195[0].Page2[0].List5[0].Li1[0].IncomeWithholdingCCPARate[0] (0.37 conf)
l_page_list_employment_place_name__1 was FL-195[0].Page2[0].List5[0].Li1[0].EmploymentPlaceName[0] (0.35 conf)
f_l_page_list_return_send_ind was FL-195[0].Page2[0].List5[0].Li1[0].ReturnSendInd[0] (0.37 conf)
l_page_list_employment_place_name__2 was FL-195[0].Page2[0].List5[0].Li1[0].EmploymentPlaceNameA[0] (0.43 conf)
l_page_list_goverment_official was FL-195[0].Page2[0].List5[0].Li1[0].GovermentOfficialSignature[0] (0.40 conf)
l_page_government_official_name was FL-195[0].Page2[0].List5[0].Li1[0].GovernmentOfficialName[0] (0.37 conf)
f_l_page_li_official_title was FL-195[0].Page2[0].List5[0].Li1[0].IssuingOfficialTitleText[0] (0.39 conf)
f_l_page_list_li_signiture was FL-195[0].Page2[0].List5[0].Li1[0].DateofSigniture[0] (0.36 conf)
l_page_list_send_employee_indicator was FL-195[0].Page2[0].List5[0].Li1[0].SendEmployeeCopyIndicator[0] (0.40 conf)
f_l_page_employer_name__2 was FL-195[0].Page3[0].EmployerNameA[0] (0.38 conf)
f_l_page_text_field__2 was FL-195[0].Page3[0].TextField[0] (0.34 conf)
f_l_page_employee_name__2 was FL-195[0].Page3[0].EmployeeNameA[0] (0.37 conf)
f_l_page_employee_ss_n__2 was FL-195[0].Page3[0].EmployeeSSN[0] (0.38 conf)
f_l_page_case_identifier__2 was FL-195[0].Page3[0].CaseIdentifierA[0] (0.39 conf)
f_l_page_order_identifier__2 was FL-195[0].Page3[0].OrderIdentifierA[0] (0.41 conf)
l_page_list_penalty_info_text was FL-195[0].Page3[0].List6[0].Li1[0].PenaltyLiabilityInfoText[0] (0.38 conf)
l_page_list_anti_provisions was FL-195[0].Page3[0].List6[0].Li1[0].AntiDiscriminationProvisionsText[0] (0.40 conf)
l_list_withholding_limits_text was FL-195[0].Page3[0].List6[0].Li1[0].SpecificPayeeWithholdingLimitsText[0] (0.42 conf)
f_l_page_employer_name__3 was FL-195[0].Page4[0].EmployerNameA[0] (0.38 conf)
f_l_page_text_field__3 was FL-195[0].Page4[0].TextField[0] (0.34 conf)
f_l_page_employee_name__3 was FL-195[0].Page4[0].EmployeeNameA[0] (0.37 conf)
f_l_page_employee_ss_n__3 was FL-195[0].Page4[0].EmployeeSSN[0] (0.38 conf)
f_l_page_case_identifier__3 was FL-195[0].Page4[0].CaseIdentifierA[0] (0.39 conf)
f_l_page_order_identifier__3 was FL-195[0].Page4[0].OrderIdentifierA[0] (0.41 conf)
f_l_list_employment_indicator__1 was FL-195[0].Page4[0].List7[0].Li1[0].EmploymentIndicator[0] (0.36 conf)
f_l_list_employment_indicator__2 was FL-195[0].Page4[0].List7[0].Li1[0].EmploymentIndicator1[0] (0.36 conf)
f_l_page_list_termination_date was FL-195[0].Page4[0].List7[0].Li1[0].TerminationDate[0] (0.37 conf)
f_l_page_list_last_know_phone was FL-195[0].Page4[0].List7[0].Li1[0].LastKnowPhone[0] (0.37 conf)
l_page_list_last_know_address__1 was FL-195[0].Page4[0].List7[0].Li1[0].LastKnowAddress1[0] (0.37 conf)
l_page_list_last_know_address__2 was FL-195[0].Page4[0].List7[0].Li1[0].LastKnowAddress2[0] (0.37 conf)
l_page_list_date_final_sd was FL-195[0].Page4[0].List7[0].Li1[0].DateFinalPaymenttoSDU[0] (0.34 conf)
f_l_page_list_li_final_paymentto_sdu_amount was FL-195[0].Page4[0].List7[0].Li1[0].FinalPaymenttoSDUAmount[0] (0.34 conf)
l_page_list_new_employer_name was FL-195[0].Page4[0].List7[0].Li1[0].NewEmployerName[0] (0.36 conf)
l_page_list_new_employer_address__1 was FL-195[0].Page4[0].List7[0].Li1[0].NewEmployerAddress1[0] (0.36 conf)
l_page_list_new_employer_address__2 was FL-195[0].Page4[0].List7[0].Li1[0].NewEmployerAddress2[0] (0.36 conf)
l_page_list_employer_state_name was FL-195[0].Page4[0].List8[0].Li1[0].EmployerStateContactName[0] (0.37 conf)
f_l_page_list_li_textfield__1 was FL-195[0].Page4[0].List8[0].Li1[0].Textfield1[0] (0.36 conf)
f_l_page_list_li_textfield__2 was FL-195[0].Page4[0].List8[0].Li1[0].Textfield2[0] (0.36 conf)
f_l_page_list_li_textfield__3 was FL-195[0].Page4[0].List8[0].Li1[0].Textfield3[0] (0.36 conf)
l_employer_state_contact_address__1 was FL-195[0].Page4[0].List8[0].Li1[0].EmployerStateContactAddress1[0] (0.37 conf)
l_employer_state_contact_address__2 was FL-195[0].Page4[0].List8[0].Li1[0].EmployerStateContactAddress2[0] (0.37 conf)
l_page_employee_state_contact_name was FL-195[0].Page4[0].List8[0].Li1[0].EmployeeStateContactName[0] (0.33 conf)
f_l_page_list_li_textfield__4 was FL-195[0].Page4[0].List8[0].Li1[0].Textfield4[0] (0.36 conf)
f_l_page_list_li_textfield__5 was FL-195[0].Page4[0].List8[0].Li1[0].Textfield5[0] (0.36 conf)
f_l_page_list_li_textfield__6 was FL-195[0].Page4[0].List8[0].Li1[0].Textfield6[0] (0.36 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

f_l_page_list_li_check_box__1
f_l_page_list_li_check_box__2
f_l_page_list_li_check_box__3
f_l_page_list_li_check_box__4
f_l_page_list_li_check_box__5
f_l_page_list_li_check_box__6
f_l_page_list_li_check_box__7
f_l_page_list_li_check_box__8
l_page_list_date_final_sd

Suggested Screen 1:

l_page_list_issuing_name
l_page_list_issuing_tribunal_name
l_page_list_obligation_description
l_page_list_goverment_official
l_page_government_official_name
l_page_list_penalty_info_text

Suggested Screen 2:

f_l_page_list_employer_name
f_l_page_list_employer_address__1
f_l_page_list_employer_address__2
f_l_page_list_employer_address__3
f_l_page_list_li_send_payment_within_days_number
l_page_list_employment_place_name__1
f_l_page_list_return_send_ind
l_page_list_employment_place_name__2
l_page_list_send_employee_indicator
f_l_list_employment_indicator__1
f_l_list_employment_indicator__2
l_page_list_last_know_address__1
l_page_list_last_know_address__2
l_page_list_new_employer_address__1
l_page_list_new_employer_address__2

Suggested Screen 3:

f_l_page_list_document_date
f_l_page_list_child_date__1
f_l_page_list_child_date__2
f_l_page_list_child_date__3
f_l_page_list_child_date__4
f_l_page_list_child_date__5
f_l_page_list_child_date__6

Suggested Screen 4:

f_l_page_list_li_ss_n
f_l_page_list_li_name
f_l_page_list_li_child_name__1
f_l_page_list_li_child_name__2
f_l_page_list_li_child_name__3
f_l_page_list_li_child_name__4
f_l_page_list_li_child_name__5
f_l_page_list_li_child_name__6
f_l_page_list_li_yes__1
f_l_page_list_li_yes__2
f_l_page_li_official_title

Suggested Screen 5:

l_private_individual_entity_name
l_list_support_current_child_amount
l_page_list_support_current
l_support_current_medical_amount
l_list_support_current_medical
l_list_support_current_amount
l_list_support_current_spousal

Suggested Screen 6:

l_support_past_due_child_amount
l_list_support_past_due_child
l_support_past_due_medical_amount
l_list_support_past_due__1
l_list_support_past_due_amount
l_list_support_past_due__2

Suggested Screen 7:

f_l_page_list_order_identifier
f_l_page_list_obligation_amount
f_l_page_list_obligation
f_l_list_obligation_total_amount
f_l_list_obligation_total
f_l_page_list_termination_date
f_l_page_list_last_know_phone

Suggested Screen 8:

income_withholding_deduction_weekly_amount__1
income_withholding_deduction_weekly_amount__2

Suggested Screen 9:

l_list_income_withholding_amount
l_income_withholding_monthly_amount
l_income_withholding_start_date
f_l_list_income_withholding_rate
l_list_withholding_limits_text

Suggested Screen 10:

f_l_li_sum_payment_amount

Suggested Screen 11:

f_page_document_tracking_number

Suggested Screen 12:

f_l_page_list_employee_name
f_l_page_list_li_employee_b
f_l_page_employer_name__1
f_l_page_employee_name__1
f_l_page_employee_ss_n__1
f_l_page_employer_name__2
f_l_page_employee_name__2
f_l_page_employee_ss_n__2
f_l_page_employer_name__3
f_l_page_employee_name__3
f_l_page_employee_ss_n__3

Suggested Screen 13:

f_l_list_remittance_identifier
f_l_page_list_case_identifier
f_l_page_case_identifier__1
f_l_page_order_identifier__1
f_l_page_case_identifier__2
f_l_page_order_identifier__2
f_l_page_case_identifier__3
f_l_page_order_identifier__3

Suggested Screen 14:

f_l_page_list_li_text_field__1
f_l_page_text_field__1
f_l_page_list_li_text_field__2
f_l_page_list_li_text_field__3
f_l_page_text_field__2
f_l_page_text_field__3
f_l_page_list_li_final_paymentto_sdu_amount

Suggested Screen 15:

l_page_state_tribe_name
l_page_list_anti_provisions
l_page_list_new_employer_name
l_page_list_employer_state_name
l_page_employee_state_contact_name

Suggested Screen 16:

l_employer_state_contact_address__1
l_employer_state_contact_address__2

Suggested Screen 17:

f_l_page_list_li_signiture
f_l_page_list_li_textfield__1
f_l_page_list_li_textfield__2
f_l_page_list_li_textfield__3
f_l_page_list_li_textfield__4
f_l_page_list_li_textfield__5
f_l_page_list_li_textfield__6

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02