Federal Parent Locator Service

Electronic Income Withholding Order

Release 08-01 -- Major

April 4, 2008

Release Specifications

Document Version 2.0

January 4, 2008

Administration for Children and Families

Office of Child Support Enforcement

370 L'Enfant Promenade S.W.

Washington, DC 20447

DCN: C8-02.03.81.02

This document was prepared for the United States Department of Health
and Human Services, Office of Child Support Enforcement under Contract
Number NIH CIOSP 263-01-D-0054 by Lockheed Martin Information Systems &
Global Services, Incorporated. The work was authorized in compliance
with the following specific prime task order:

> Delivery Order Number: HHS-ACF-2006-C-2500M
>
> Delivery Order Title: Electronic Income Withholding Order
>
> Document Date: January 2008

Table of Contents

1\. Enhance e-IWO System (OCSE Ref #2333)
[1-1](#enhance-e-iwo-system-ocse-ref-2333)

1.1 Summary of Changes [1-1](#summary-of-changes)

1.2 Background [1-1](#background)

1.3 Description of Changes [1-1](#description-of-changes)

1.4 Impact on States [1-2](#impact-on-states)

1.5 Record Specifications [1-2](#record-specifications)

APPENDICES

A. e-IWO Record Layout A-[1](#e-iwo-record-layout)

B. Acknowledgement Record Layout B-[1](#acknowledgement-record-layout)

C. e-IWO Universal Headers and Trailers
C-[1](#e-iwo-universal-headers-and-trailers)

List of Charts

Chart A-1: e-IWO Detail Record A-2

Chart B-1: Acknowledgement Record B-2

Chart C-1: Universal Header (File and Batch) C-2

Chart C-2: Universal Trailer (File and Batch) C-5

# Enhance e-IWO System (OCSE Ref #2333)

The Electronic Income Withholding Order (e-IWO) Detail file layout is
being modified from the original e-IWO pilot project to support the
revised IWO Form and to accommodate the batching of orders, editing and
reporting errors, and mapping electronic records to forms transmitted
through the OCSE Network host.

## Summary of Changes

Several new elements have been added to the e-IWO Detail flat file
layout, and the XML schema has been redesigned to accommodate file and
batch header information. A new Universal File Header and Trailer have
been added to be used with both e-IWO Detail and Acknowledgement Files.

## Background

The Federal Office of Child Support Enforcement (OCSE), in partnership
with States, public- and private-sector employers, payroll processors
and other payroll-related organizations, formed an e-IWO Workgroup in
August 2004 to develop an electronic version of the Federal,
standardized paper forms titled, *Order/Notice to Withhold Income for
Child Support*. This workgroup developed electronic formats (flat file
and XML schema) so that:

-   States can transmit income withholding orders electronically; and

-   Employers can electronically notify States regarding the status of
    IWOs, including terminations and lump sum payments.

The e-IWO Pilot Project has resulted in:

-   increased child support collections,

-   reduced administrative expenditures for States (for example, in
    postage, paper, and handling),

-   reduced processing and handling costs for employers,

-   improved communication between child support agencies and employers,
    and

-   consistent and uniform format for withholding information.

In order to assist with the exchange of IWOs between States and
employers, OCSE has undertaken an initiative to develop a portal that
will provide a single point of access for both parties to send and
receive data.

## Description of Changes

The changes outlined in this specification are modifications made to the
existing flat file\
e-IWO record layouts used by States and the Defense Finance Accounting
Service (DFAS). There are several new elements being added to the e-IWO
detail record in order to conform to the Office of Management and
Budget's (OMB) new Income Withholding Form. Additionally, new header and
trailer records are being added to allow for batching and editing by the
OCSE Network host. The new elements added to the e-IWO Detail Record
are:

-   Lump Sum Payment Amount,

-   Remittance Identifier,

-   Document Image Text,

-   First Error Field Name,

-   Second Error Field Name, and

-   Multiple Error Indicator.

The e-IWO XML schema has been modified to add the elements above and to
incorporate the use of headers and trailers to allow for multiple
batches being sent in an XML document.

## Impact on States

At the time of implementation, OCSE will convert to the new record
layout for processing State e-IWO files through the OCSE Network host.
All States that currently send electronic IWOs to DFAS will be required
to send their files in the new format.

States that do not currently send to DFAS, but that elect to begin to
use the OCSE Network host to send to employers, should request the
*e-IWO Software Interface Specification for States and Employers*. This
documentation provides the entire specifications for startup and using
the OCSE Network host. This document can be requested by contacting Bill
Stuart at <William.K.Stuart@lmco.com>. This change does not impact
States that send Kids 1^st^ data files to DFAS.

## Record Specifications

See Appendix A, "e-IWO Detail Record Layout", Chart A-1, "e-IWO Detail
Record".

See Appendix B, "Acknowledgement Record Layout", Chart B-1,
"Acknowledgement Record".

See Appendix C, "e-IWO Universal Headers and Trailers", for new records
shown in Chart C-1, "Universal Header (File and Batch)" and Chart C-2,
"Universal Trailer (File and Batch)".

# e-IWO Record Layout {#e-iwo-record-layout .Head-1-App}

This appendix contains the record specifications for the record that is
affected by the changes made for this release.

Chart A-1 presents the e-IWO Detail Record with changes highlighted in
turquoise.

+-------+------------+------+---+---+---+-----------------------+----+
| CHART |            |      |   |   |   |                       |    |
| A-1   |            |      |   |   |   |                       |    |
| e-IWO |            |      |   |   |   |                       |    |
| D     |            |      |   |   |   |                       |    |
| ETAIL |            |      |   |   |   |                       |    |
| R     |            |      |   |   |   |                       |    |
| ECORD |            |      |   |   |   |                       |    |
|       |            |      |   |   |   |                       |    |
| OMB   |            |      |   |   |   |                       |    |
| Co    |            |      |   |   |   |                       |    |
| ntrol |            |      |   |   |   |                       |    |
| No:   |            |      |   |   |   |                       |    |
| 0970  |            |      |   |   |   |                       |    |
| -0154 |            |      |   |   |   |                       |    |
| Expir |            |      |   |   |   |                       |    |
| ation |            |      |   |   |   |                       |    |
| Date: |            |      |   |   |   |                       |    |
| 10/31 |            |      |   |   |   |                       |    |
| /2010 |            |      |   |   |   |                       |    |
+=======+============+======+===+===+===+=======================+====+
| El    | Definition | Loca | L | T | R | Data Element Rules    | Fo |
| ement |            | tion | e | y | e |                       | rm |
| Name  |            |      | n | p | q |                       |    |
|       |            |      | g | e | / |                       | XR |
|       |            |      | t |   | O |                       | ef |
|       |            |      | h |   | p |                       |    |
|       |            |      |   |   | t |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Doc   | A code     | 1-3  | 3 | A | R | Value must always be  | N  |
| ument | that       |      |   | / |   | 'DTL'                 | /A |
| Code  | indicates  |      |   | N |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | primary    |      |   |   |   |                       |    |
|       | e-IWO      |      |   |   |   |                       |    |
|       | record     |      |   |   |   |                       |    |
|       | follows.   |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| [Fill | [For       | [4-6 | [ | [ | [ | []{.mark}             | [N |
| er]{. | future     | ]{.m | 3 | A | O |                       | /A |
| mark} | u          | ark} | ] | / | ] |                       | ]{ |
|       | se]{.mark} |      | { | N | { |                       | .m |
|       |            |      | . | ] | . |                       | ar |
|       |            |      | m | { | m |                       | k} |
|       |            |      | a | . | a |                       |    |
|       |            |      | r | m | r |                       |    |
|       |            |      | k | a | k |                       |    |
|       |            |      | } | r | } |                       |    |
|       |            |      |   | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Doc   | A code     | 7-9  | 3 | A | R | Valid Values:         | 1a |
| ument | that       |      |   | / |   |                       |    |
| A     | indicates  |      |   | N |   | AMD -- Amended: Any   | 1b |
| ction | the [type  |      |   |   |   | change for the        |    |
| Code  | of         |      |   |   |   | submitted case        | 1a |
|       | I          |      |   |   |   | number/identifier by  |    |
|       | WO]{.mark} |      |   |   |   | the submitting State, | 1c |
|       | document.  |      |   |   |   | except termination to |    |
|       |            |      |   |   |   | the original order.   |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | LUM -- Lump Sum: Sent |    |
|       |            |      |   |   |   | when a State, Tribe   |    |
|       |            |      |   |   |   | or Territory is       |    |
|       |            |      |   |   |   | notified, or made     |    |
|       |            |      |   |   |   | aware, that a "Lump   |    |
|       |            |      |   |   |   | Sum" payment will be  |    |
|       |            |      |   |   |   | made and they are     |    |
|       |            |      |   |   |   | requesting a          |    |
|       |            |      |   |   |   | deduction be made     |    |
|       |            |      |   |   |   | from this "Lump Sum". |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | ORG -- Original: New  |    |
|       |            |      |   |   |   | order for the         |    |
|       |            |      |   |   |   | submitted case        |    |
|       |            |      |   |   |   | number/identifier by  |    |
|       |            |      |   |   |   | the submitting State. |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | TRM -- Termination:   |    |
|       |            |      |   |   |   | Closure of an order,  |    |
|       |            |      |   |   |   | stoppage of wage      |    |
|       |            |      |   |   |   | withholding for the   |    |
|       |            |      |   |   |   | submitted case        |    |
|       |            |      |   |   |   | number/ identifier by |    |
|       |            |      |   |   |   | the submitting State. |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Doc   | The date   | 1    | 8 | A | R | Must be [a valid      | 1d |
| ument | the record | 0-17 |   | / |   | date]{.mark} in       |    |
| Date  | was        |      |   | N |   | CCYYMMDD format.      |    |
|       | generated. |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Is    | The name   | 1    | 3 | A | R | State, Tribe or       | 1f |
| suing | of the     | 8-52 | 5 | / |   | Territory full name.  |    |
| S     | ju         |      |   | N |   | [The first character  |    |
| tate- | risdiction |      |   |   |   | must not be a         |    |
| Tribe | (State,    |      |   |   |   | space.]{.mark}        |    |
| -Terr | Tribe,     |      |   |   |   |                       |    |
| itory | Territory, |      |   |   |   |                       |    |
| Name  | etc.)      |      |   |   |   |                       |    |
|       | issuing    |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | document.  |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Is    | The name   | 5    | 3 | A | O | [If entered, should   | 1h |
| suing | of the     | 3-87 | 5 | / |   | be a full             |    |
| Ju    | county,    |      |   | N |   | name.]{.mark}         |    |
| risdi | city,      |      |   |   |   |                       |    |
| ction | district   |      |   |   |   |                       |    |
| Name  | or Tribe   |      |   |   |   |                       |    |
|       | that is    |      |   |   |   |                       |    |
|       | issuing    |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | document.  |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Case  | A case     | 88   | 1 | A | R | Must be the IV-D Case | 1g |
| Ident | identifier | -102 | 5 | / |   | ID submitted for all  |    |
| ifier | is a value |      |   | N |   | external FPLS         |    |
|       | assigned   |      |   |   |   | sources, FCR, etc.    |    |
|       | by a State |      |   |   |   |                       |    |
|       | to         |      |   |   |   |                       |    |
|       | uniquely   |      |   |   |   |                       |    |
|       | identify   |      |   |   |   |                       |    |
|       | each IV-D  |      |   |   |   |                       |    |
|       | case in    |      |   |   |   |                       |    |
|       | the State. |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Name of    | 103  | 5 | A | R | [The first character  | 2a |
| loyer | the        | -159 | 7 | / |   | must not be a         |    |
| Name  | employer/  |      |   | N |   | space.]{.mark}        |    |
|       | withholder |      |   |   |   |                       |    |
|       | to whom    |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | w          |      |   |   |   |                       |    |
|       | ithholding |      |   |   |   |                       |    |
|       | order is   |      |   |   |   |                       |    |
|       | being      |      |   |   |   |                       |    |
|       | sent.      |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Line 1 of  | 160  | 2 | A | R | [The first character  | 2b |
| loyer | the        | -184 | 5 | / |   | must not be a         |    |
| Ad    | e          |      |   | N |   | space.]{.mark}        |    |
| dress | mployer/wi |      |   |   |   |                       |    |
| Line  | thholder's |      |   |   |   |                       |    |
| 1     | address.   |      |   |   |   |                       |    |
| Text  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Line 2 of  | 185  | 2 | A | O |                       | 2b |
| loyer | the        | -209 | 5 | / |   |                       | -1 |
| Ad    | e          |      |   | N |   |                       |    |
| dress | mployer/wi |      |   |   |   |                       |    |
| Line  | thholder's |      |   |   |   |                       |    |
| 2     | address.   |      |   |   |   |                       |    |
| Text  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | E          | 210  | 2 | A | R | [The first character  | 2b |
| loyer | mployer/wi | -231 | 2 | / |   | must not be a         | -1 |
| Ad    | thholder's |      |   | N |   | space.]{.mark}        |    |
| dress | city       |      |   |   |   |                       |    |
| City  | address.   |      |   |   |   |                       |    |
| Name  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | E          | 232  | 2 | A | R | Valid two-character   | 2b |
| loyer | mployer/wi | -233 |   |   |   | alphabetic State/     | -2 |
| Ad    | thholder's |      |   |   |   | Territory Code. Must  |    |
| dress | State      |      |   |   |   | be equal to one of    |    |
| State | Code.      |      |   |   |   | the following State   |    |
| Code  |            |      |   |   |   | codes:                |    |
|       |            |      |   |   |   | AL;AK;AZ;AR;          |    |
|       |            |      |   |   |   | AS;CA;CO;CT;DE;DC;FL; |    |
|       |            |      |   |   |   | GA;GU;HI;ID;          |    |
|       |            |      |   |   |   | IL;IN;IA;KS;KY;LA;ME; |    |
|       |            |      |   |   |   | MD;MA;MH;MI;MN;MS;    |    |
|       |            |      |   |   |   | MO;MT;NE;NV;NH;NJ;NM; |    |
|       |            |      |   |   |   | NY;NC;ND;OH;OK;OR;PA; |    |
|       |            |      |   |   |   | PR;RI;SC;SD;TN;TX;UT  |    |
|       |            |      |   |   |   | ;VT;VA;VI;WA;WV;WI;WY |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | E          | 234  | 5 | N | R |                       | 2b |
| loyer | mployer/wi | -238 |   |   |   |                       | -3 |
| Ad    | thholder's |      |   |   |   |                       |    |
| dress | ZIP Code.  |      |   |   |   |                       |    |
| ZIP   |            |      |   |   |   |                       |    |
| Code  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | E          | 239  | 4 | [ | O |                       | 2b |
| loyer | mployer/wi | -242 |   | A |   |                       | -4 |
| Ad    | thholder's |      |   | / |   |                       |    |
| dress | extension  |      |   | ] |   |                       |    |
| Ext   | ZIP Code.  |      |   | { |   |                       |    |
| ZIP   |            |      |   | . |   |                       |    |
| Code  |            |      |   | m |   |                       |    |
|       |            |      |   | a |   |                       |    |
|       |            |      |   | r |   |                       |    |
|       |            |      |   | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
|       |            |      |   | N |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| EIN   | E          | 243  | 9 | N | R | [Must contain an FEIN | 2c |
| Text  | mployer/wi | -251 |   |   |   | of an employer that   |    |
|       | thholder's |      |   |   |   | participates in the   |    |
|       | FEIN.      |      |   |   |   | e-IWO                 |    |
|       |            |      |   |   |   | project.]{.mark}      |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Obligor's  | 252- | 2 | A | R | Letters A-Z or        | 3a |
| loyee | last name. | 271  | 0 | / |   | spaces. No special    |    |
| Last  |            |      |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed[. The first   |    |
|       |            |      |   |   |   | character must not be |    |
|       |            |      |   |   |   | a space.]{.mark}      |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Obligor's  | 272  | 1 | A | R | Letters A-Z or        | 3a |
| loyee | first      | -286 | 5 | / |   | spaces. No special    | -1 |
| First | name.      |      |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Obligor's  | 287  | 1 | A | O | Letters A-Z or        | 3a |
| loyee | middle     | -301 | 5 | / |   | spaces. No special    | -2 |
| M     | name or    |      |   | N |   | characters or         |    |
| iddle | initial.   |      |   |   |   | imbedded spaces.      |    |
| Name  |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Obligor's  | 302  | 4 | A | O |                       | 3a |
| loyee | name       | -305 |   | / |   |                       | -3 |
| S     | suffix.    |      |   | N |   |                       |    |
| uffix |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Obligor's  | 306  | 9 | N | R |                       | 3b |
| loyee | Social     | -314 |   |   |   |                       |    |
| SSN   | Security   |      |   |   |   |                       |    |
|       | number.    |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Obligor's  | 315  | 8 | A | O | Must be [a valid      | [  |
| loyee | date of    | -322 |   | / |   | date]{.mark} in       | 31 |
| Birth | birth.     |      |   | N |   | CCYYMMDD format. If   | ]{ |
| Date  |            |      |   |   |   | unknown, fill with    | .m |
|       |            |      |   |   |   | spaces.               | ar |
|       |            |      |   |   |   |                       | k} |
+-------+------------+------+---+---+---+-----------------------+----+
| Ob    | Obligee's  | 323  | 5 | A | R | Letters A-Z or        | 3c |
| ligee | last name. | -379 | 7 | / |   | spaces. No special    |    |
| Last  |            |      |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed. [The first   |    |
|       |            |      |   |   |   | character must not be |    |
|       |            |      |   |   |   | a space.]{.mark}      |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Ob    | Obligee's  | 380  | 1 | A | R | Letters A-Z or        | 3c |
| ligee | first      | -394 | 5 | / |   | spaces. No special    | -1 |
| First | name.      |      |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Ob    | Obligee's  | 395  | 1 | A | O | Letters A-Z or        | 3c |
| ligee | middle     | -409 | 5 | / |   | spaces. No special    | -2 |
| M     | name or    |      |   | N |   | characters or         |    |
| iddle | initial.   |      |   |   |   | imbedded spaces.      |    |
| Name  |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Ob    | Obligee's  | 410  | 4 | A | O |                       | 3c |
| ligee | name       | -413 |   | / |   |                       | -3 |
| Name  | suffix.    |      |   | N |   |                       |    |
| S     |            |      |   |   |   |                       |    |
| uffix |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Is    | The name   | 414  | 3 | A | R | Must contain full     | 4  |
| suing | of the     | -448 | 5 | / |   | name.                 |    |
| Tri   | State,     |      |   | N |   |                       |    |
| bunal | Tribe or   |      |   |   |   |                       |    |
| Name  | Territory  |      |   |   |   |                       |    |
|       | that       |      |   |   |   |                       |    |
|       | issued the |      |   |   |   |                       |    |
|       | support or |      |   |   |   |                       |    |
|       | w          |      |   |   |   |                       |    |
|       | ithholding |      |   |   |   |                       |    |
|       | order.     |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | The dollar | 449  | 1 | N | R | -   Numeric           | 5a |
| pport | amount to  | -459 | 1 |   |   |                       |    |
| Cu    | be         |      |   |   |   | -   Decimal Assumed   |    |
| rrent | withheld   |      |   |   |   |                       |    |
| Child | for        |      |   |   |   | -   Unsigned          |    |
| A     | payment of |      |   |   |   |                       |    |
| mount | current    |      |   |   |   | -   No Rounding       |    |
|       | child      |      |   |   |   |                       |    |
|       | support.   |      |   |   |   | -   Right Justify     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | Indicates  | 460  | 1 | A | C | If there is a dollar  | 5b |
| pport | the        |      |   | / | R | amount other than     |    |
| Cu    | interval   |      |   | N |   | zero in Support       |    |
| rrent | the        |      |   |   |   | Current Child Amount  |    |
| Child | support    |      |   |   |   | field (449-459), this |    |
| Freq  | current    |      |   |   |   | field is required.    |    |
| uency | amount is  |      |   |   |   |                       |    |
| Code  | required   |      |   |   |   | Valid values:         |    |
|       | to be      |      |   |   |   |                       |    |
|       | paid.      |      |   |   |   | A -- Annually         |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | B -- Bi-Weekly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | M -- Monthly          |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | Q -- Quarterly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | S -- Semi-Monthly     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | W -- Weekly           |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | X -- Semi-Annually    |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | [Space fill if not    |    |
|       |            |      |   |   |   | applicable.]{.mark}   |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | The dollar | 461  | 1 | N | R | -   Numeric           | 6a |
| pport | amount to  | -471 | 1 |   |   |                       |    |
| Past  | be         |      |   |   |   | -   Decimal Assumed   |    |
| Due   | withheld   |      |   |   |   |                       |    |
| Child | for        |      |   |   |   | -   Unsigned          |    |
| A     | payment of |      |   |   |   |                       |    |
| mount | past-due   |      |   |   |   | -   No Rounding       |    |
|       | child      |      |   |   |   |                       |    |
|       | support.   |      |   |   |   | -   Right Justify     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | Indicates  | 472  | 1 | A | C | If there is a dollar  | 6b |
| pport | the        |      |   | / | R | amount other than     |    |
| Past  | interval   |      |   | N |   | zero in Support Past  |    |
| Due   | the        |      |   |   |   | Due Child Amount      |    |
| Child | past-due   |      |   |   |   | field (461-471), this |    |
| Freq  | child      |      |   |   |   | field is required.    |    |
| uency | support    |      |   |   |   |                       |    |
| Code  | amount is  |      |   |   |   | Valid values:         |    |
|       | required   |      |   |   |   |                       |    |
|       | to be      |      |   |   |   | A -- Annually         |    |
|       | paid.      |      |   |   |   |                       |    |
|       |            |      |   |   |   | B -- Bi-Weekly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | M -- Monthly          |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | Q -- Quarterly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | S -- Semi-Monthly     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | W -- Weekly           |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | X -- Semi-Annually    |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | [Space fill if not    |    |
|       |            |      |   |   |   | applicable.]{.mark}   |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | The dollar | 473  | 1 | N | R | -   Numeric           | 7a |
| pport | amount to  | -483 | 1 |   |   |                       |    |
| Cu    | be         |      |   |   |   | -   Decimal Assumed   |    |
| rrent | withheld   |      |   |   |   |                       |    |
| Me    | for        |      |   |   |   | -   Unsigned          |    |
| dical | payment of |      |   |   |   |                       |    |
| A     | current    |      |   |   |   | -   No Rounding       |    |
| mount | medical    |      |   |   |   |                       |    |
|       | support.   |      |   |   |   | -   Right Justify     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | Indicates  | 484  | 1 | A | C | If there is a dollar  | 7b |
| pport | the        |      |   | / | R | amount other than     |    |
| Cu    | interval   |      |   | N |   | zero in Support       |    |
| rrent | the        |      |   |   |   | Current Medical       |    |
| Me    | current    |      |   |   |   | Amount field          |    |
| dical | medical    |      |   |   |   | (473-483), this field |    |
| Freq  | support    |      |   |   |   | is required.          |    |
| uency | amount is  |      |   |   |   |                       |    |
| Code  | required   |      |   |   |   | Valid values:         |    |
|       | to be      |      |   |   |   |                       |    |
|       | paid.      |      |   |   |   | A -- Annually         |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | B -- Bi-Weekly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | M -- Monthly          |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | Q -- Quarterly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | S -- Semi-Monthly     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | W -- Weekly           |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | X -- Semi-Annually    |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | [Space fill if not    |    |
|       |            |      |   |   |   | applicable.]{.mark}   |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | The dollar | 485  | 1 | N | R | -   Numeric           | 8a |
| pport | amount to  | -495 | 1 |   |   |                       |    |
| Past  | be         |      |   |   |   | -   Decimal Assumed   |    |
| Due   | withheld   |      |   |   |   |                       |    |
| Me    | for        |      |   |   |   | -   Unsigned          |    |
| dical | payment of |      |   |   |   |                       |    |
| A     | past-due   |      |   |   |   | -   No Rounding       |    |
| mount | medical    |      |   |   |   |                       |    |
|       | support.   |      |   |   |   | -   Right Justify     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | Indicates  | 496  | 1 | A | C | If there is a dollar  | 8b |
| pport | the        |      |   | / | R | amount other than     |    |
| Past  | interval   |      |   | N |   | zero in Support Past  |    |
| Due   | the        |      |   |   |   | Due Medical Amount    |    |
| Me    | past-due   |      |   |   |   | field (485-495), this |    |
| dical | medical    |      |   |   |   | field is required.    |    |
| Freq  | support    |      |   |   |   |                       |    |
| uency | amount is  |      |   |   |   | Valid values:         |    |
| Code  | required   |      |   |   |   |                       |    |
|       | to be      |      |   |   |   | A -- Annually         |    |
|       | paid.      |      |   |   |   |                       |    |
|       |            |      |   |   |   | B -- Bi-Weekly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | M -- Monthly          |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | Q -- Quarterly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | S -- Semi-Monthly     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | W -- Weekly           |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | X -- Semi-Annually    |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | [Space fill if not    |    |
|       |            |      |   |   |   | applicable.]{.mark}   |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | The dollar | 497  | 1 | N | R | -   Numeric           | 9a |
| pport | amount to  | -507 | 1 |   |   |                       |    |
| Cu    | be         |      |   |   |   | -   Decimal Assumed   |    |
| rrent | withheld   |      |   |   |   |                       |    |
| Sp    | for        |      |   |   |   | -   Unsigned          |    |
| ousal | payment of |      |   |   |   |                       |    |
| A     | current    |      |   |   |   | -   No Rounding       |    |
| mount | spousal    |      |   |   |   |                       |    |
|       | support.   |      |   |   |   | -   Right Justify     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | Indicates  | 508  | 1 | A | C | If there is a dollar  | 9b |
| pport | the        |      |   | / | R | amount other than     |    |
| Cu    | interval   |      |   | N |   | zero in Support       |    |
| rrent | the        |      |   |   |   | Current Spousal       |    |
| Sp    | spousal    |      |   |   |   | Amount field          |    |
| ousal | support is |      |   |   |   | (497-507), this field |    |
| Freq  | required   |      |   |   |   | is required.          |    |
| uency | to be      |      |   |   |   |                       |    |
| Code  | paid.      |      |   |   |   | Valid values:         |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | A -- Annually         |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | B -- Bi-Weekly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | M -- Monthly          |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | Q -- Quarterly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | S -- Semi-Monthly     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | W -- Weekly           |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | X -- Semi-Annually    |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | [Space fill if not    |    |
|       |            |      |   |   |   | applicable.]{.mark}   |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | The dollar | 509  | 1 | N | R | -   Numeric           | 1  |
| pport | amount to  | -519 | 1 |   |   |                       | 0a |
| Past  | be         |      |   |   |   | -   Decimal Assumed   |    |
| Due   | withheld   |      |   |   |   |                       |    |
| Sp    | for        |      |   |   |   | -   Unsigned          |    |
| ousal | payment of |      |   |   |   |                       |    |
| A     | past-due   |      |   |   |   | -   No Rounding       |    |
| mount | spousal    |      |   |   |   |                       |    |
|       | support.   |      |   |   |   | -   Right Justify     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Su    | Indicates  | 520  | 1 | A | C | If there is a dollar  | 1  |
| pport | the        |      |   | / | R | amount other than     | 0b |
| Past  | interval   |      |   | N |   | zero in Support Past  |    |
| Due   | the        |      |   |   |   | Due Spousal Amount    |    |
| Sp    | past-due   |      |   |   |   | field (509-519), this |    |
| ousal | spousal    |      |   |   |   | field is required.    |    |
| Freq  | support    |      |   |   |   |                       |    |
| uency | amount is  |      |   |   |   | Valid values:         |    |
| Code  | required   |      |   |   |   |                       |    |
|       | to be      |      |   |   |   | A -- Annually         |    |
|       | paid.      |      |   |   |   |                       |    |
|       |            |      |   |   |   | B -- Bi-Weekly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | M -- Monthly          |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | Q -- Quarterly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | S -- Semi-Monthly     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | W -- Weekly           |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | X -- Semi-Annually    |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | [Space fill if not    |    |
|       |            |      |   |   |   | applicable.]{.mark}   |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Oblig | The dollar | 521  | 1 | N | R | -   Numeric           | 1  |
| ation | amount to  | -531 | 1 |   |   |                       | 1a |
| Other | be         |      |   |   |   | -   Decimal Assumed   |    |
| A     | withheld   |      |   |   |   |                       |    |
| mount | for        |      |   |   |   | -   Unsigned          |    |
|       | payment of |      |   |   |   |                       |    |
|       | mis        |      |   |   |   | -   No Rounding       |    |
|       | cellaneous |      |   |   |   |                       |    |
|       | ob         |      |   |   |   | -   Right Justify     |    |
|       | ligations. |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Oblig | Indicates  | 532  | 1 | A | C | If there is a dollar  | 1  |
| ation | the        |      |   | / | R | amount other than     | 1b |
| Other | interval   |      |   | N |   | zero in Obligation    |    |
| Freq  | the        |      |   |   |   | Other Amount field    |    |
| uency | mis        |      |   |   |   | (521-531), this field |    |
| Code  | cellaneous |      |   |   |   | is required.          |    |
|       | o          |      |   |   |   |                       |    |
|       | bligations |      |   |   |   | Valid Values:         |    |
|       | amount is  |      |   |   |   |                       |    |
|       | required   |      |   |   |   | A -- Annually         |    |
|       | to be      |      |   |   |   |                       |    |
|       | paid.      |      |   |   |   | B -- Bi-Weekly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | M -- Monthly          |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | Q -- Quarterly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | S -- Semi-Monthly     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | W -- Weekly           |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | X -- Semi-Annually    |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | [Space fill if not    |    |
|       |            |      |   |   |   | applicable.]{.mark}   |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Oblig | D          | 533  | 3 | A | C | If there is a dollar  | 1  |
| ation | escription | -567 | 5 | / | R | amount other than     | 1c |
| Other | of the     |      |   | N |   | zero in Obligation    |    |
| D     | mis        |      |   |   |   | Other Amount field    |    |
| escri | cellaneous |      |   |   |   | (521-531), this field |    |
| ption | ob         |      |   |   |   | is required.          |    |
| Text  | ligations. |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Oblig | The sum of | 568  | 1 | N | R | -   Numeric           | 1  |
| ation | the        | -578 | 1 |   |   |                       | 2a |
| Total | current    |      |   |   |   | -   Decimal Assumed   |    |
| A     | child      |      |   |   |   |                       |    |
| mount | support,   |      |   |   |   | -   Unsigned          |    |
|       | the        |      |   |   |   |                       |    |
|       | past-due   |      |   |   |   | -   No Rounding       |    |
|       | child      |      |   |   |   |                       |    |
|       | support,   |      |   |   |   | -   Right Justify     |    |
|       | the        |      |   |   |   |                       |    |
|       | current    |      |   |   |   | -   Zero Fill to Left |    |
|       | cash       |      |   |   |   |                       |    |
|       | medical    |      |   |   |   | -   Zero Fill if N/A  |    |
|       | support,   |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | past-due   |      |   |   |   |                       |    |
|       | cash       |      |   |   |   |                       |    |
|       | medical    |      |   |   |   |                       |    |
|       | support,   |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | current    |      |   |   |   |                       |    |
|       | spousal    |      |   |   |   |                       |    |
|       | support,   |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | past-due   |      |   |   |   |                       |    |
|       | spousal    |      |   |   |   |                       |    |
|       | support,   |      |   |   |   |                       |    |
|       | and the    |      |   |   |   |                       |    |
|       | mis        |      |   |   |   |                       |    |
|       | cellaneous |      |   |   |   |                       |    |
|       | ob         |      |   |   |   |                       |    |
|       | ligations. |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Oblig | Indicates  | 579  | 1 | A | C | If there is a dollar  | 1  |
| ation | the        |      |   | / | R | amount other than     | 2b |
| Total | interval   |      |   | N |   | zero in Obligation    |    |
| Freq  | the total  |      |   |   |   | Total Amount field    |    |
| uency | obligation |      |   |   |   | (pos. 568-578), this  |    |
| Code  | is         |      |   |   |   | field is required.    |    |
|       | required   |      |   |   |   |                       |    |
|       | to be      |      |   |   |   | Valid Values:         |    |
|       | paid.      |      |   |   |   |                       |    |
|       |            |      |   |   |   | A -- Annually         |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | B -- Bi-Weekly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | M -- Monthly          |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | Q -- Quarterly        |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | S -- Semi-Monthly     |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | W -- Weekly           |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | X -- Semi-Annually    |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | [Space fill if not    |    |
|       |            |      |   |   |   | applicable.]{.mark}   |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Ar    | Indicates  | 580  | 1 | A | O | Valid values:         | 6c |
| rears | whether    |      |   | / |   |                       |    |
| 12wk  | past due   |      |   | N |   | Y -- Greater than 12  |    |
| Ov    | child      |      |   |   |   | weeks                 |    |
| erdue | support is |      |   |   |   |                       |    |
| Code  | in arrears |      |   |   |   | N -- Not Greater than |    |
|       | for a      |      |   |   |   | 12 weeks              |    |
|       | period     |      |   |   |   |                       |    |
|       | longer     |      |   |   |   | [Space]{.mark}        |    |
|       | than 12    |      |   |   |   | allowed.              |    |
|       | weeks.     |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| I     | The amount | 581  | 1 | N | R | -   Numeric           | 1  |
| ncome | the        | -591 | 1 |   |   |                       | 3a |
| W     | employer   |      |   |   |   | -   Decimal Assumed   |    |
| ithho | should     |      |   |   |   |                       |    |
| lding | withhold   |      |   |   |   | -   Unsigned          |    |
| Dedu  | if the     |      |   |   |   |                       |    |
| ction | employee   |      |   |   |   | -   No Rounding       |    |
| W     | is paid    |      |   |   |   |                       |    |
| eekly | weekly.    |      |   |   |   | -   Right Justify     |    |
| A     |            |      |   |   |   |                       |    |
| mount |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| I     | The amount | 592  | 1 | N | R | -   Numeric           | 1  |
| ncome | the        | -602 | 1 |   |   |                       | 3b |
| W     | employer   |      |   |   |   | -   Decimal Assumed   |    |
| ithho | should     |      |   |   |   |                       |    |
| lding | withhold   |      |   |   |   | -   Unsigned          |    |
| Dedu  | if the     |      |   |   |   |                       |    |
| ction | employee   |      |   |   |   | -   No Rounding       |    |
| Bi-W  | is paid    |      |   |   |   |                       |    |
| eekly | every two  |      |   |   |   | -   Right Justify     |    |
| A     | weeks.     |      |   |   |   |                       |    |
| mount |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| I     | The amount | 603  | 1 | N | R | -   Numeric           | 1  |
| ncome | the        | -613 | 1 |   |   |                       | 3c |
| W     | employer   |      |   |   |   | -   Decimal Assumed   |    |
| ithho | should     |      |   |   |   |                       |    |
| lding | withhold   |      |   |   |   | -   Unsigned          |    |
| S     | if the     |      |   |   |   |                       |    |
| emimo | employee   |      |   |   |   | -   No Rounding       |    |
| nthly | is paid    |      |   |   |   |                       |    |
| A     | twice a    |      |   |   |   | -   Right Justify     |    |
| mount | month.     |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| I     | The amount | 614  | 1 | N | R | -   Numeric           | 1  |
| ncome | the        | -624 | 1 |   |   |                       | 3d |
| W     | employer   |      |   |   |   | -   Decimal Assumed   |    |
| ithho | should     |      |   |   |   |                       |    |
| lding | withhold   |      |   |   |   | -   Unsigned          |    |
| Mo    | if the     |      |   |   |   |                       |    |
| nthly | employee   |      |   |   |   | -   No Rounding       |    |
| A     | is paid    |      |   |   |   |                       |    |
| mount | once a     |      |   |   |   | -   Right Justify     |    |
|       | month.     |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill to Left |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   Zero Fill if N/A  |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emplo | The State, | 625  | 3 | A | O |                       | 15 |
| yment | Tribe or   | -659 | 5 | / |   |                       |    |
| Place | Territory  |      |   | N |   |                       |    |
| Name  | where the  |      |   |   |   |                       |    |
|       | NCP is     |      |   |   |   |                       |    |
|       | employed   |      |   |   |   |                       |    |
|       | -- used to |      |   |   |   |                       |    |
|       | advise the |      |   |   |   |                       |    |
|       | employer   |      |   |   |   |                       |    |
|       | about      |      |   |   |   |                       |    |
|       | w          |      |   |   |   |                       |    |
|       | ithholding |      |   |   |   |                       |    |
|       | li         |      |   |   |   |                       |    |
|       | mitations, |      |   |   |   |                       |    |
|       | req        |      |   |   |   |                       |    |
|       | uirements, |      |   |   |   |                       |    |
|       | etc.       |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Begin | The number | 660  | 2 | N | R |                       | 16 |
| W     | of days    | -661 |   |   |   |                       |    |
| ithho | within     |      |   |   |   |                       |    |
| lding | which the  |      |   |   |   |                       |    |
| W     | employer   |      |   |   |   |                       |    |
| ithin | must       |      |   |   |   |                       |    |
| Days  | commence   |      |   |   |   |                       |    |
| N     | income     |      |   |   |   |                       |    |
| umber | wi         |      |   |   |   |                       |    |
|       | thholding. |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| I     | The        | 662  | 8 | A | R | Must be [a valid      | 17 |
| ncome | effective  | -669 |   | / |   | date]{.mark} in       |    |
| W     | date of    |      |   | N |   | CCYYMMDD format.      |    |
| ithho | the income |      |   |   |   |                       |    |
| lding | wi         |      |   |   |   |                       |    |
| Start | thholding. |      |   |   |   |                       |    |
| Date  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Send  | Number of  | 670  | 2 | N | R |                       | 18 |
| Pa    | days       | -671 |   |   |   |                       |    |
| yment | within     |      |   |   |   |                       |    |
| W     | which an   |      |   |   |   |                       |    |
| ithin | employer   |      |   |   |   |                       |    |
| Days  | or other   |      |   |   |   |                       |    |
| N     | withholder |      |   |   |   |                       |    |
| umber | of income  |      |   |   |   |                       |    |
|       | must remit |      |   |   |   |                       |    |
|       | amounts    |      |   |   |   |                       |    |
|       | withheld   |      |   |   |   |                       |    |
|       | pursuant   |      |   |   |   |                       |    |
|       | to the     |      |   |   |   |                       |    |
|       | issuing    |      |   |   |   |                       |    |
|       | State's    |      |   |   |   |                       |    |
|       | law.       |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| I     | The        | 672  | 2 | N | R |                       | 20 |
| ncome | highest    | -673 |   |   |   |                       |    |
| W     | percentage |      |   |   |   |                       |    |
| ithho | of income  |      |   |   |   |                       |    |
| lding | that can   |      |   |   |   |                       |    |
| CCPA  | be         |      |   |   |   |                       |    |
| Pe    | withheld   |      |   |   |   |                       |    |
| rcent | from the   |      |   |   |   |                       |    |
| Rate  | employee   |      |   |   |   |                       |    |
|       | or         |      |   |   |   |                       |    |
|       | obligor's  |      |   |   |   |                       |    |
|       | wages.     |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Payee | The name   | 674  | 5 | A | R | [The first character  | 21 |
| Name  | of the     | -730 | 7 | / |   | must not be a         |    |
|       | State      |      |   | N |   | space.]{.mark}        |    |
|       | Di         |      |   |   |   |                       |    |
|       | sbursement |      |   |   |   |                       |    |
|       | Unit,      |      |   |   |   |                       |    |
|       | i          |      |   |   |   |                       |    |
|       | ndividual, |      |   |   |   |                       |    |
|       | tribu      |      |   |   |   |                       |    |
|       | nal/court, |      |   |   |   |                       |    |
|       | or Tribal  |      |   |   |   |                       |    |
|       | child      |      |   |   |   |                       |    |
|       | support    |      |   |   |   |                       |    |
|       | e          |      |   |   |   |                       |    |
|       | nforcement |      |   |   |   |                       |    |
|       | agency to  |      |   |   |   |                       |    |
|       | which      |      |   |   |   |                       |    |
|       | payments   |      |   |   |   |                       |    |
|       | are        |      |   |   |   |                       |    |
|       | required   |      |   |   |   |                       |    |
|       | to be      |      |   |   |   |                       |    |
|       | sent.      |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Payee | Line 1 of  | 731  | 2 | A | O |                       | 23 |
| Ad    | the        | -755 | 5 | / |   |                       |    |
| dress | payee's    |      |   | N |   |                       |    |
| Line  | address.   |      |   |   |   |                       |    |
| 1     |            |      |   |   |   |                       |    |
| Text  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Payee | Line 2 of  | 756  | 2 | A | O |                       | 23 |
| Ad    | the        | -780 | 5 | / |   |                       | -1 |
| dress | payee's    |      |   | N |   |                       |    |
| Line  | address.   |      |   |   |   |                       |    |
| 2     |            |      |   |   |   |                       |    |
| Text  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Payee | Payee's    | 781  | 2 | A | O |                       | 23 |
| Ad    | city       | -802 | 2 | / |   |                       | -2 |
| dress | address.   |      |   | N |   |                       |    |
| City  |            |      |   |   |   |                       |    |
| Name  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Payee | Payee's    | 803  | 2 | A | O | Valid two-character   | 23 |
| Ad    | State      | -804 |   |   |   | alphabetic State [or  | -3 |
| dress | code.      |      |   |   |   | Territory]{.mark}     |    |
| State |            |      |   |   |   | Code.                 |    |
| Code  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Payee | Payee's    | 805  | 5 | N | O |                       | 23 |
| Ad    | ZIP Code.  | -809 |   |   |   |                       | -4 |
| dress |            |      |   |   |   |                       |    |
| ZIP   |            |      |   |   |   |                       |    |
| Code  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Payee | Payee's    | 810  | 4 | [ | O |                       | 23 |
| Ad    | extension  | -813 |   | A |   |                       | -5 |
| dress | ZIP Code.  |      |   | / |   |                       |    |
| Ext   |            |      |   | ] |   |                       |    |
| ZIP   |            |      |   | { |   |                       |    |
| Code  |            |      |   | . |   |                       |    |
|       |            |      |   | m |   |                       |    |
|       |            |      |   | a |   |                       |    |
|       |            |      |   | r |   |                       |    |
|       |            |      |   | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
|       |            |      |   | N |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Payee | State and  | 814  | 7 | N | R | Either State and      | 24 |
| Remit | County     | -820 |   |   |   | County FIPS or Tribal |    |
| tance | FIPS Code  |      |   |   |   | Place Code. The first |    |
| FIPS  | for        |      |   |   |   | two characters are    |    |
| Code  | remitting  |      |   |   |   | the State Code. The   |    |
|       | payments   |      |   |   |   | next three are the    |    |
|       | via        |      |   |   |   | County Code. The last |    |
|       | EFT/EDI.   |      |   |   |   | two are filled by the |    |
|       |            |      |   |   |   | user.                 |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | Only the first five   |    |
|       |            |      |   |   |   | characters (State     |    |
|       |            |      |   |   |   | Code and County Code) |    |
|       |            |      |   |   |   | are required.         |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Gover | Name of    | 821  | 7 | A | R | [The first character  | 26 |
| nment | government | -890 | 0 | / |   | must not be a         |    |
| Off   | official   |      |   | N |   | space.]{.mark}        |    |
| icial | a          |      |   |   |   |                       |    |
| Name  | uthorizing |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | document.  |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Is    | Title of   | 891  | 5 | A | R | [The first character  | 27 |
| suing | go         | -940 | 0 | / |   | must not be a         |    |
| Off   | vernmental |      |   | N |   | space.]{.mark}        |    |
| icial | official   |      |   |   |   |                       |    |
| Title | a          |      |   |   |   |                       |    |
| Text  | uthorizing |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | document.  |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| F     | Future Use | 941  | 1 | A | [ | Future use            |    |
| iller |            |      |   | / | O |                       |    |
|       |            |      |   | N | ] |                       |    |
|       |            |      |   |   | { |                       |    |
|       |            |      |   |   | . |                       |    |
|       |            |      |   |   | m |                       |    |
|       |            |      |   |   | a |                       |    |
|       |            |      |   |   | r |                       |    |
|       |            |      |   |   | k |                       |    |
|       |            |      |   |   | } |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Send  | Indicates  | 942  | 1 | A | R | Valid values:         | 28 |
| Emp   | if         |      |   | / |   |                       |    |
| loyee | employer   |      |   | N |   | Y -- Yes              |    |
| Copy  | is         |      |   |   |   |                       |    |
| Indi  | required   |      |   |   |   | N -- No               |    |
| cator | to provide |      |   |   |   |                       |    |
|       | a copy of  |      |   |   |   |                       |    |
|       | the notice |      |   |   |   |                       |    |
|       | to the     |      |   |   |   |                       |    |
|       | employee.  |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Pe    | Describes  | 943- | 1 | A | O | States should insert  | 29 |
| nalty | additiona  | 1102 | 6 | / |   | the citation for the  |    |
| Liab  | l/specific |      | 0 | N |   | appropriate "Penalty  |    |
| ility | State,     |      |   |   |   | Liability" text from  |    |
| Info  | Tribal, or |      |   |   |   | their State law.      |    |
| Text  | Territory  |      |   |   |   |                       |    |
|       | penalties  |      |   |   |   |                       |    |
|       | or         |      |   |   |   |                       |    |
|       | l          |      |   |   |   |                       |    |
|       | iabilities |      |   |   |   |                       |    |
|       | regarding  |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | employer's |      |   |   |   |                       |    |
|       | failure to |      |   |   |   |                       |    |
|       | obey the   |      |   |   |   |                       |    |
|       | notice.    |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Anti  | Describes  | 1    | 1 | A | O | States should insert  | 30 |
| disc  | additiona  | 103- | 6 | / |   | the citation for the  |    |
| rimin | l/specific | 1262 | 0 | N |   | appropriate           |    |
| ation | i          |      |   |   |   | "Anti-discrimination" |    |
| Provi | nformation |      |   |   |   | text from their State |    |
| sions | if the     |      |   |   |   | law.                  |    |
| Text  | employer   |      |   |   |   |                       |    |
|       | d          |      |   |   |   |                       |    |
|       | ischarges, |      |   |   |   |                       |    |
|       | fails to   |      |   |   |   |                       |    |
|       | employ, or |      |   |   |   |                       |    |
|       | d          |      |   |   |   |                       |    |
|       | isciplines |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | employee   |      |   |   |   |                       |    |
|       | as a       |      |   |   |   |                       |    |
|       | result of  |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | notice.    |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Spe   | Additional | 1    | 1 | A | O |                       | 31 |
| cific | I          | 263- | 6 | / |   |                       |    |
| Payee | nformation | 1422 | 0 | N |   |                       |    |
| W     | regarding  |      |   |   |   |                       |    |
| ithho | w          |      |   |   |   |                       |    |
| lding | ithholding |      |   |   |   |                       |    |
| L     | li         |      |   |   |   |                       |    |
| imits | mitations. |      |   |   |   |                       |    |
| Text  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Contact    | 1    | 5 | A | O |                       | 37 |
| loyee | name.      | 423- | 7 | / |   |                       |    |
| State |            | 1479 |   | N |   |                       |    |
| Co    |            |      |   |   |   |                       |    |
| ntact |            |      |   |   |   |                       |    |
| Name  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Contact    | 1    | 1 | [ | O |                       | 38 |
| loyee | phone      | 480- | 0 | A |   |                       |    |
| State | number.    | 1489 |   | / |   |                       |    |
| Co    |            |      |   | ] |   |                       |    |
| ntact |            |      |   | { |   |                       |    |
| Phone |            |      |   | . |   |                       |    |
| N     |            |      |   | m |   |                       |    |
| umber |            |      |   | a |   |                       |    |
|       |            |      |   | r |   |                       |    |
|       |            |      |   | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
|       |            |      |   | N |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Contact    | 1    | 1 | [ | O |                       | 39 |
| loyee | fax        | 490- | 0 | A |   |                       |    |
| State | number.    | 1499 |   | / |   |                       |    |
| Co    |            |      |   | ] |   |                       |    |
| ntact |            |      |   | { |   |                       |    |
| Fax   |            |      |   | . |   |                       |    |
| N     |            |      |   | m |   |                       |    |
| umber |            |      |   | a |   |                       |    |
|       |            |      |   | r |   |                       |    |
|       |            |      |   | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
|       |            |      |   | N |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Contact    | 1    | 4 | A | O |                       | 40 |
| loyee | e-Mail     | 500- | 8 | / |   |                       |    |
| State | address.   | 1547 |   | N |   |                       |    |
| Co    |            |      |   |   |   |                       |    |
| ntact |            |      |   |   |   |                       |    |
| Email |            |      |   |   |   |                       |    |
| Ad    |            |      |   |   |   |                       |    |
| dress |            |      |   |   |   |                       |    |
| Text  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Doc   | A number   | 1    | 3 | A | O | First two digits must | 19 |
| ument | assigned   | 548- | 0 | / |   | begin with numeric    |    |
| Tra   | by the     | 1577 |   | N |   | FIPS State Code.      |    |
| cking | entity     |      |   |   |   |                       |    |
| N     | sending    |      |   |   |   |                       |    |
| umber | the        |      |   |   |   |                       |    |
|       | document   |      |   |   |   |                       |    |
|       | that       |      |   |   |   |                       |    |
|       | uniquely   |      |   |   |   |                       |    |
|       | identifies |      |   |   |   |                       |    |
|       | the        |      |   |   |   |                       |    |
|       | document.  |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Order | A unique   | 1    | 3 | A | O |                       | 1i |
| Ident | identifier | 578- | 0 | / |   |                       |    |
| ifier | that is    | 1607 |   | N |   |                       |    |
|       | associated |      |   |   |   |                       |    |
|       | with a     |      |   |   |   |                       |    |
|       | specific   |      |   |   |   |                       |    |
|       | child      |      |   |   |   |                       |    |
|       | support    |      |   |   |   |                       |    |
|       | obligation |      |   |   |   |                       |    |
|       | within a   |      |   |   |   |                       |    |
|       | case.      |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Employer   | 1    | 5 | A | O |                       | 32 |
| loyer | outreach   | 608- | 7 | / |   |                       |    |
| State | or         | 1664 |   | N |   |                       |    |
| Co    | customer   |      |   |   |   |                       |    |
| ntact | service    |      |   |   |   |                       |    |
| Name  | contact    |      |   |   |   |                       |    |
|       | name.      |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Line 1 of  | 1    | 2 | A | O |                       | 36 |
| loyer | the        | 665- | 5 | / |   |                       | -1 |
| State | employer   | 1689 |   | N |   |                       |    |
| Co    | outreach   |      |   |   |   |                       |    |
| ntact | or         |      |   |   |   |                       |    |
| Ad    | customer   |      |   |   |   |                       |    |
| dress | service    |      |   |   |   |                       |    |
| Line  | contact's  |      |   |   |   |                       |    |
| 1     | address.   |      |   |   |   |                       |    |
| Text  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Line 2 of  | 1    | 2 | A | O |                       | 36 |
| loyer | the        | 690- | 5 | / |   |                       | -2 |
| State | employer   | 1714 |   | N |   |                       |    |
| Co    | outreach   |      |   |   |   |                       |    |
| ntact | or         |      |   |   |   |                       |    |
| Ad    | customer   |      |   |   |   |                       |    |
| dress | service    |      |   |   |   |                       |    |
| Line  | contact's  |      |   |   |   |                       |    |
| 2     | address.   |      |   |   |   |                       |    |
| Text  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Employer   | 1    | 2 | A | O |                       | 36 |
| loyer | outreach   | 715- | 2 | / |   |                       | -3 |
| State | or         | 1736 |   | N |   |                       |    |
| Co    | customer   |      |   |   |   |                       |    |
| ntact | service    |      |   |   |   |                       |    |
| Ad    | contact's  |      |   |   |   |                       |    |
| dress | city       |      |   |   |   |                       |    |
| City  | address.   |      |   |   |   |                       |    |
| Name  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Employer   | 1    | 2 | A | O | Valid two-character   | 36 |
| loyer | outreach   | 737- |   |   |   | alphabetic State [or  | -4 |
| State | or         | 1738 |   |   |   | Territory]{.mark}     |    |
| Co    | customer   |      |   |   |   | Code.                 |    |
| ntact | service    |      |   |   |   |                       |    |
| Ad    | contact's  |      |   |   |   |                       |    |
| dress | State      |      |   |   |   |                       |    |
| State | code.      |      |   |   |   |                       |    |
| Code  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Employer   | 1    | 5 | N | O |                       | 36 |
| loyer | outreach   | 739- |   |   |   |                       | -5 |
| State | or         | 1743 |   |   |   |                       |    |
| Co    | customer   |      |   |   |   |                       |    |
| ntact | service    |      |   |   |   |                       |    |
| Ad    | ZIP Code.  |      |   |   |   |                       |    |
| dress |            |      |   |   |   |                       |    |
| ZIP   |            |      |   |   |   |                       |    |
| Code  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Employer   | 1    | 4 | [ | O |                       | 36 |
| loyer | outreach   | 744- |   | A |   |                       | -6 |
| State | or         | 1747 |   | / |   |                       |    |
| Co    | customer   |      |   | ] |   |                       |    |
| ntact | Service    |      |   | { |   |                       |    |
| Ad    | contact's  |      |   | . |   |                       |    |
| dress | extension  |      |   | m |   |                       |    |
| Ext   | ZIP Code.  |      |   | a |   |                       |    |
| ZIP   |            |      |   | r |   |                       |    |
| Code  |            |      |   | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
|       |            |      |   | N |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Employer   | 1    | 1 | [ | O |                       | 33 |
| loyer | outreach   | 748- | 0 | A |   |                       |    |
| State | or         | 1757 |   | / |   |                       |    |
| Co    | customer   |      |   | ] |   |                       |    |
| ntact | service    |      |   | { |   |                       |    |
| Phone | contact    |      |   | . |   |                       |    |
| N     | phone      |      |   | m |   |                       |    |
| umber | number.    |      |   | a |   |                       |    |
|       |            |      |   | r |   |                       |    |
|       |            |      |   | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
|       |            |      |   | N |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Employer   | 1    | 1 | [ | O |                       | 34 |
| loyer | outreach   | 758- | 0 | A |   |                       |    |
| State | or         | 1767 |   | / |   |                       |    |
| Co    | customer   |      |   | ] |   |                       |    |
| ntact | service    |      |   | { |   |                       |    |
| Fax   | contact    |      |   | . |   |                       |    |
| N     | fax        |      |   | m |   |                       |    |
| umber | number.    |      |   | a |   |                       |    |
|       |            |      |   | r |   |                       |    |
|       |            |      |   | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
|       |            |      |   | N |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Emp   | Employer   | 1    | 4 | A | O |                       | 35 |
| loyer | outreach   | 768- | 8 | / |   |                       |    |
| State | or         | 1815 |   | N |   |                       |    |
| Co    | customer   |      |   |   |   |                       |    |
| ntact | service    |      |   |   |   |                       |    |
| Email | contact    |      |   |   |   |                       |    |
| Ad    | e-mail     |      |   |   |   |                       |    |
| dress | address.   |      |   |   |   |                       |    |
| Text  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 2 | A | O | Letters A-Z or        | 3d |
| 1     | last name. | 816- | 0 | / |   | spaces. No special    |    |
| Last  |            | 1835 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 1 | A | R | Letters A-Z or        | 3d |
| 1     | first      | 836- | 5 | / |   | spaces. No special    | -1 |
| First | name.      | 1850 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed. [The first   |    |
|       |            |      |   |   |   | character must not be |    |
|       |            |      |   |   |   | a space.]{.mark}      |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 1 | A | O | Letters A-Z or        | 3d |
| 1     | middle     | 851- | 5 | / |   | spaces. No special    | -2 |
| M     | name or    | 1865 |   | N |   | characters or         |    |
| iddle | initial.   |      |   |   |   | imbedded spaces       |    |
| Name  |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 4 | A | O |                       | 3d |
| 1     | name       | 866- |   | / |   |                       | -3 |
| S     | suffix.    | 1869 |   | N |   |                       |    |
| uffix |            |      |   |   |   |                       |    |
| Name  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 8 | A | O | Must be [a valid      | 3e |
| 1     | date of    | 870- |   | / |   | date]{.mark} in       |    |
| Birth | birth.     | 1877 |   | N |   | CCYYMMDD format.      |    |
| Date  |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | If unknown, fill this |    |
|       |            |      |   |   |   | field with spaces.    |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 2 | A | O | Letters A-Z or        | 3f |
| 2     | last name. | 878- | 0 | / |   | spaces. No special    |    |
| Last  |            | 1897 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 1 | A | C | Letters A-Z or        | 3f |
| 2     | first      | 898- | 5 | / | R | spaces. No special    | -1 |
| First | name.      | 1912 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | If there is any other |    |
|       |            |      |   |   |   | data present for      |    |
|       |            |      |   |   |   | Child 2, this field   |    |
|       |            |      |   |   |   | is required.          |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 1 | A | O | Letters A-Z or        | 3f |
| 2     | middle     | 913- | 5 | / |   | spaces. No special    | -2 |
| M     | name or    | 1927 |   | N |   | characters or         |    |
| iddle | initial.   |      |   |   |   | imbedded spaces.      |    |
| Name  |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 4 | A | O |                       | 3f |
| 2     | name       | 928- |   | / |   |                       | -3 |
| S     | suffix.    | 1931 |   | N |   |                       |    |
| uffix |            |      |   |   |   |                       |    |
| Name  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 8 | A | O | Must be [a valid      | 3g |
| 2     | date of    | 932- |   | / |   | date]{.mark} in       |    |
| Birth | birth.     | 1939 |   | N |   | CCYYMMDD format.      |    |
| Date  |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | If unknown, fill this |    |
|       |            |      |   |   |   | field with spaces.    |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 2 | A | O | Letters A-Z or        | 3h |
| 3     | last name. | 940- | 0 | / |   | spaces. No special    |    |
| Last  |            | 1959 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 1 | A | C | Letters A-Z or        | 3h |
| 3     | first      | 960- | 5 | / | R | spaces. No special    | -1 |
| First | name.      | 1974 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | If there is any other |    |
|       |            |      |   |   |   | data present for      |    |
|       |            |      |   |   |   | Child 3, this field   |    |
|       |            |      |   |   |   | is required.          |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 1 | A | O | Letters A-Z or        | 3h |
| 3     | middle     | 975- | 5 | / |   | spaces. No special    | -2 |
| M     | name or    | 1989 |   | N |   | characters or         |    |
| iddle | initial.   |      |   |   |   | imbedded spaces.      |    |
| Name  |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 4 | A | O |                       | 3h |
| 3     | name       | 990- |   | / |   |                       | -3 |
| S     | suffix.    | 1993 |   | N |   |                       |    |
| uffix |            |      |   |   |   |                       |    |
| Name  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 1    | 8 | [ | O | Must be [a valid      | 3i |
| 3     | date of    | 994- |   | A |   | date]{.mark} in       |    |
| Birth | birth.     | 2001 |   | / |   | CCYYMMDD format.      |    |
| Date  |            |      |   | ] |   |                       |    |
|       |            |      |   | { |   | If unknown, fill this |    |
|       |            |      |   | . |   | field with spaces.    |    |
|       |            |      |   | m |   |                       |    |
|       |            |      |   | a |   |                       |    |
|       |            |      |   | r |   |                       |    |
|       |            |      |   | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
|       |            |      |   | N |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 2 | A | O | Letters A-Z or        | 3j |
| 4     | last name. | 002- | 0 | / |   | spaces. No special    |    |
| Last  |            | 2021 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 1 | A | C | Letters A-Z or        | 3j |
| 4     | first      | 022- | 5 | / | R | spaces. No special    | -1 |
| First | name.      | 2036 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | If there is any other |    |
|       |            |      |   |   |   | data present for      |    |
|       |            |      |   |   |   | Child 4, this field   |    |
|       |            |      |   |   |   | is required.          |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 1 | A | O | Letters A-Z or        | 3j |
| 4     | middle     | 037- | 5 | / |   | spaces. No special    | -2 |
| M     | name or    | 2051 |   | N |   | characters or         |    |
| iddle | initial.   |      |   |   |   | imbedded spaces.      |    |
| Name  |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 4 | A | O |                       | 3j |
| 4     | name       | 052- |   | / |   |                       | -3 |
| S     | suffix.    | 2055 |   | N |   |                       |    |
| uffix |            |      |   |   |   |                       |    |
| Name  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 8 | A | O | Must be [a valid      | 3k |
| 4     | date of    | 056- |   | / |   | date]{.mark} in       |    |
| Birth | birth.     | 2063 |   | N |   | CCYYMMDD format.      |    |
| Date  |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | If unknown, fill this |    |
|       |            |      |   |   |   | field with spaces.    |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 2 | A | O | Letters A-Z or        | 3l |
| 5     | last name. | 064- | 0 | / |   | spaces. No special    |    |
| Last  |            | 2083 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 1 | A | C | Letters A-Z or        | 3l |
| 5     | first      | 084- | 5 | / | R | spaces. No special    | -1 |
| First | name.      | 2098 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | If there is any other |    |
|       |            |      |   |   |   | data present for      |    |
|       |            |      |   |   |   | Child 5, this field   |    |
|       |            |      |   |   |   | is required.          |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 1 | A | O | Letters A-Z or        | 3l |
| 5     | middle     | 099- | 5 | / |   | spaces. No special    | -2 |
| M     | name or    | 2113 |   | N |   | characters or         |    |
| iddle | initial.   |      |   |   |   | imbedded spaces.      |    |
| Name  |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 4 | A | O |                       | 3l |
| 5     | name       | 114- |   | / |   |                       | -3 |
| S     | suffix.    | 2117 |   | N |   |                       |    |
| uffix |            |      |   |   |   |                       |    |
| Name  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 8 | A | O | Must be [a valid      | 3m |
| 5     | date of    | 118- |   | / |   | date]{.mark} in       |    |
| Birth | birth.     | 2125 |   | N |   | CCYYMMDD format.      |    |
| Date  |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | If unknown, fill this |    |
|       |            |      |   |   |   | field with spaces.    |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 2 | A | O | Letters A-Z or        | 3n |
| 6     | last name. | 126- | 0 | / |   | spaces. No special    |    |
| Last  |            | 2145 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 1 | A | C | Letters A-Z or        | 3n |
| 6     | first      | 146- | 5 | / | R | spaces. No special    | -1 |
| First | name.      | 2160 |   | N |   | characters or         |    |
| Name  |            |      |   |   |   | imbedded spaces.      |    |
|       |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | If there is any other |    |
|       |            |      |   |   |   | data present for      |    |
|       |            |      |   |   |   | Child 6, this field   |    |
|       |            |      |   |   |   | is required.          |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 1 | A | O | Letters A-Z or        | 3n |
| 6     | middle     | 161- | 5 | / |   | spaces. No special    | -2 |
| M     | name or    | 2175 |   | N |   | characters or         |    |
| iddle | initial.   |      |   |   |   | imbedded spaces.      |    |
| Name  |            |      |   |   |   | Hyphens and           |    |
|       |            |      |   |   |   | apostrophes are       |    |
|       |            |      |   |   |   | allowed.              |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 4 | A | O |                       | 3n |
| 6     | name       | 176- |   | / |   |                       | -3 |
| S     | suffix.    | 2179 |   | N |   |                       |    |
| uffix |            |      |   |   |   |                       |    |
| Name  |            |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| Child | Child's    | 2    | 8 | A | O | Must be [a valid      | 3o |
| 6     | date of    | 180- |   | / |   | date]{.mark} in       |    |
| Birth | birth.     | 2187 |   | N |   | CCYYMMDD format.      |    |
| Date  |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | If unknown, fill this |    |
|       |            |      |   |   |   | field with spaces.    |    |
+-------+------------+------+---+---+---+-----------------------+----+
| [Lump | [The       | [2   | [ | [ | [ | [If the Document      | 14 |
| Sum   | dollar     | 188- | 1 | N | R | Action Code (pos 7-9) |    |
| Pa    | amount     | 2198 | 1 | ] | ] | is 'LUM' this field   |    |
| yment | that       | ]{.m | ] | { | { | is required.]{.mark}  |    |
| Amou  | should be  | ark} | { | . | . |                       |    |
| nt]{. | withheld   |      | . | m | m | -   [Numeric]{.mark}  |    |
| mark} | from a     |      | m | a | a |                       |    |
|       | "Lump Sum" |      | a | r | r | -   [Decimal          |    |
|       | paymen     |      | r | k | k |     Assumed]{.mark}   |    |
|       | t.]{.mark} |      | k | } | } |                       |    |
|       |            |      | } |   |   | -   [Unsigned]{.mark} |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   [No               |    |
|       |            |      |   |   |   |     Rounding]{.mark}  |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   [Right            |    |
|       |            |      |   |   |   |     Justify]{.mark}   |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   [Zero Fill to     |    |
|       |            |      |   |   |   |     Left]{.mark}      |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | -   [Zero Fill if     |    |
|       |            |      |   |   |   |     N/A]{.mark}       |    |
|       |            |      |   |   |   |                       |    |
|       |            |      |   |   |   | [If the Document      |    |
|       |            |      |   |   |   | Action Code (pos.     |    |
|       |            |      |   |   |   | 7-9) is 'TRM', 'ORG'  |    |
|       |            |      |   |   |   | or 'AMD', fill this   |    |
|       |            |      |   |   |   | field with            |    |
|       |            |      |   |   |   | zeros.]{.mark}        |    |
+-------+------------+------+---+---+---+-----------------------+----+
| [Fill | [For       | [2   | [ | [ | [ | [For Future           | [  |
| er]{. | Future     | 199- | 9 | A | O | Use]{.mark}           | ]{ |
| mark} | U          | 2207 | ] | / | ] |                       | .m |
|       | se]{.mark} | ]{.m | { | N | { |                       | ar |
|       |            | ark} | . | ] | . |                       | k} |
|       |            |      | m | { | m |                       |    |
|       |            |      | a | . | a |                       |    |
|       |            |      | r | m | r |                       |    |
|       |            |      | k | a | k |                       |    |
|       |            |      | } | r | } |                       |    |
|       |            |      |   | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| [     | [The       | [2   | [ | [ | [ | [The identifier that  | 22 |
| Remit | identifier | 208- | 2 | A | R | States want the       |    |
| tance | that       | 2227 | 0 | / | ] | employer to use, so   |    |
| Ide   | employers  | ]{.m | ] | N | { | the State or Tribe    |    |
| ntifi | must       | ark} | { | ] | . | can identify and      |    |
| er]{. | include    |      | . | { | m | apply the payment     |    |
| mark} | when       |      | m | . | a | correctly. This       |    |
|       | sending    |      | a | m | r | identifier may be,    |    |
|       | payments   |      | r | a | k | but is not required   |    |
|       | for this   |      | k | r | } | to be, the case       |    |
|       | IW         |      | } | k |   | identifier designated |    |
|       | O.]{.mark} |      |   | } |   | by the State, Tribe   |    |
|       |            |      |   |   |   | or Territory.]{.mark} |    |
+-------+------------+------+---+---+---+-----------------------+----+
| [Doc  | [Uniquely  | [2   | [ | [ | [ | [First two positions  | N  |
| ument | identifies | 228- | 2 | A | O | must be the State     | /A |
| Image | and        | 2252 | 5 | / | ] | FIPS Code.]{.mark}    |    |
| Te    | associates | ]{.m | ] | N | { |                       |    |
| xt]{. | cover      | ark} | { | ] | . |                       |    |
| mark} | letters,   |      | . | { | m |                       |    |
|       | or other   |      | m | . | a |                       |    |
|       | documents  |      | a | m | r |                       |    |
|       | with an    |      | r | a | k |                       |    |
|       | e-IWO to a |      | k | r | } |                       |    |
|       | data       |      | } | k |   |                       |    |
|       | fil        |      |   | } |   |                       |    |
|       | e.]{.mark} |      |   |   |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| [     | [Name of   | [2   | [ | [ | [ | [FOR USE BY PORTAL    | [N |
| First | the first  | 253- | 3 | A | O | ONLY:]{.mark}         | /A |
| Err   | field that | 2284 | 2 | / | ] |                       | ]{ |
| or]{. | did not    | ]{.m | ] | N | { | [Used by the portal   | .m |
| mark} | pass the   | ark} | { | ] | . | to return the first   | ar |
|       | e-IWO      |      | . | { | m | element that did not  | k} |
| [     | edit       |      | m | . | a | pass the portal       |    |
| Field | s.]{.mark} |      | a | m | r | edits.]{.mark}        |    |
| Na    |            |      | r | a | k |                       |    |
| me]{. |            |      | k | r | } |                       |    |
| mark} |            |      | } | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| [S    | [Name of   | [2   | [ | [ | [ | [FOR USE BY PORTAL    | [N |
| econd | the second | 285- | 3 | A | O | ONLY:]{.mark}         | /A |
| Error | field that | 2316 | 2 | / | ] |                       | ]{ |
| Field | did not    | ]{.m | ] | N | { | [Used by the portal   | .m |
| Na    | pass the   | ark} | { | ] | . | to return the second  | ar |
| me]{. | e-IWO      |      | . | { | m | element that did not  | k} |
| mark} | edit       |      | m | . | a | pass the portal       |    |
|       | s.]{.mark} |      | a | m | r | edits.]{.mark}        |    |
|       |            |      | r | a | k |                       |    |
|       |            |      | k | r | } |                       |    |
|       |            |      | } | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| [Mul  | [Indicates | [    | [ | [ | [ | [FOR USE BY PORTAL    | [  |
| tiple | that a     | 2317 | 1 | A | O | ONLY:]{.mark}         | ]{ |
| Error | record has | ]{.m | ] | / | ] |                       | .m |
| In    | more than  | ark} | { | N | { | [Valid                | ar |
| dicat | two        |      | . | ] | . | Values:]{.mark}       | k} |
| or]{. | error      |      | m | { | m |                       |    |
| mark} | s.]{.mark} |      | a | . | a | [T -- True]{.mark}    |    |
|       |            |      | r | m | r |                       |    |
|       |            |      | k | a | k | [F -- False]{.mark}   |    |
|       |            |      | } | r | } |                       |    |
|       |            |      |   | k |   | [If more than two     |    |
|       |            |      |   | } |   | errors exist in the   |    |
|       |            |      |   |   |   | record, this field    |    |
|       |            |      |   |   |   | will be set to 'T'.   |    |
|       |            |      |   |   |   | If less than 2 errors |    |
|       |            |      |   |   |   | exist it will be set  |    |
|       |            |      |   |   |   | to "F".]{.mark}       |    |
+-------+------------+------+---+---+---+-----------------------+----+
| [Fill | [Future    | [2   | [ | [ | [ | []{.mark}             | [N |
| er]{. | U          | 318- | 8 | A | O |                       | /A |
| mark} | se]{.mark} | 2406 | 9 | / | ] |                       | ]{ |
|       |            | ]{.m | ] | N | { |                       | .m |
|       |            | ark} | { | ] | . |                       | ar |
|       |            |      | . | { | m |                       | k} |
|       |            |      | m | . | a |                       |    |
|       |            |      | a | m | r |                       |    |
|       |            |      | r | a | k |                       |    |
|       |            |      | k | r | } |                       |    |
|       |            |      | } | k |   |                       |    |
|       |            |      |   | } |   |                       |    |
+-------+------------+------+---+---+---+-----------------------+----+

# Acknowledgement Record Layout {#acknowledgement-record-layout .Head-1-App}

This appendix contains the record specifications for the e-IWO
Acknowledgement records that are affected by the changes made for this
release.

Chart B-1 presents the Acknowledgement Record with changes highlighted
in turquoise.

+----------+------------+-----+----+---+---+--------------------------+
| CHART    |            |     |    |   |   |                          |
| B-1:     |            |     |    |   |   |                          |
| ACKNOWL  |            |     |    |   |   |                          |
| EDGEMENT |            |     |    |   |   |                          |
| RECORD   |            |     |    |   |   |                          |
|          |            |     |    |   |   |                          |
| [OMB     |            |     |    |   |   |                          |
| Control  |            |     |    |   |   |                          |
| No:      |            |     |    |   |   |                          |
| 0        |            |     |    |   |   |                          |
| 970-0154 |            |     |    |   |   |                          |
| Ex       |            |     |    |   |   |                          |
| piration |            |     |    |   |   |                          |
| Date:    |            |     |    |   |   |                          |
| 10       |            |     |    |   |   |                          |
| /31/2010 |            |     |    |   |   |                          |
| ]{.mark} |            |     |    |   |   |                          |
+==========+============+=====+====+===+===+==========================+
| Element  | Definition | Lo  | Le | T | R | Data Element Rules       |
| Name     |            | cat | ng | y | e |                          |
|          |            | ion | th | p | q |                          |
|          |            |     |    | e | . |                          |
|          |            |     |    |   | / |                          |
|          |            |     |    |   | O |                          |
|          |            |     |    |   | p |                          |
|          |            |     |    |   | t |                          |
|          |            |     |    |   | . |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Document | A code     | 1-3 | 3  | A | R | Value must be 'ACK'.     |
| Code     | that       |     |    | / |   |                          |
|          | indicates  |     |    | N |   |                          |
|          | the        |     |    |   |   |                          |
|          | ackno      |     |    |   |   |                          |
|          | wledgement |     |    |   |   |                          |
|          | record     |     |    |   |   |                          |
|          | follows.   |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Document | A code     | 4-6 | 3  | A | R | Valid Values:            |
| Action   | that       |     |    | / |   |                          |
| Code     | indicates  |     |    | N |   | AMD -- Amended: The      |
|          | the type   |     |    |   |   | value input by the       |
|          | of         |     |    |   |   | State, Tribe, or         |
|          | document.  |     |    |   |   | Territory in the         |
|          |            |     |    |   |   | Document Action Code     |
|          |            |     |    |   |   | field (pos. 4-6 in the   |
|          |            |     |    |   |   | Detail Record).          |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | EMP -- Action initiated  |
|          |            |     |    |   |   | by an employer. For      |
|          |            |     |    |   |   | example, if the NCP is   |
|          |            |     |    |   |   | no longer employed,      |
|          |            |     |    |   |   | 'EMP' would be input and |
|          |            |     |    |   |   | a value of 'T' would be  |
|          |            |     |    |   |   | placed in the Record     |
|          |            |     |    |   |   | Disposition Code (pos.   |
|          |            |     |    |   |   | 154-155) If an employer  |
|          |            |     |    |   |   | is notifying a State,    |
|          |            |     |    |   |   | Tribe, or Territory      |
|          |            |     |    |   |   | about a pending "Lump    |
|          |            |     |    |   |   | Sum" they would input    |
|          |            |     |    |   |   | EMP and put an 'L' in    |
|          |            |     |    |   |   | the Record Disposition   |
|          |            |     |    |   |   | Code (pos. 154-155).     |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | LUM -- Lump Sum: The     |
|          |            |     |    |   |   | value input by the       |
|          |            |     |    |   |   | State, Tribe, or         |
|          |            |     |    |   |   | Territory in the         |
|          |            |     |    |   |   | Document Action Code     |
|          |            |     |    |   |   | field (positions 4-6 in  |
|          |            |     |    |   |   | the Detail Record).      |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | ORG -- Original: The     |
|          |            |     |    |   |   | value input by the       |
|          |            |     |    |   |   | State, Tribe or          |
|          |            |     |    |   |   | Territory in the         |
|          |            |     |    |   |   | Document Action Code     |
|          |            |     |    |   |   | field (pos. 4-6 in the   |
|          |            |     |    |   |   | Detail Record).          |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | TRM -- Termination: The  |
|          |            |     |    |   |   | value input by the       |
|          |            |     |    |   |   | State, Tribe, or         |
|          |            |     |    |   |   | Territory in the         |
|          |            |     |    |   |   | Document Action Code     |
|          |            |     |    |   |   | field (pos. 4-6 in the   |
|          |            |     |    |   |   | Detail Record).          |
+----------+------------+-----+----+---+---+--------------------------+
| Case     | A case     | 7   | 15 | A | R | This is the Case         |
| Id       | identifier | -21 |    | / |   | Identifier as input by   |
| entifier | is a value |     |    | N |   | the State in positions   |
|          | assigned   |     |    |   |   | 88-102 of the e-IWO      |
|          | by a State |     |    |   |   | Detail record.           |
|          | to         |     |    |   |   |                          |
|          | uniquely   |     |    |   |   |                          |
|          | identify   |     |    |   |   |                          |
|          | each IV-D  |     |    |   |   |                          |
|          | case in    |     |    |   |   |                          |
|          | the State. |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| EIN Text | The        | 22  | 9  | N | R |                          |
|          | Employer/  | -30 |    |   |   |                          |
|          | Wi         |     |    |   |   |                          |
|          | thholder's |     |    |   |   |                          |
|          | FEIN.      |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Employee | The        | 31  | 20 | A | R | Letters A-Z or spaces.   |
| Last     | Obligor's  | -50 |    | / |   | No special characters or |
| Name     | Last Name. |     |    | N |   | imbedded spaces. Hyphens |
|          |            |     |    |   |   | and apostrophes are      |
|          |            |     |    |   |   | allowed. [The first      |
|          |            |     |    |   |   | character must not be a  |
|          |            |     |    |   |   | space.]{.mark}           |
+----------+------------+-----+----+---+---+--------------------------+
| Employee | The        | 51  | 15 | A | R | Letters A-Z or spaces.   |
| First    | Obligor's  | -65 |    | / |   | No special characters or |
| Name     | First      |     |    | N |   | imbedded spaces. Hyphens |
|          | Name.      |     |    |   |   | and apostrophes are      |
|          |            |     |    |   |   | allowed. [The first      |
|          |            |     |    |   |   | character must not be a  |
|          |            |     |    |   |   | space.]{.mark}           |
+----------+------------+-----+----+---+---+--------------------------+
| Employee | The        | 66  | 15 | A | O | Letters A-Z or spaces.   |
| Middle   | Obligor's  | -80 |    | / |   | No special characters or |
| Name     | Middle     |     |    | N |   | imbedded spaces. Hyphens |
|          | Name or    |     |    |   |   | and apostrophes are      |
|          | Initial.   |     |    |   |   | allowed.                 |
+----------+------------+-----+----+---+---+--------------------------+
| Employee | The        | 81  | 4  | A | O |                          |
| Name     | Obligor's  | -84 |    | / |   |                          |
| Suffix   | Name       |     |    | N |   |                          |
|          | Suffix     |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Employee | The        | 85  | 9  | N | R |                          |
| SSN      | Obligor's  | -93 |    |   |   |                          |
|          | SSN        |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Document | An         | 94- | 30 | A | O | This is the Document     |
| Tracking | identifier | 123 |    | / |   | Tracking Number as input |
| Number   | assigned   |     |    | N |   | by the State in position |
|          | by the     |     |    |   |   | 1548-1577 of the e-IWO   |
|          | entity     |     |    |   |   | Detail record.           |
|          | sending    |     |    |   |   |                          |
|          | the        |     |    |   |   |                          |
|          | document   |     |    |   |   |                          |
|          | that       |     |    |   |   |                          |
|          | uniquely   |     |    |   |   |                          |
|          | identifies |     |    |   |   |                          |
|          | the        |     |    |   |   |                          |
|          | document.  |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Order    | A unique   | 1   | 30 | A | O | This is the Order        |
| Id       | identifier | 24- |    | / |   | Identifier as input by   |
| entifier | that is    | 153 |    | N |   | the State in position    |
|          | associated |     |    |   |   | 1578-1607 of the e-IWO   |
|          | with a     |     |    |   |   | Detail record.           |
|          | specific   |     |    |   |   |                          |
|          | child      |     |    |   |   |                          |
|          | support    |     |    |   |   |                          |
|          | obligation |     |    |   |   |                          |
|          | within a   |     |    |   |   |                          |
|          | case.      |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Record   | Indicates  | 1   | 2  | A | R | Values are:              |
| Dis      | whether a  | 54- |    | / |   |                          |
| position | record was | 155 |    | N |   | A -- Record Accepted     |
| Status   | accepted   |     |    |   |   |                          |
| Code     | or         |     |    |   |   | L -- Lump Sum            |
|          | rejected   |     |    |   |   |                          |
|          | by the     |     |    |   |   | R -- Record Rejected     |
|          | employer.  |     |    |   |   |                          |
|          |            |     |    |   |   | T -- Termination         |
+----------+------------+-----+----+---+---+--------------------------+
| Rejected | The reason | 1   | 3  | A | C | Only if the value in     |
| Reason   | an e-IWO   | 56- |    | / | R | Record Disposition       |
| Code     | record was | 158 |    | N |   | Status equals 'R', is    |
|          | rejected   |     |    |   |   | this required to be      |
|          | by an      |     |    |   |   | completed.               |
|          | employer.  |     |    |   |   |                          |
|          |            |     |    |   |   | Values are:              |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | D -- Duplicate IWO       |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | N -- NCP no longer at    |
|          |            |     |    |   |   | the employer             |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | O -- Other Reason        |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | U -- NCP not known to    |
|          |            |     |    |   |   | employer                 |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | X -- Employer could not  |
|          |            |     |    |   |   | electronically process   |
|          |            |     |    |   |   | this record.             |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | Z -- Termination cannot  |
|          |            |     |    |   |   | be processed; no current |
|          |            |     |    |   |   | IWO in place             |
+----------+------------+-----+----+---+---+--------------------------+
| Filler   | Reserved   | 159 | 1  | A | O |                          |
|          | for future |     |    | / |   |                          |
|          | use.       |     |    | N |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Ter      | Date that  | 1   | 8  | [ | O | Must be [a valid         |
| mination | an         | 60- |    | A |   | date]{.mark} in CCYYMMDD |
| Date     | employee   | 167 |    | / |   | format.                  |
|          | left or    |     |    | ] |   |                          |
|          | was        |     |    | { |   | If not applicable, fill  |
|          | terminated |     |    | . |   | this field with spaces.  |
|          | by an      |     |    | m |   |                          |
|          | employer.  |     |    | a |   |                          |
|          |            |     |    | r |   |                          |
|          |            |     |    | k |   |                          |
|          |            |     |    | } |   |                          |
|          |            |     |    | N |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| NCP Last | Line 1 of  | 1   | 25 | A | O |                          |
| Known    | the NCP's  | 68- |    | / |   |                          |
| Address  | last known | 192 |    | N |   |                          |
| Line 1   | address.   |     |    |   |   |                          |
| Text     |            |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| NCP Last | Line 2 of  | 1   | 25 | A | O |                          |
| Known    | the NCP's  | 93- |    | / |   |                          |
| Address  | last known | 217 |    | N |   |                          |
| Line 2   | address.   |     |    |   |   |                          |
| Text     |            |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| NCP Last | NCP's last | 2   | 22 | A | O |                          |
| Known    | known city | 18- |    | / |   |                          |
| Address  | address.   | 239 |    | N |   |                          |
| City     |            |     |    |   |   |                          |
| Name     |            |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| NCP Last | NCP's last | 2   | 2  | A | O | Valid two-character      |
| Known    | known      | 40- |    |   |   | alphabetic State         |
| Address  | State      | 241 |    |   |   | [or]{.mark}              |
| State    | code.      |     |    |   |   | [Territory]{.mark} Code. |
| Code     |            |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| NCP Last | NCP's last | 2   | 5  | N | O |                          |
| Known    | known      | 42- |    |   |   |                          |
| Address  | address    | 246 |    |   |   |                          |
| ZIP Code | five-digit |     |    |   |   |                          |
|          | ZIP Code.  |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| NCP Last | NCP's last | 2   | 4  | A | O |                          |
| Known    | known      | 47- |    | / |   |                          |
| Address  | four       | 250 |    | N |   |                          |
| Ext ZIP  | -character |     |    |   |   |                          |
| Code     | ZIP Code.  |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Final    | Date of    | 2   | 8  | [ | O | Must be [a valid         |
| Payment  | the final  | 51- |    | A |   | date]{.mark} in CCYYMMDD |
| Made     | payment    | 258 |    | / |   | format.                  |
| Date     | sent to    |     |    | ] |   |                          |
|          | the SDU.   |     |    | { |   | If not applicable, fill  |
|          |            |     |    | . |   | this field with spaces.  |
|          |            |     |    | m |   |                          |
|          |            |     |    | a |   |                          |
|          |            |     |    | r |   |                          |
|          |            |     |    | k |   |                          |
|          |            |     |    | } |   |                          |
|          |            |     |    | N |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Final    | Amount of  | 2   | 11 | N | [ | Numeric                  |
| Payment  | the final  | 59- |    |   | R |                          |
| Amount   | payment    | 269 |    |   | ] | -   Decimal Assumed      |
|          | sent to    |     |    |   | { |                          |
|          | the SDU.   |     |    |   | . | -   Unsigned             |
|          | This only  |     |    |   | m |                          |
|          | applies    |     |    |   | a | -   No Rounding          |
|          | when an    |     |    |   | r |                          |
|          | employee   |     |    |   | k | -   Right Justify        |
|          | has been   |     |    |   | } |                          |
|          | terminated |     |    |   |   | -   Zero Fill to Left    |
|          | or left    |     |    |   |   |                          |
|          | his/her    |     |    |   |   | -   Zero Fill if N/A     |
|          | employer.  |     |    |   |   |                          |
|          |            |     |    |   |   | The last payment/wages   |
|          |            |     |    |   |   | that were paid to an NCP |
|          |            |     |    |   |   | that has left or been    |
|          |            |     |    |   |   | terminated.              |
+----------+------------+-----+----+---+---+--------------------------+
| New      | Name of    | 2   | 57 | A | O |                          |
| Employer | NCP's new  | 70- |    | / |   |                          |
| Name     | employer.  | 326 |    | N |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| New      | Line 1 of  | 3   | 25 | A | O |                          |
| Employer | New        | 27- |    | / |   |                          |
| Address  | Employer's | 351 |    | N |   |                          |
| Line 1   | Address.   |     |    |   |   |                          |
| Text     |            |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| New      | Line 2 of  | 3   | 25 | A | O |                          |
| Employer | New        | 52- |    | / |   |                          |
| Address  | Employer's | 376 |    | N |   |                          |
| Line 2   | Address.   |     |    |   |   |                          |
| Text     |            |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| New      | New        | 3   | 22 | A | O |                          |
| Employer | Employer's | 77- |    | / |   |                          |
| Address  | City       | 398 |    | N |   |                          |
| City     |            |     |    |   |   |                          |
| Name     |            |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| New      | New        | 3   | 2  | A | O | Valid two-character      |
| Employer | Employer's | 99- |    |   |   | alphabetic State         |
| State    | State      | 400 |    |   |   | [or]{.mark}              |
| Code     | code.      |     |    |   |   | [Territory]{.mark} Code  |
+----------+------------+-----+----+---+---+--------------------------+
| New      | New        | 4   | 5  | N | O |                          |
| Employer | Employer's | 01- |    |   |   |                          |
| Address  | five       | 405 |    |   |   |                          |
| ZIP Code | character  |     |    |   |   |                          |
|          | ZIP Code.  |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| New      | New        | 4   | 4  | A | O |                          |
| Employer | Employer's | 06- |    | / |   |                          |
| Address  | four       | 409 |    | N |   |                          |
| Ext ZIP  | character  |     |    |   |   |                          |
| Code     | ZIP Code.  |     |    |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| Payment  | The date   | 4   | 8  | A | O | Must be [a valid         |
| Lump Sum | an         | 10- |    | / |   | date]{.mark} in CCYYMMDD |
| Date     | employer   | 417 |    | N |   | format.                  |
|          | a          |     |    |   |   |                          |
|          | nticipates |     |    |   |   | [If there is a dollar    |
|          | that a     |     |    |   |   | amount other than zero   |
|          | Lump Sum   |     |    |   |   | in the Payment Lump Sum  |
|          | Payment    |     |    |   |   | Amount field (418-428),  |
|          | will be    |     |    |   |   | this field should be     |
|          | disbursed  |     |    |   |   | filled.]{.mark}          |
|          | to an      |     |    |   |   |                          |
|          | employee.  |     |    |   |   | If the Document Action   |
|          |            |     |    |   |   | Code (pos. 4-6) is 'EMP' |
|          |            |     |    |   |   | and the Record           |
|          |            |     |    |   |   | Disposition Status Code  |
|          |            |     |    |   |   | (pos. 154-155) equals    |
|          |            |     |    |   |   | 'T', this field must be  |
|          |            |     |    |   |   | blank.                   |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | If unknown or not        |
|          |            |     |    |   |   | applicable, fill this    |
|          |            |     |    |   |   | field with spaces.       |
+----------+------------+-----+----+---+---+--------------------------+
| Payment  | An amount  | 4   | 11 | N | [ | -   Numeric              |
| Lump Sum | the        | 18- |    |   | R |                          |
| Amount   | employer   | 428 |    |   | ] | -   Decimal Assumed      |
|          | intends to |     |    |   | { |                          |
|          | issue as a |     |    |   | . | -   Unsigned             |
|          | Lump Sum   |     |    |   | m |                          |
|          | Payment to |     |    |   | a | -   No Rounding          |
|          | the        |     |    |   | r |                          |
|          | employee.  |     |    |   | k | -   Right Justify        |
|          |            |     |    |   | } |                          |
|          |            |     |    |   |   | -   Zero Fill to Left    |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | -   Zero Fill if N/A     |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | [If the Document Action  |
|          |            |     |    |   |   | Code (pos. 4-6) is 'EMP' |
|          |            |     |    |   |   | and the Record           |
|          |            |     |    |   |   | Disposition Status Code  |
|          |            |     |    |   |   | (pos. 154-155) equals    |
|          |            |     |    |   |   | 'L', the dollar amount   |
|          |            |     |    |   |   | in this field must be    |
|          |            |     |    |   |   | filled with an amount    |
|          |            |     |    |   |   | greater than             |
|          |            |     |    |   |   | \$0.00.]{.mark}          |
|          |            |     |    |   |   |                          |
|          |            |     |    |   |   | If the Document Action   |
|          |            |     |    |   |   | Code (pos. 4-6) is 'EMP' |
|          |            |     |    |   |   | and the Record           |
|          |            |     |    |   |   | Disposition Status Code  |
|          |            |     |    |   |   | (pos. 154-155) equals    |
|          |            |     |    |   |   | 'T', the dollar amounts  |
|          |            |     |    |   |   | in this field must be    |
|          |            |     |    |   |   | zero filled.             |
+----------+------------+-----+----+---+---+--------------------------+
| Payment  | The type   | 4   | 35 | A | O | Possible values are      |
| Lump Sum | of Lump    | 29- |    | / |   | "bonus", "severance" or  |
| Type     | Sum        | 463 |    | N |   | other unique             |
| Text     | Payment    |     |    |   |   | identifiers.             |
|          | that will  |     |    |   |   |                          |
|          | be         |     |    |   |   | [If the Document Action  |
|          | disbursed  |     |    |   |   | Code (pos. 4-6) is 'EMP' |
|          | to an      |     |    |   |   | and the Record           |
|          | employee.  |     |    |   |   | Disposition Status Code  |
|          | Examples   |     |    |   |   | (pos. 154-155) equals    |
|          | of a Lump  |     |    |   |   | 'L', this field must be  |
|          | Sum        |     |    |   |   | filled.]{.mark}          |
|          | Payment    |     |    |   |   |                          |
|          | include    |     |    |   |   | If the Document Action   |
|          | bonus,     |     |    |   |   | Code (pos. 4-6) is 'EMP' |
|          | severance, |     |    |   |   | and the Record           |
|          | c          |     |    |   |   | Disposition Status Code  |
|          | ommission, |     |    |   |   | (pos. 154-155) equals    |
|          | etc.       |     |    |   |   | 'T', this field must be  |
|          |            |     |    |   |   | blank.                   |
+----------+------------+-----+----+---+---+--------------------------+
| [NCP     | [Last      | [   | [  | [ | [ | []{.mark}                |
| Last     | known      | 464 | 10 | A | O |                          |
| Known    | phone      | -47 | ]{ | / | ] |                          |
| Phone    | number for | 3]{ | .m | N | { |                          |
| Number   | the        | .ma | ar | ] | . |                          |
| ]{.mark} | NC         | rk} | k} | { | m |                          |
|          | P.]{.mark} |     |    | . | a |                          |
|          |            |     |    | m | r |                          |
|          |            |     |    | a | k |                          |
|          |            |     |    | r | } |                          |
|          |            |     |    | k |   |                          |
|          |            |     |    | } |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| [First   | [Name of   | [   | [  | [ | [ | [FOR USE BY PORTAL       |
| Error    | the first  | 474 | 32 | A | O | ONLY:]{.mark}            |
| Field    | field that | -50 | ]{ | / | ] |                          |
| Name     | did not    | 5]{ | .m | N | { | [Used by the portal to   |
| ]{.mark} | pass the   | .ma | ar | ] | . | return the first element |
|          | e-IWO      | rk} | k} | { | m | that did not pass the    |
|          | edit       |     |    | . | a | portal edits.]{.mark}    |
|          | s.]{.mark} |     |    | m | r |                          |
|          |            |     |    | a | k |                          |
|          |            |     |    | r | } |                          |
|          |            |     |    | k |   |                          |
|          |            |     |    | } |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| [Second  | [Name of   | [   | [  | [ | [ | [FOR USE BY PORTAL       |
| Error    | the second | 506 | 32 | A | O | ONLY:]{.mark}            |
| Field    | field that | -53 | ]{ | / | ] |                          |
| Name     | did not    | 7]{ | .m | N | { | [Used by the portal to   |
| ]{.mark} | pass the   | .ma | ar | ] | . | return the second        |
|          | e-IWO      | rk} | k} | { | m | element that did not     |
|          | edit       |     |    | . | a | pass the portal          |
|          | s.]{.mark} |     |    | m | r | edits.]{.mark}           |
|          |            |     |    | a | k |                          |
|          |            |     |    | r | } |                          |
|          |            |     |    | k |   |                          |
|          |            |     |    | } |   |                          |
+----------+------------+-----+----+---+---+--------------------------+
| [        | [Indicates | [53 | [1 | [ | [ | [FOR USE BY PORTAL       |
| Multiple | that a     | 8]{ | ]{ | A | O | ONLY:]{.mark}            |
| Error    | record has | .ma | .m | / | ] |                          |
| I        | more than  | rk} | ar | N | { | [Valid Values:]{.mark}   |
| ndicator | 2          |     | k} | ] | . |                          |
| ]{.mark} | error      |     |    | { | m | [T -- True]{.mark}       |
|          | s.]{.mark} |     |    | . | a |                          |
|          |            |     |    | m | r | [F -- False]{.mark}      |
|          |            |     |    | a | k |                          |
|          |            |     |    | r | } | [If more than two errors |
|          |            |     |    | k |   | exist in the record,     |
|          |            |     |    | } |   | this field will be set   |
|          |            |     |    |   |   | to 'T'. If less than two |
|          |            |     |    |   |   | errors exist, this field |
|          |            |     |    |   |   | will be set to           |
|          |            |     |    |   |   | "F".]{.mark}             |
+----------+------------+-----+----+---+---+--------------------------+
| Filler   | Future Use | 5   | [  | A | O |                          |
|          |            | 39- | 35 | / |   |                          |
|          |            | 573 | ]{ | N |   |                          |
|          |            |     | .m |   |   |                          |
|          |            |     | ar |   |   |                          |
|          |            |     | k} |   |   |                          |
+----------+------------+-----+----+---+---+--------------------------+

# e-IWO Universal Headers and Trailers {#e-iwo-universal-headers-and-trailers .Head-1-App}

This appendix contains the record specifications for the new e-IWO
Universal Headers and Trailers that are established by the changes made
for this release. Each file contains a set of File Headers and File
Trailers and can have multiple sets of Batch Headers and Batch Trailers
depending on the number of unique employers or States that have data
within the file.

Chart C-1 presents the Universal Header.

Chart C-2 presents the Universal Trailer.

+---------+------------+----+----+---+---+---------------------------+
| **CHART |            |    |    |   |   |                           |
| C-1:    |            |    |    |   |   |                           |
| UN      |            |    |    |   |   |                           |
| IVERSAL |            |    |    |   |   |                           |
| HEADER  |            |    |    |   |   |                           |
| (FILE   |            |    |    |   |   |                           |
| AND     |            |    |    |   |   |                           |
| B       |            |    |    |   |   |                           |
| ATCH)** |            |    |    |   |   |                           |
|         |            |    |    |   |   |                           |
| [OMB    |            |    |    |   |   |                           |
| Control |            |    |    |   |   |                           |
| No:     |            |    |    |   |   |                           |
| 09      |            |    |    |   |   |                           |
| 70-0154 |            |    |    |   |   |                           |
| Exp     |            |    |    |   |   |                           |
| iration |            |    |    |   |   |                           |
| Date:   |            |    |    |   |   |                           |
| 10/3    |            |    |    |   |   |                           |
| 1/2010] |            |    |    |   |   |                           |
| {.mark} |            |    |    |   |   |                           |
+=========+============+====+====+===+===+===========================+
| Element | Definition | Lo | Le | T | R | Data Element Rules        |
| Name    |            | ca | ng | y | e |                           |
|         |            | ti | th | p | q |                           |
|         |            | on |    | e | . |                           |
|         |            |    |    |   | / |                           |
|         |            |    |    |   | O |                           |
|         |            |    |    |   | p |                           |
|         |            |    |    |   | t |                           |
|         |            |    |    |   | . |                           |
+---------+------------+----+----+---+---+---------------------------+
| D       | A code     | 1  | 3  | A | R | Required for all Headers. |
| ocument | that       | -3 |    |   |   |                           |
| Code    | indicates  |    |    |   |   | First two characters      |
|         | whether    |    |    |   |   | indicate header type.     |
|         | the header |    |    |   |   |                           |
|         | is for a   |    |    |   |   | FH ALWAYS indicates a     |
|         | file or a  |    |    |   |   | File Header.              |
|         | batch,     |    |    |   |   |                           |
|         | [and the   |    |    |   |   | BH ALWAYS indicates a     |
|         | type of    |    |    |   |   | Batch Header.             |
|         | record     |    |    |   |   |                           |
|         | that       |    |    |   |   | Third character indicates |
|         | follow     |    |    |   |   | the record type. The      |
|         | s.]{.mark} |    |    |   |   | record types are:         |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | A -- Acknowledgement:     |
|         |            |    |    |   |   | File sent from an         |
|         |            |    |    |   |   | employer to a State (FHA, |
|         |            |    |    |   |   | BHA)                      |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | I -- IWO Detail: File     |
|         |            |    |    |   |   | sent from a State to an   |
|         |            |    |    |   |   | employer (FHI, BHI)       |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | K -- Acknowledgement      |
|         |            |    |    |   |   | Result: File sent from    |
|         |            |    |    |   |   | portal to employer (FHK,  |
|         |            |    |    |   |   | BHK). Used by the portal  |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | R -- IWO Receipt: File    |
|         |            |    |    |   |   | sent from employer to     |
|         |            |    |    |   |   | State (FHR, BHR)          |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | S -- IWO Result: File     |
|         |            |    |    |   |   | sent from portal to State |
|         |            |    |    |   |   | (FHS, BHS). Used by the   |
|         |            |    |    |   |   | portal.                   |
+---------+------------+----+----+---+---+---------------------------+
| Control | An         | 4- | 22 | A | R | Required for all Headers. |
| Number  | identifier | 25 |    | / |   |                           |
|         | assigned   |    |    | N |   | A unique alphanumeric     |
|         | by the     |    |    |   |   | number that identifies a  |
|         | State,     |    |    |   |   | specific file or a batch  |
|         | Tribe, or  |    |    |   |   | within a file.            |
|         | Territory  |    |    |   |   |                           |
|         | that       |    |    |   |   | The File Header (FH) will |
|         | uniquely   |    |    |   |   | have a unique control     |
|         | identifies |    |    |   |   | number to identify a      |
|         | a file or  |    |    |   |   | file.                     |
|         | group of   |    |    |   |   |                           |
|         | records in |    |    |   |   | The State must assign a   |
|         | a batch.   |    |    |   |   | unique control number for |
|         |            |    |    |   |   | each employer batch (BHI) |
|         |            |    |    |   |   | contained in a file.      |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | [Recommended]{.mark}      |
|         |            |    |    |   |   | Format:                   |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | 5 Digit FIPS -- 21000     |
|         |            |    |    |   |   | (2-digit State FIPS Code  |
|         |            |    |    |   |   | Number followed by 3      |
|         |            |    |    |   |   | zeroes)                   |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | Date -- YYMMDD            |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | Time -- HHMMSSS           |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | Sequence \# -- 0000       |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | The employer/payroll      |
|         |            |    |    |   |   | processor must return the |
|         |            |    |    |   |   | Batch Control Number sent |
|         |            |    |    |   |   | to them when returning an |
|         |            |    |    |   |   | IWO Receipt (BHR).        |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | [For Acknowledgements,    |
|         |            |    |    |   |   | employers may enter an    |
|         |            |    |    |   |   | identifier of their       |
|         |            |    |    |   |   | choosing.]{.mark}         |
+---------+------------+----+----+---+---+---------------------------+
| State   | The        | 2  | 5  | A | C | [Required in File (FHI)   |
| FIPS    | S          | 6- |    | / | R | and Batch (BHI)           |
| Code    | tate/Tribe | 30 |    | N |   | Header]{.mark} for IWO    |
|         | Territory  |    |    |   |   | Detail sent by States.    |
|         | State FIPS |    |    |   |   |                           |
|         | Code for   |    |    |   |   | Required in Batch Header  |
|         | which the  |    |    |   |   | for Acknowledgement (BHA) |
|         | batches    |    |    |   |   | sent by an employer or    |
|         | are        |    |    |   |   | their agent.              |
|         | intended.  |    |    |   |   |                           |
|         |            |    |    |   |   | Required in Batch Header  |
|         |            |    |    |   |   | for IWO Receipt (BHR)     |
|         |            |    |    |   |   | sent by employer or their |
|         |            |    |    |   |   | agent.                    |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | Format:                   |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | 21000 (two-digit State    |
|         |            |    |    |   |   | FIPS Code number followed |
|         |            |    |    |   |   | by three zeroes)          |
+---------+------------+----+----+---+---+---------------------------+
| EIN     | The        | 3  | 9  | [ | C | Required in File Header   |
| Text    | Employer's | 1- |    | A | R | for Acknowledgement (FHA) |
|         | FEIN.      | 39 |    | / |   | sent by employers.        |
|         |            |    |    | ] |   |                           |
|         |            |    |    | { |   | Required in File Header   |
|         |            |    |    | . |   | [and Batch Header]{.mark} |
|         |            |    |    | m |   | for IWO Receipt (FHR [and |
|         |            |    |    | a |   | BHR]{.mark}) sent by      |
|         |            |    |    | r |   | employer or their agent.  |
|         |            |    |    | k |   |                           |
|         |            |    |    | } |   | Required in Batch Header  |
|         |            |    |    | N |   | for IWO Detail (BHI) sent |
|         |            |    |    |   |   | by States.                |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | Required in Batch Header  |
|         |            |    |    |   |   | for Acknowledgement (BHA) |
|         |            |    |    |   |   | sent by employer or their |
|         |            |    |    |   |   | agent.                    |
|         |            |    |    |   |   |                           |
|         |            |    |    |   |   | [If N/A fill with         |
|         |            |    |    |   |   | spaces.]{.mark}           |
+---------+------------+----+----+---+---+---------------------------+
| Payroll | The FEIN   | 4  | 9  | [ | C | Required in File Headers  |
| Pr      | of the     | 0- |    | A | R | for Acknowledgement (FHA) |
| ocessor | employer's | 48 |    | / |   | sent by employer's agent. |
| EIN     | agent or a |    |    | ] |   |                           |
| Text    | third      |    |    | { |   | Required in File Header   |
|         | party.     |    |    | . |   | for IWO Receipt (FHR)     |
|         |            |    |    | m |   | sent by employer's agent. |
|         |            |    |    | a |   |                           |
|         |            |    |    | r |   | Optional in Batch Header  |
|         |            |    |    | k |   | for IWO Detail (BHI) sent |
|         |            |    |    | } |   | by States to be forwarded |
|         |            |    |    | N |   | to employer's agent. [If  |
|         |            |    |    |   |   | N/A fill with             |
|         |            |    |    |   |   | spaces.]{.mark}           |
+---------+------------+----+----+---+---+---------------------------+
| C       | The date   | 4  | 8  | [ | R | Required for all Headers. |
| reation | the header | 9- |    | A |   |                           |
| Date    | was        | 56 |    | / |   | [Must be a valid date     |
|         | generated. |    |    | ] |   | in]{.mark} CCYYMMDD       |
|         |            |    |    | { |   | format.                   |
|         |            |    |    | . |   |                           |
|         |            |    |    | m |   |                           |
|         |            |    |    | a |   |                           |
|         |            |    |    | r |   |                           |
|         |            |    |    | k |   |                           |
|         |            |    |    | } |   |                           |
|         |            |    |    | N |   |                           |
+---------+------------+----+----+---+---+---------------------------+
| C       | The time   | 5  | 6  | [ | R | Required for all Headers. |
| reation | the header | 7- |    | A |   |                           |
| Time    | was        | 62 |    | / |   | [Must be a valid time     |
|         | generated. |    |    | ] |   | in]{.mark} HHMMSS format. |
|         |            |    |    | { |   |                           |
|         |            |    |    | . |   |                           |
|         |            |    |    | m |   |                           |
|         |            |    |    | a |   |                           |
|         |            |    |    | r |   |                           |
|         |            |    |    | k |   |                           |
|         |            |    |    | } |   |                           |
|         |            |    |    | N |   |                           |
+---------+------------+----+----+---+---+---------------------------+
| Filler  | IWO Detail | 63 | Va | [ | O | The filler length varies  |
|         |            |    | ri | A |   | according to the file to  |
| FHI and | Ackno      |    | es | / |   | which it is associated.   |
| BHI     | wledgement |    |    | N |   |                           |
|         |            |    | 23 | ] |   |                           |
| FHA and | IWO Result |    | 44 | { |   |                           |
| BHA     |            |    |    | . |   |                           |
|         | IWO        |    | 5  | m |   |                           |
| FHS and | Receipt    |    | 11 | a |   |                           |
| BHS     |            |    |    | r |   |                           |
|         | Ackno      |    | 23 | k |   |                           |
| FHR and | wledgement |    | 44 | } |   |                           |
| BHR     | Result     |    |    |   |   |                           |
|         |            |    | 18 |   |   |                           |
| FHK and |            |    |    |   |   |                           |
| BHK     |            |    | 5  |   |   |                           |
|         |            |    | 11 |   |   |                           |
+---------+------------+----+----+---+---+---------------------------+

+---------+--------------+----+----+---+---+--------------------------+
| **CHART |              |    |    |   |   |                          |
| C-2:    |              |    |    |   |   |                          |
| UN      |              |    |    |   |   |                          |
| IVERSAL |              |    |    |   |   |                          |
| TRAILER |              |    |    |   |   |                          |
| (FILE   |              |    |    |   |   |                          |
| AND     |              |    |    |   |   |                          |
| B       |              |    |    |   |   |                          |
| ATCH)** |              |    |    |   |   |                          |
|         |              |    |    |   |   |                          |
| [OMB    |              |    |    |   |   |                          |
| Control |              |    |    |   |   |                          |
| No:     |              |    |    |   |   |                          |
| 09      |              |    |    |   |   |                          |
| 70-0154 |              |    |    |   |   |                          |
| Exp     |              |    |    |   |   |                          |
| iration |              |    |    |   |   |                          |
| Date:   |              |    |    |   |   |                          |
| 10/3    |              |    |    |   |   |                          |
| 1/2010] |              |    |    |   |   |                          |
| {.mark} |              |    |    |   |   |                          |
+=========+==============+====+====+===+===+==========================+
| Element | Definition   | Lo | Le | T | R | Data Element Rules       |
| Name    |              | ca | ng | y | e |                          |
|         |              | ti | th | p | q |                          |
|         |              | on |    | e | . |                          |
|         |              |    |    |   | / |                          |
|         |              |    |    |   | O |                          |
|         |              |    |    |   | p |                          |
|         |              |    |    |   | t |                          |
|         |              |    |    |   | . |                          |
+---------+--------------+----+----+---+---+--------------------------+
| D       | A code that  | 1  | 3  | A | R | Required for all         |
| ocument | indicates    | -3 |    |   |   | Trailers.                |
| Code    | whether the  |    |    |   |   |                          |
|         | Trailer is   |    |    |   |   | First 2 characters       |
|         | for a file   |    |    |   |   | indicate Trailer type.   |
|         | or a batch,  |    |    |   |   | FT ALWAYS indicates a    |
|         | [and the     |    |    |   |   | File Trailer, BT ALWAYS  |
|         | type of      |    |    |   |   | indicates a Batch        |
|         | record       |    |    |   |   | Trailer. Third character |
|         | (s).]{.mark} |    |    |   |   | indicates the record     |
|         |              |    |    |   |   | type. The record types   |
|         |              |    |    |   |   | are:                     |
|         |              |    |    |   |   |                          |
|         |              |    |    |   |   | A -- Acknowledgement:    |
|         |              |    |    |   |   | File sent from an        |
|         |              |    |    |   |   | employer to a State      |
|         |              |    |    |   |   | (FTA, BTA)               |
|         |              |    |    |   |   |                          |
|         |              |    |    |   |   | I -- IWO Detail: File    |
|         |              |    |    |   |   | sent from a State to an  |
|         |              |    |    |   |   | employer (FTI, BTI)      |
|         |              |    |    |   |   |                          |
|         |              |    |    |   |   | K -- Acknowledgement     |
|         |              |    |    |   |   | Result: File sent from   |
|         |              |    |    |   |   | portal to an employer    |
|         |              |    |    |   |   | (FTK, BTK). Used by the  |
|         |              |    |    |   |   | portal.                  |
|         |              |    |    |   |   |                          |
|         |              |    |    |   |   | R -- IWO Receipt: File   |
|         |              |    |    |   |   | sent from employer to    |
|         |              |    |    |   |   | State (FTR, BTR)         |
|         |              |    |    |   |   |                          |
|         |              |    |    |   |   | S -- IWO Result: File    |
|         |              |    |    |   |   | sent from portal to      |
|         |              |    |    |   |   | State (FTS, BTS). Used   |
|         |              |    |    |   |   | by the portal.           |
+---------+--------------+----+----+---+---+--------------------------+
| Control | An           | 4- | 22 | A | R | Required for all         |
| Number  | identifier   | 25 |    | / |   | Trailers.                |
|         | assigned by  |    |    | N |   |                          |
|         | the State,   |    |    |   |   | A unique alphanumeric    |
|         | Tribe or     |    |    |   |   | number that identifies a |
|         | Territory    |    |    |   |   | specific file or a batch |
|         | that         |    |    |   |   | within a file.           |
|         | uniquely     |    |    |   |   |                          |
|         | identifies a |    |    |   |   | This is the same number  |
|         | file or      |    |    |   |   | as specified in the      |
|         | group of     |    |    |   |   | corresponding File or    |
|         | records in a |    |    |   |   | Batch Header Control     |
|         | batch.       |    |    |   |   | Number.                  |
+---------+--------------+----+----+---+---+--------------------------+
| Batch   | Indicates    | 2  | 5  | N | [ | Used with file trailers  |
| Count   | the number   | 6- |    |   | R | (FTI, FTA, FTS, FTR, and |
|         | of batches   | 30 |    |   | ] | FTK).                    |
|         | contained in |    |    |   | { |                          |
|         | the file.    |    |    |   | . | [Zero fill if batch      |
|         |              |    |    |   | m | trailers (BTI, BTA, BTS, |
|         |              |    |    |   | a | BTR, and BTK).]{.mark}   |
|         |              |    |    |   | r |                          |
|         |              |    |    |   | k |                          |
|         |              |    |    |   | } |                          |
+---------+--------------+----+----+---+---+--------------------------+
| Record  | Indicates    | 3  | 5  | N | [ | Used with batch trailers |
| Count   | the number   | 1- |    |   | R | (BTI, BTA, BTS, BTR, and |
|         | of records   | 35 |    |   | ] | BTK).                    |
|         | contained in |    |    |   | { |                          |
|         | a batch      |    |    |   | . | [Zero fill if file       |
|         |              |    |    |   | m | trailers (FTI, FTA, FTS, |
|         |              |    |    |   | a | FTR, and FTK).]{.mark}   |
|         |              |    |    |   | r |                          |
|         |              |    |    |   | k |                          |
|         |              |    |    |   | } |                          |
+---------+--------------+----+----+---+---+--------------------------+
| E       | Indicates    | 3  | 5  | N | C | Used for IWO Result File |
| mployer | the number   | 6- |    |   | R | [(BTS)]{.mark}. Only     |
| Sent    | of           | 40 |    |   |   | used by the portal.      |
| Count   | [v           |    |    |   |   | [Always fill with        |
|         | alid]{.mark} |    |    |   |   | zeros]{.mark}            |
|         | records sent |    |    |   |   |                          |
|         | to an        |    |    |   |   |                          |
|         | employer     |    |    |   |   |                          |
|         | after the    |    |    |   |   |                          |
|         | editing      |    |    |   |   |                          |
|         | process.     |    |    |   |   |                          |
+---------+--------------+----+----+---+---+--------------------------+
| State   | Indicates    | 4  | 5  | N | C | Used for Acknowledgement |
| Sent    | the number   | 1- |    |   | R | Result File              |
| Count   | of           | 45 |    |   |   | [(BTK)]{.mark}. Only     |
|         | [v           |    |    |   |   | used by the portal.      |
|         | alid]{.mark} |    |    |   |   | [Always fill with        |
|         | records sent |    |    |   |   | zeros]{.mark}            |
|         | to a State   |    |    |   |   |                          |
|         | after the    |    |    |   |   |                          |
|         | editing      |    |    |   |   |                          |
|         | process.     |    |    |   |   |                          |
+---------+--------------+----+----+---+---+--------------------------+
| Filler  | IWO Detail   | 46 | Va | [ | O | The filler length varies |
|         |              |    | ri | A |   | according to the file    |
| FTI and | Ack          |    | es | / |   | that it is associated    |
| BTI     | nowledgement |    |    | N |   | with.                    |
|         |              |    | 23 | ] |   |                          |
| FTA and | IWO Result   |    | 61 | { |   |                          |
| BTA     |              |    |    | . |   |                          |
|         | IWO Receipt  |    | 5  | m |   |                          |
| FTS and |              |    | 28 | a |   |                          |
| BTS     | Ack          |    |    | r |   |                          |
|         | nowledgement |    | 23 | k |   |                          |
| FTR and | Result       |    | 61 | } |   |                          |
| BTR     |              |    |    |   |   |                          |
|         |              |    | 35 |   |   |                          |
| FTK and |              |    |    |   |   |                          |
| BTK     |              |    | 5  |   |   |                          |
|         |              |    | 28 |   |   |                          |
+---------+--------------+----+----+---+---+--------------------------+