1. (1) The Notice form in Paragraph (5) shall be used by the Clerk of Court for the purpose of providing notice to an obligor of support in Tennessee that an Income Withholding for Support has been issued which will direct the obligor’s employer or payer of income to withhold income from an obligor of support to meet the child or spousal support obligation.

2. (2) This Notice is used:

   1. (a) When, pursuant to T.C.A. § 36-5-501(b)(1)(B) no Order for Income Assignment had been previously issued for any reason, and where the records of the Clerk or the Department of Human Services show the obligor is currently delinquent;
   2. (b) When, pursuant to T.C.A. § 36-5-501(b)(1)(D) an Affidavit of Arrearage pursuant to 1240-02-02-.11 to support the issuance of an Order for Income Assignment is filed by the custodial parent, a guardian, or other caretaker to whom child support was previously directed alleging the obligor is now in arrears as defined by T.C.A. § 36-5- 101(f)(1) and T.C.A. § 36-5-501(b)(1)(G); or
3. (3) For an Order for Income Assignment, the Federal Income Withholding for Support (Order for Income Assignment) form referenced in 1240-02-02-.04(1)(a) will be attached to the notice to the obligor in Paragraph (5).

4. (4) Appeals.

   1. (a) The obligor may contest this Notice of Income Assignment by filing a written request for a hearing with the Clerk’s office shown on the Notice within fifteen (15) days of the mailing of the Notice. The grounds for contesting the Notice are that the income withholding is improper due to a mistake of fact, or the amount withheld is improper due to a mistake of fact.
   2. (b) If the obligor contests the Notice of Income Assignment within the above time limit, a hearing will be promptly set and the magistrate or court shall conduct a hearing and make a determination. The employer will continue to withhold income unless a decision favorable to the obligor is rendered. The obligor and the employer will be notified of the decision within forty-five (45) days of the date the Income Withholding for Support (also called an Order for Income Assignment or Income Assignment) was issued.
5. (5) Form: STATE OF TENNESSEE NOTICE OF ISSUANCE OF INCOME ASSIGNMENT DUE TO DELINQUENCY You are hereby notified pursuant to T.C.A. § 36-5-501(b)(2) that due to a delinquency in your child support payments in the amount of $__________ as of the _____ day of __________, ______, your employer, or other person, corporation, or institution which is a payer of income has been directed, pursuant to T.C.A. § 36-5-501, to withhold income payable to you to satisfy your support obligation in the amounts and for the purposes shown in the attached Order/Notice to Withhold Income for Child Support (Order for Income Assignment). Your total arrearage as of the ______ day of ___________, ______, is $ _________ plus twelve (12%) per annum simple interest. You may contest this Notice of Income Assignment by filing a written request for a hearing with ___________________________________<Court Clerk’s Office> at the address above within fifteen
6. (15) days of the mailing of this notice as noted above. The grounds for contesting the Notice are that the income withholding is improper due to a mistake of fact, or the amount withheld is improper due to a mistake of fact. If you contest this Notice of Income Assignment within the above time limit, a hearing will be promptly set and the magistrate or court shall conduct a hearing and make a determination. Your employer will continue to withhold income unless a decision favorable to you is rendered. You and your employer will be notified of the decision within forty-five (45) days of the date the Order/Notice to Withhold Income for Child Support (also called an Order for Income Assignment or Income Assignment) was issued. It is your responsibility to keep the Court Clerk/and the local child support office informed of the name and address of your current employer, whether you have access to health insurance coverage, and if so, the health insurance policy information. You must also immediately notify the Court Clerk/and the local child support office of any changes in, or any additional employment, including the name and address of the new employer. Your new employer will be notified of the Order for Income Assignment. An Order for Income Assignment shall be mandatory as long as current support or arrearages are still owed. Clerks of court are authorized to issue an Order for Income Assignment to the employer or payer of income of the obligor and to institute the process to assign income when the obligor fails to pay court costs, but shall not have priority over the Order for Income Assignment for child or spousal support. CERTIFICATE OF SERVICE I hereby certify that a copy of this NOTICE OF ISSUANCE OF INCOME ASSIGNMENT DUE TO DELINQUENCY was served on the Respondent by delivering to him/her by <certified mail, return receipt requested; registered mail; electronic mail; facsimile; personal service> on this the _______________ day of __________________, ______. _____________________________________ <Court Clerk>

Authority: T.C.A. §§ 4-5-202, 8-21-403, 36-5-116, 36-5-501, and 71-1-132(c); 42 U.S.C. §§ 651 et seq., 42 U.S.C §§ 652(a)(11), 654(9)(E), 654a(g)(1)(A)(ii), 654b(a), and 666(a)(8) and (b); 45 C.F.R. §§ 303.6(c)(1), 303.7, and 303.100; and United States Department of Health and Human Services Office of Child Support Enforcement Action Transmittal 04-05 (July 15, 2004). Administrative History: Original rule filed October 14, 1999; effective December 28, 1999. Amendment filed August 17, 2005; effective October 31, 2005. Amendment filed September 8, 2009; effective December 7, 2009.