1. (1) The Notice form in Paragraph (5) shall be used by the Department of Human Services or its contractors which establish or enforce support under Title IV-D of the Social Security Act for the purpose of providing notice to an obligor of support in Tennessee that an initial Income Withholding for Support (Order for Income Assignment) 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) For an initial Order for Income Assignment, the Federal Income Withholding for Support form referenced in 1240-02-02-.04(1)(a) will be attached to the Notice form in Paragraph (5).
3. (3) The Department may combine the language in this form with language of the notices issued by the Department described in this Chapter to provide notice of various actions taken by the court or actions taken administratively by the Department, and the form may be modified and transmitted by the TCSES system to contain, as may be applicable, combinations of the language in any of those notices on one form.

4. (4) Appeals.

   1. (a) The obligor may contest this Order of Income Assignment by filing a written request for an administrative hearing with the local child support office shown on the Order within fifteen (15) days of the mailing date of the Order. The grounds for contesting the initial Order are the correct identity of the individual subject to the order, and a mistake of fact, or for an Order due to a delinquency, the amount of support not paid, the timeliness of the support paid, or the reasonableness of the amount ordered to be paid to reduce the arrears.
   2. (b) If the obligor contests the Order of Income Assignment within the above time limit, a hearing will be promptly set. 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 Order of Income Withholding for Support (also called an Order for Income Assignment or Income Assignment) was issued. If an unfavorable decision is rendered, the obligor has a right to further appeal the decision as described in the Department’s administrative order following the decision.
5. (5) Form: STATE OF TENNESSEE DEPARTMENT OF HUMAN SERVICES NOTICE OF ISSUANCE OF INCOME ASSIGNMENT TO: _________________________________________<OBLIGOR> _________________________________________<ADDRESS> _________________________________________ FROM: ____________________________________<LOCAL CHILD SUPPORT OFFICE > ____________________________________<ADDRESS> ____________________________________<TELEPHONE NUMBER> MAILING DATE OF NOTICE: ___________________________________ Pursuant to a court order, statutory requirements directing payment by Income Withholding for Support (Order for Income Assignment), or administrative actions by the Department of Human Services, you have been ordered to pay your child support obligation by means of an income assignment. This is to notify you that your employer, or other person, corporation, or institution which is a payer of income has been directed, pursuant to Tennessee Code Annotated, § 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 Income Withholding for Support (Order for Income Assignment). You may contest this Order of Income Assignment by filing a written request for an administrative hearing with the local child support office at the address above within fifteen (15) days of the mailing of this Order as noted above. The grounds for contesting the Order are the correct identity of the individual subject to the order, and a mistake of fact, or for an Order due to a delinquency, the amount of support not paid, the timeliness of the support paid, or the reasonableness of the amount ordered to be paid to reduce the arrears. If you contest this Order of Income Assignment within the above time limit, a hearing will be promptly set. 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 Income Withholding for Support (also called an Order for Income Assignment or Income Assignment) was issued. If an unfavorable decision is rendered, you have a right to further appeal the decision as described in the Department’s administrative order following the decision. 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.

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.