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Get NY Payment Listing Form 2011-2024

PAYMENT LISTING FORM Employer Name Address Employer FEIN Remittance Date SEND PAYMENTS ONLY TO THIS ADDRESS NYS CHILD SUPPORT PROCESSING CENTER PO BOX 15363 ALBANY NY 12212-5363 PLEASE ENTER THE TOTAL AMOUNT ENCLOSED IMPORTANT INFORMATION NOTICE TO EMPLOYERS ELECTRONIC PAYMENT SERVICE AVAILABLE The New York State Child Support Processing Center strongly encourages employers to remit child support payments via Electronic Funds Transfer EFT. An EFT has the benefit of reduced cost accurate submission and faster processing of the child support payment. For many employers EFT may represent substantial savings over individual check preparation* To facilitate EFT please contact any Customer Service Representative at 1-888-208-4485 or write for an informational packet to New York State Child Support Processing Center PO Box 15363 Albany New York 122125363. DIRECTIONS Please refer to the Income Withholding for Order/Notice for Support IWO to obtain complete and correct information to complete the fields below. All information must be recorded to make sure that the respondent/employee receives credit for the support withholding. RESPONDENT/EMPLOYEE NAME First Last MI NEW YORK CASE IDENTIFIER DATE S OF WITHHOLDING AMOUNT Page 1 Total For additional respondents/employees please continue to Page 2. W 12-2011 Page 1 Total of Page 1 and Page 2 Enter this amount in the box on the top right side of Page 1 Page 2. An EFT has the benefit of reduced cost accurate submission and faster processing of the child support payment. For many employers EFT may represent substantial savings over individual check preparation* To facilitate EFT please contact any Customer Service Representative at 1-888-208-4485 or write for an informational packet to New York State Child Support Processing Center PO Box 15363 Albany New York 122125363. For many employers EFT may represent substantial savings over individual check preparation* To facilitate EFT please contact any Customer Service Representative at 1-888-208-4485 or write for an informational packet to New York State Child Support Processing Center PO Box 15363 Albany New York 122125363. DIRECTIONS Please refer to the Income Withholding for Order/Notice for Support IWO to obtain complete and correct information to complete the fields below. DIRECTIONS Please refer to the Income Withholding for Order/Notice for Support IWO to obtain complete and correct information to complete the fields below. All information must be recorded to make sure that the respondent/employee receives credit for the support withholding. All information must be recorded to make sure that the respondent/employee receives credit for the support withholding. RESPONDENT/EMPLOYEE NAME First Last MI NEW YORK CASE IDENTIFIER DATE S OF WITHHOLDING AMOUNT Page 1 Total For additional respondents/employees please continue to Page 2. RESPONDENT/EMPLOYEE NAME First Last MI NEW YORK CASE IDENTIFIER DATE S OF WITHHOLDING AMOUNT Page 1 Total For additional respondents/employees please continue to Page 2. W 12-2011 Page 1 Total of Page 1 and Page 2 Enter this amount in the box on the top right side of Page 1 Page 2. .

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