SSN:

We are writing to you about court order number (1) . We plan to (2) (3) Social Security payments beginning (4) . Therefore, we will also (5) the amount we take out to satisfy the court order. We will withhold $ (6) a month. We will send the new amount to (7) no later than the 15th of each month.

If you have any questions, please write to us at the above address.

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  The PSC will send this notice when we are withholding a percentage and the dollar amount changes because of a change in the benefit amount.

   

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  Fill-ins:

  1. (1) 

     case/civil action number

  2. (2) 

     increase/decrease

  3. (3) 

     beneficiary's name, possessive in format: John Smith's

  4. (4) 

     month and year

  5. (5) 

     increase/decrease

  6. (6) 

     new dollar amount being withheld

  7. (7) 

     “You” or name of person/place receiving the garnished payments