SSN:

We are writing to you about court order number (1) . Beginning (2) , we will withhold less of (3) Social Security payment. We have changed the monthly amount that we withhold to $ (4) . This is (5) percent of (6) payment amount.

As required by the Consumer Credit Protection Act (15 U.S.C. Section 1673), we have reduced the amount we withhold because of the enclosed proof that (7) is supporting another spouse and/or dependent child. We will send the new amount to (8) 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 the individual has proved that he /she is supporting a second family.

   

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  Fill-ins:

  1. (1) 

     case/civil action number

  2. (2) 

     month and year

  3. (3) 

     beneficiary's full name as it appears on the MBR

  4. (4) 

     new dollar amount being withheld

  5. (5) 

     percentage being withheld

  6. (6) 

     beneficiary's last name, possessive, in format: Mr. Smith's

  7. (7) 

     beneficiary's last name in format: Mr. Smith

  8. (8) 

     name of person/place receiving the garnished payments