Report Employee Terminations and Temporary Absences

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Report terminations and temporary absences of employees for whom you have received an income withholding order from ND Child Support.

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Employer

*Federal Employer Identification Number (FEIN):

(123456789)

Employee

*Remittance Identifier:

(123456789)

*Last 4 Digits of SSN:

(4444)

Status Type

Termination

Seasonal Absence

Temporary Layoff

Workers Compensation Absence

Disability Benefit Absence

Other Absence

(One status type is required)

*Required

Questions or problems? Please contact ND Child Support Division at:

Phone: (701) 328-6524