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____I request that these payments be withheld from my wages pursuant to an INCOME. Instructs employers and federal agencies on how to process income withholding orders including examples of calculations.(5) Fill in the name of the person obligated to make payments. STOP. Judicial Officers or staff will complete the rest of this page. Fill out the form in our online filing application. Withholding Order to see if appropriate for your situation. 1. Complete this form with your name and case number. 2.