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Awg Hearing Request

This document is a request form for a hearing or eligibility determination regarding administrative wage garnishment. It provides instructions for disputing a debt for which wage garnishment is proposed, including options to request a hearing based on the existence or amount of the debt, or assert ineligibility. It notes requirements to provide documentation and financial information. The form collects contact and employment information and a signature acknowledging the penalties for fraudulent claims.

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Haley Slaughter
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450 views1 page

Awg Hearing Request

This document is a request form for a hearing or eligibility determination regarding administrative wage garnishment. It provides instructions for disputing a debt for which wage garnishment is proposed, including options to request a hearing based on the existence or amount of the debt, or assert ineligibility. It notes requirements to provide documentation and financial information. The form collects contact and employment information and a signature acknowledging the penalties for fraudulent claims.

Uploaded by

Haley Slaughter
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Administrative Wage Garnishment MAIL OR FAX FORM TO:

Request for Hearing or Eligibility FAX: (855) 292-9623


Determination EMAIL: [email protected]
Mail: Bureau of the Fiscal Service
Attn: AWG Analyst
Date NRWLFHof Intent Sent: 
Post Office Box 830794
Birmingham, Al 35283-0794

Responisble Party
Treasury Case Number 
$JHQF\Name
$JHQF\ $FFRXQW1XPEHU
Account Balance 
If you object to garnishment of your wages for the debt mentioned above, you can use this form to request
a hearing or to assert ineligibility for garnishment based on the facts of your employment. Please check
the appropriate box(es) below. Your request for a hearing or assertion of ineligibility must be in
writing, signed, and delivered to the address above. EXPLAIN any additional facts concerning
your objection on a separate sheet of paper and, together with all supporting documentation,
enclose it with this request. Your objection(s) will be considered based on the information and
documents you provide with this form, and any records held by the agency.

I request a hearing based on the e[LVWHQFH RI WKHGHEW ±,GRQRWRZHWKHGHEW


I request a hearing based on the aPRXQW RIWKHGHEW ±,GRQRWRZHWKHIXOODPRXQW RIWKHGHEW

I request a hearing based on the gDUQLVKPHQW DPRXQW ±3URSRVHGJDUQLVKPHQWZRXOGFDXVH


ILQDQFLDOKDUGVKLS
NOTE: You must provide a signed financial statement along with copies of earnings and
income records and proof of expenses. To obtain a copy of the financial statement form,
go to https://fiscal.treasury.gov/files/cross-servicing/consumer-finstmt.pdf and fax it to
the number listed above.
,am ineligible for garnishment because I was LQYROXQWDULO\WHUPLQDWHGIURPP\ODVWHPSOR\PHQW
DQG,KDYHEHHQHPSOR\HGLQP\FXUUHQWMREIRUOHVVWKDQPRQWKV
NOTE: You must attach documentation from your employer showing the date you were
hired in your current job and documentation from prior employer showing termination.

Responsible Party AGGUHVV


Responsible Party 3KRQH1o.
(PSOR\HU1DPHDQG$GGUHVV

(PSOR\HU3KRQH1XPEHU

I have read and understand the Important Notice Concerning Administrative Wage Garnishment enclosed
in the form.
,XQGHUVWDQG WKDWLI,PDNHRUSURYLGHDQ\NQRZLQJO\ IDOVHRUIULYRORXV F O D L P V  R U  VWDWHPHQWVUHSUHVHQWDWLRQV RU
HYLGHQFHWRD)HGHUDO $JHQF\,PD\EHVXEMHFWWRSHQDOWLHVXQGHUWKH)DOVH &ODLPV$FW86& RU
FULPLQDOSHQDOWLHVXQGHU86&DQG

6LJQDWXUHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB'DWHBBBBBBBBBBBBBBBBBBBBBBBBBBBB

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