Appendix A to Part 212 - Model Notice to Account Holder
31:2.1.1.1.10.2.1.1.1 : Appendix A
Appendix A to Part 212 - Model Notice to Account Holder
A financial institution may use the following model notice to
meet the requirements of § 212.7. Although use of the model notice
is not required, a financial institution using it properly is
deemed to be in compliance with § 212.7.
Information in brackets should be completed by the financial
institution. Where the bracketed information indicates a choice of
words, as indicated by a slash, the financial institution should
either select the appropriate words or provide substitute words
suitable to the garnishment process in a given jurisdiction.
Parenthetical wording in italics represents instructions to the
financial institution and should not be printed with the notice. In
most cases, this wording indicates that the model language either
is optional for the financial institution, or should only be
included if some condition is met.
MODEL NOTICE:
[Financial institution name, city, and State, shown as
letterhead or otherwise printed at the beginning of the notice]
IMPORTANT INFORMATION ABOUT YOUR ACCOUNT
Date:
Notice to:
Account Number:
Why am I receiving this notice?
On [date on which garnishment order was served], [Name of
financial institution] received a garnishment order from a court to
[freeze/remove] funds in your account. The amount of the
garnishment order was for $[amount of garnishment order]. We are
sending you this notice to let you know what we have done in
response to the garnishment order.
What is garnishment?
Garnishment is a legal process that allows a creditor to remove
funds from your [bank]/[credit union] account to satisfy a debt
that you have not paid. In other words, if you owe money to a
person or company, they can obtain a court order directing your
[bank]/[credit union] to take money out of your account to pay off
your debt. If this happens, you cannot use that money in your
account.
What has happened to my account?
On [date of account review], we researched your account and
identified one or more Federal benefit payments deposited in the
last 2 months. In most cases, Federal benefit payments are
protected from garnishment. As required by Federal regulations,
therefore, we have established a “protected amount” of funds that
will remain available to you and that will not be [frozen/removed]
from your account in response to the garnishment order.
(Conditional paragraph if funds have been frozen) Your
account contained additional money that may not be protected from
garnishment. As required by law, we have [placed a hold on/removed]
these funds in the amount of $[amount frozen] and may have to turn
these funds over to your creditor as directed by the garnishment
order.
The chart below summarizes this information about your
account(s):
Account Summary as of [date of account
review]
 
| Account number | Amount in account
 | Amount protected | Amount subject to garnishment
(now [frozen/removed]) | Garnishment fee charged | 
|  |  |  |  |  | 
 
 
Please note that these amount(s) may be affected by deposits or
withdrawals after the protected amount was calculated on [date of
account review].
Do I need to do anything to access my protected funds?
You may use the “protected amount” of money in your account as
you normally would. There is nothing else that you need to do to
make sure that the “protected amount” is safe.
Who garnished my account?
The creditor who obtained a garnishment order against you is
[name of creditor].
What types of Federal benefit payments are protected from
garnishment?
In most cases, you have protections from garnishment if the
funds in your account include one or more of the following Federal
benefit payments:
• Social Security benefits • Supplemental Security Income benefits
• Veterans benefits • Railroad retirement benefits • Railroad
Unemployment Insurance benefits • Civil Service Retirement System
benefits • Federal Employees Retirement System benefits
(Conditional section if funds have been frozen) What
should I do if I think that additional funds in my account are from
Federal benefit payments?
If you believe that additional funds in your account(s) are from
Federal benefit payments and should not have been [frozen/removed],
there are several things you can do.
(Conditional sentence if applicable for the jurisdiction)
You can fill out a garnishment exemption form and submit it to the
court.
You may contact the creditor that garnished your account and
explain that additional funds are from Federal benefit payments and
should be released back to you. (Conditional sentence if contact
information is in the garnishment order) The creditor may be
contacted at [contact information included in the garnishment
order].
You may also consult an attorney (lawyer) to help you prove to
the creditor who garnished your account that additional funds are
from Federal benefit payments and cannot be taken. If you cannot
afford an attorney, you can seek assistance from a free attorney or
a legal aid society. (Optional sentences) [Name of State,
local, or independent legal aid service] is an organization that
provides free legal aid and can be reached at [contact
information]. You can find information about other free legal aid
programs at [insert “http://www.lawhelp.org” or other legal
aid programs website].
(Optional section) How to contact [name of financial
institution].
This notice contains all the information that we have about the
garnishment order. However, if you have a question about your
account, you may contact us at [contact number].