Title 31
PART 212 APPENDIX A
Account number | Amount in account |
Amount protected | Amount subject to garnishment (now [frozen/removed]) | Garnishment fee charged |
---|---|---|---|---|
(If the account holder has multiple accounts, add a row for each account.)
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].