Government of Ontario: Ministry of Community and Social Services

Family Responsibility Office
P.O. Box 220
Downsview ON M3M 3A3

NOTICE TO FAMILY RESPONSIBILITY OFFICE BY INCOME SOURCE

Family Responsibility and Support Arrears Enforcement Act, 1996

Form 5

Family Responsibility Office Case Number:

I, (Name of income source), have received a Support Deduction Notice dated , 20 regarding (Name of Payor)

DISPUTE BY INCOME SOURCE

I am not an income source of the payor named in the
Support Deduction Notice for the following reasons:
(check as many as apply)
I do not owe any money or make any payments to the payor.
The payor has never worked for me.
Other (specify)

TERMINATION OR INTERRUPTION OF PAYMENTS

The payor has worked for me, but stopped working for me on (Date)
State reason why payor stopped working:

Is termination permanent or a lay off
give date of recall, if known

Other (specify)

RESUMPTION OF PAYMENTS

Support deduction will resume as of (State date of return to work)

I am not aware of any other employment held by the payor or any other income source of the payor.
OR
I am aware of other employment or income sources of the payor.
If yes, provide complete details:

Name of Income Source:
Name of individual, corporation or other organization

Address (street & number)
Unit/Apt. Number
City Province
Postal Code

Name of Contact Person at Income Source: Name
Position
Telephone Number

Date
Signature of Authorized Individual

If you receive a Support Deduction Notice in respect of a payor and you are not an income source for the payor, the law says that you must notify the Family Responsibility Office in writing of this fact. Anyone who fails to notify the Director can be found guilty of an offence and fined up to $10,000.

The law also says that, after receiving a Support Deduction Notice, an income source must make deductions and payments to the Family Responsibility Office. If the income source fails to make the deduction and payments without a proper reason, a court may order the income source to pay the amount that should have been deducted.

The law also says that you must write to the Family Responsibility Office if you were an income source but are no longer an income source for a payor or if you resume being an income source for a payor after deductions and payments are interrupted or terminated.

FRO-18E (June 15, 2005)

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