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National Medical Support Notice

Note: This is a brief explanation of the employer's responsibility for withholding medical support and using the National Medical Support Notice. For a complete explanation, read the instructions contained within the National Medical Support Notice.

The National Medical Support Notice (NMSN) is a standardized federal form that all state IV-D child support agencies must use. The form complies with section 609 (a)(3) and (4) of ERISA.

This form includes the following:

  • Applicable state law that provides for withholding employee contributions due under any group health plan to provide coverage.
  • Length of time the withholding is required.
  • The priority under state law between amounts to be withheld for cash support and amounts to be withheld for medical support where funds are not available for full withholding for both.
  • Name and telephone number of the appropriate county Child Support Enforcement (CSE) Unit to contact.
  • Detailed instructions to help in completing the forms.


The NMSN has several parts:

  • Part A: Notice to Withhold For Health Care Coverage, will be completed by the child support agency and sent to the employer with the rest of the packet.
  • Employer Response - to respond if one of the following situations exists:
    • You do not provide health care coverage for your employees.
    • The employee is not eligible for the health care coverage you provide.
    • The employee has been terminated or has left this employment.
    • The deduction for health care coverage cannot be made because of state or federal withholding limits and/or the state’s priority for withholding. The limitations will be included in the instructions that come with the NMSN or with the instructions received from your state.

Otherwise, follow the steps below to comply with the NMSN:

  • Part B: Medical Support Notice To Plan Administrator. This document should be sent to your health care plan administrator for handling.
  • Plan Administrator Response - should be completed by your plan administrator, according to the accompanying instructions, and returned to the child support agency.

Employer Responsibilities: Step-By-Step

  • Determine if any of the four categories listed on the Employer Response apply to you or to the employee.
  • If so, complete the Employer Response form and return it to the issuing agency within 20 business days. If none of the four categories applies, forward Part B: Medical Support Notice to your plan administrator.
  • The plan administrator will notify you when enrollment has been completed. Then notify your payroll office or service to make the appropriate deductions for the employee contribution required under the health plan. At this point, you can determine whether the total deductions are greater than the maximum allowed under the Consumer Credit Protection Act (CCPA) and any applicable state law.
  • If the amount of support plus the deduction for health care premiums exceeds the maximum deduction allowed, you must refer to state law where the employee is employed to determine the priority for payment. In Colorado, the deduction of the health premium is the first priority. It is deducted, along with taxes, from the gross income before determining disposable income.
  • If enrollment cannot be completed until after a waiting period or other contingency you must notify the plan administrator as to when the employee is eligible for enrollment.

Who to Contact
If you have questions about the National Medical Support Notice, contact the county CSE Unit noted on the form.

OCSE Income Withholding Resources
The Federal Office of Child Support Enforcement (OCSE) also offers resources and assistance concerning income withholding to employers. If you have further questions or need more information, please visit OCSE Income Withholding Process for Private Sector Employers if you are a private sector employer, or OCSE Income Withholding Process for Federal Agency Employers if you are a federal agency employer.

Legal Authority
26-13-121.5 CRS