Lump Sum Payment Notification Form Help
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This form can be used to submit employees that have an active Texas OAG Income Withholding Order and will receive a Lump Sum payment greater than $500.

If you would like more information on Lump Sum payments, Texas statutes, or other methods to submit Notices of Lump Sum payments (via Data Transfer System, Fax, mail), click here or click on the Help Button next to the page title on this page.

Instructions:

  1. Enter your company’s information with at least the following required fields (*): FEIN, Employer Name, Contact Name, Contact Phone and Fax Number.
  2. Add each employee that will be receiving a Lump Sum Payment with at least the following required fields (*): Employee Name, SSN, Lump Sum Amount. Click the ‘Add Employee’ button to add each employee to the table below.
  3. Review the employee(s) added. Use the ‘Remove’ link to remove any employee prior to submitting the form. Use the ‘Clear All Employees’ button to remove all employees from the table.
  4. Ensure all mandatory fields are complete, then click ‘Submit Lump Sum Form’ to complete the submission.

Employer Information












Employee Information


#First NameMILast NameSSNCase IDCause / Order IDLump SumRemove
No Employee has been added.