Form WC(DO)-379 "Order for Distribution of Temporary Award (For Child Support)" - New Jersey

What Is Form WC(DO)-379?

This is a legal form that was released by the New Jersey Department of Labor & Workforce Development - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2006;
  • The latest edition provided by the New Jersey Department of Labor & Workforce Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form WC(DO)-379 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Labor & Workforce Development.

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Download Form WC(DO)-379 "Order for Distribution of Temporary Award (For Child Support)" - New Jersey

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WC(DO) – 379 (4-06)
WC CASE NO. (S) _________________
ORDER FOR DISTRIBUTION
State of New Jersey
OF TEMPORARY AWARD
Department of Labor and
__________________________________
(For Child Support)
Workforce Development
Page 1 of 2
Division of Workers’ Compensation
District Office: _____________________
FEIN
SOCIAL SECURITY NUMBER
NAME
NAME
AGE
ADDRESS
ADDRESS (Including County)
APPEARING
VS
NAME (Indicate if Not Covered or if Self-Insured)
NAME
ADDRESS (Including County)
NAME
PROBATION CASE NO.
ADDRESS (Including County)
CS-
APPEARING
1. The Division of Workers’ Compensation has matched data received from the New Jersey Administrative
Office of the Courts on child support judgment debtors against the information the Division maintains for
individuals who have filed workers’ compensation claims, and the match has identified the petitioner as a
child support judgment debtor;
2. Total support arrears owed by the petitioner on all cases enforceable through the state Probation Division
are $_____________ as of ____/____/____, as indicated in the records of ______________Probation
Division;
3. The net proceeds of the within award are more than $2,000.00, after payment of attorney fees, witness fees,
costs, fees payable to health care providers, reimbursement to the employer, employer’s insurance carrier,
Second Injury Fund of the State of New Jersey, State Division of Temporary Disability Insurance and an
approved Private Plan covered under the Temporary Disability Benefits Law or other reimbursement to an
employer or employer’s workers’ compensation carrier as provided in R.S. 34:15-40.
4. The petitioner has one or more support orders and ____ does / ____ does not support a current spouse or
child not covered by a current child support order;
5. The petitioner ____ does / ____ does not owe more than twelve weeks arrears on obligor’s support orders,
in total.
WC(DO) – 379 (4-06)
WC CASE NO. (S) _________________
ORDER FOR DISTRIBUTION
State of New Jersey
OF TEMPORARY AWARD
Department of Labor and
__________________________________
(For Child Support)
Workforce Development
Page 1 of 2
Division of Workers’ Compensation
District Office: _____________________
FEIN
SOCIAL SECURITY NUMBER
NAME
NAME
AGE
ADDRESS
ADDRESS (Including County)
APPEARING
VS
NAME (Indicate if Not Covered or if Self-Insured)
NAME
ADDRESS (Including County)
NAME
PROBATION CASE NO.
ADDRESS (Including County)
CS-
APPEARING
1. The Division of Workers’ Compensation has matched data received from the New Jersey Administrative
Office of the Courts on child support judgment debtors against the information the Division maintains for
individuals who have filed workers’ compensation claims, and the match has identified the petitioner as a
child support judgment debtor;
2. Total support arrears owed by the petitioner on all cases enforceable through the state Probation Division
are $_____________ as of ____/____/____, as indicated in the records of ______________Probation
Division;
3. The net proceeds of the within award are more than $2,000.00, after payment of attorney fees, witness fees,
costs, fees payable to health care providers, reimbursement to the employer, employer’s insurance carrier,
Second Injury Fund of the State of New Jersey, State Division of Temporary Disability Insurance and an
approved Private Plan covered under the Temporary Disability Benefits Law or other reimbursement to an
employer or employer’s workers’ compensation carrier as provided in R.S. 34:15-40.
4. The petitioner has one or more support orders and ____ does / ____ does not support a current spouse or
child not covered by a current child support order;
5. The petitioner ____ does / ____ does not owe more than twelve weeks arrears on obligor’s support orders,
in total.
WC(DO) - 379.1 (4-06)
WC CASE NO. (S) __________________
ORDER FOR DISTRIBUTION
State of New Jersey
OF TEMPORARY AWARD
Department of Labor and
__________________________________
(For Child Support)
Workforce Development
Page 2 of 2
Division of Workers Compensation
District Office: _____________________
IT IS ON THIS ___________ DAY OF ____________,______, HEREBY ORDERED THAT
1. The petitioner shall pay $___________ for Child Support arrearage(s), through the ______________
Probation Division. The employer or employer’s insurance carrier shall deduct said payment from the
petitioner’s net proceeds.
2. The employer or employer’s insurance carrier shall contact the _______________ Probation Division prior
to the distribution of proceeds to the petitioner in order to arrange for the satisfaction of the child support
judgment.
3. This order adjudicates the disbursement of net proceeds of the within award as it pertains to satisfaction of
the above referenced child support obligation. All other provisions previously entered in this or related
matters shall remain in full force and effect until further order of the court.
4. Periodic indemnity benefits due and owing from the date of the execution of the within order are subject to
the appropriate garnishment rate until such time as the child support obligations have been satisfied or
indemnity benefits exhausted. The employer or employer’s carrier shall contact the applicable Probation
Department to verify rates and amounts and shall make payments as appropriate.
5. A copy of this order shall be served upon the ______________ Probation Division by the respondent’s
attorney within 10 days from the execution of this order.
_________________________
________________________________________
Petitioner’s Attorney
Judge of Compensation
Date
__________________________
_________________________________
Petitioner
Name (Print or Type)
____________________________
Respondent’s Attorney
Page of 2