FL-397 - Request for Income and Benefit Information From Employer

Summary

Request for Income and Benefit Information From Employer

Text

Form ID: FL-397
Title: Request for Income and Benefit Information From Employer
Effective Date: 2003-01-01
Mandatory Form: yes
Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-397
Primary Download URL: https://www.courts.ca.gov/documents/fl397.pdf
Form Detail Page:
Request for Income and Benefit Information From Employer
(FL-397)
Ask the employer of your former spouse or domestic partner to give you information about employment status and wages if you did not receive a response using form FL-396 or the response received was incomplete.
Get form FL-397
Effective: January 1, 2003
PDF Text:
FOR COURT USE ONLY
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
CASE NUMBER:
REQUEST FOR INCOME AND BENEFIT
INFORMATION FROM EMPLOYER
To (employer name):
This notice is served on you, under California Family Code section 3664(b), in regard to your employee (name):
I request that the information sought be sent to me on or before (date):                                                        , which is at least 15 days 
from the date of this request.
REQUEST FOR INCOME AND BENEFIT
INFORMATION FROM EMPLOYER
Form Adopted for Mandatory Use
Judicial Council of California
FL-397 [Rev. January 1, 2003]
Family Code, § 3664
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
CITY AND ZIP CODE:
BRANCH NAME:
STREET ADDRESS:
MAILING ADDRESS:
FL-397
3.
1.
4. I request that you, as the employer of the above employee, provide the following information (indicated by checked boxes below).
If you wish, you may return a copy of this form with the information filled out or provide the information on a separate form.
a. Occupation of employee:
Presently employed: Yes Nob. (1)
(2) If employed, current employment status: Full time Part time
(3) If not presently employed:
(a) Date of separation:
(b) Reasons for separation:
c. Starting date of employment:
d. Gross salary or wages for the previous month (including commissions, bonuses, and overtime):
e. Total salary or wages for the previous 12 months (including commissions, bonuses, and overtime):
f. Federal income tax withheld for the previous month:
g. State income tax withheld for the previous month:
h. Social Security and Medicare Tax ("FICA" and "MEDI") deducted for the previous month:
i. Any other deductions from the paycheck for the previous month (for each deduction state purpose and amount):
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address):
I previously served a request for an Income and Expense Declaration (form FL-150) after judgment on your employee and:2.
a. There was no response within 35 days 
b. The response was incomplete as to wage information.
or
ATTORNEY FOR (Name):
TELEPHONE NO. (Optional): FAX NO. (Optional):
E–MAIL ADDRESS (Optional):
Page 1 of 2
www.courtinfo.ca.gov

REQUEST FOR INCOME AND BENEFIT
INFORMATION FROM EMPLOYER
RESPONDENT/DEFENDANT:
CASE NUMBER:PETITIONER/PLAINTIFF:
Date:
FL-397 [Rev. January 1, 2003]
(SIGNATURE OF REQUESTING PARTY)(TYPE OR PRINT NAME)
(5) Use of company assets (vehicle, housing, health club facility, etc.)
Not available Not enrolled Enrolled (specify value to employee):
k. Attach a copy of the employee's three most recent pay stubs.
5. You are entitled to have me pay the reasonable co sts of copying the information in this request.
6. Under Family Code section 3664(f), your compliance with this request is voluntary except upon order of the court or upon 
agreement of the parties, employers, and employee affected.
NOTICE TO EMPLOYEE
I have served a copy of the attached Request for Income and Benefit Information From Employer on your 
employer under Family Code section 3664(b).
Under Family Code section 3664(c), you are notified that:
The information sought by me is limited to the income and benefits provided to you by your employer.
The information may be protected by right of privacy.
If you object to the production of this information by the employer to me, you must notify the court, in writing, 
of this objection prior to the date specified in paragraph 3 of the attached request.
If, upon your objection, I do not agree, in writing, to cancel or narrow the scope of my request, you should 
consult an attorney regarding your right to privacy and how to protect this right.
You may have other rights provided by Family Code section 3664 and otherwise.
NOTICE TO REQUESTING PARTY
Under Family Code section 3664(e), service of this request on the employer and of the copy of the request on 
the employee must be by certified mail, postage prepaid, return receipt requested, to the last known address of 
the party to be served, or by personal service.
1.
2.
3.
4.
5.
j. Benefits provided:
(1) Vision insurance Not available Not enrolled Enrolled (specify value to employee):
(2) Life insurance Not available Not enrolled Enrolled (specify value to employee):
(3) Health insurance Not available Not enrolled Enrolled (specify value to employee):
(4) Contributions toward 
retirement plan
Not available Not enrolled Enrolled (specify asset value to 
employee):
Page 2 of 2

Retrieval chunks

• #1

  Form ID: FL-397 Title: Request for Income and Benefit Information From Employer Effective Date: 2003-01-01 Mandatory Form: yes Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-397 Primary Download URL: https://www.courts.ca.gov/documents/fl397.pdf Form Detail Page: Request for Income and Benefit Informatio…

• #2

  I previously served a request for an Income and Expense Declaration (form FL-150) after judgment on your employee and:2. a. There was no response within 35 days b. The response was incomplete as to wage information. or ATTORNEY FOR (Name): TELEPHONE NO. (Optional): FAX NO. (Optional): E–MAIL ADDRESS (Optional): …

• #3

  (3) Health insurance Not available Not enrolled Enrolled (specify value to employee): (4) Contributions toward retirement plan Not available Not enrolled Enrolled (specify asset value to employee): Page 2 of 2