Instructions:        
1) Enter the employer information.      
2) Enclose a check equal to the total amount withheld for all the employees paying child support   
3) Complete and Print the list form      
4) Make check payable to: Illinois State Disbursement Unit    
5) Mail the check and the list form to: Illinois State Disbursement Unit  
    P.O. Box 5400    
    Carol Stream, IL 60197-5400  
          Counties
001 ADAMS
003 ALEXANDER
005 BOND
007 BOONE
009 BROWN
011 BUREAU
013 CALHOUN
015 CARROLL
EMPLOYER INFORMATION[1] 017 CASS
Employer Name   019 CHAMPAIGN
Contact Name   021 CHRISTIAN
Address   023 CLARK
025 CLAY
City   State - Zip   027 CLINTON
Telephone Number   Fax Number   029 COLES
031 COOK
033 CRAWFORD
Employee Name[2] SSN[3] County[4] Docket Number[5] Dollar Amount[6] 035 CUMBERLAND
037 DE KALB
          039 DE WITT
          041 DOUGLAS
          043 DU PAGE
          045 EDGAR
          047 EDWARDS
          049 EFFINGHAM
          051 FAYETTE
          053 FORD
          055 FRANKLIN
          057 FULTON
          059 GALLATIN
          061 GREENE
          063 GRUNDY
          065 HAMILTON
          067 HANCOCK
          069 HARDIN
          071 HENDERSON
          073 HENRY
          075 IROQUOIS
          077 JACKSON
          079 JASPER
          081 JEFFERSON
          083 JERSEY
          085 JO DAVIESS
          087 JOHNSON
          089 KANE
          091 KANKAKEE
          093 KENDALL
          095 KNOX
          097 LAKE
          099 LA SALLE
101 LAWRENCE
TOTAL AMOUNT  $                     -   103 LEE
105 LIVINGSTON
107 LOGAN
109 MCDONOUGH
111 MCHENRY
113 MCLEAN
115 MACON
117 MACOUPIN
119 MADISON
121 MARION
123 MARSHALL
125 MASON
127 MASSAC
129 MENARD
131 MERCER
133 MONROE
135 MONTGOMERY
137 MORGAN
139 MOULTRIE
141 OGLE
143 PEORIA
145 PERRY
147 PIATT
149 PIKE
151 POPE
153 PULASKI
155 PUTNAM
157 RANDOLPH
159 RICHLAND
161 ROCK ISLAND
163 ST CLAIR
165 SALINE
167 SANGAMON
169 SCHUYLER
171 SCOTT
173 SHELBY
175 STARK
177 STEPHENSON
179 TAZEWELL
181 UNION
183 VERMILION
185 WABASH
187 WARREN
189 WASHINGTON
191 WAYNE
193 WHITE
195 WHITESIDE
197 WILL
199 WILLIAMSON
201 WINNEBAGO
203 WOODFORD

[1]
Enter company name, contact person's name, address, telephone and fax number
[2]
Enter the name of the employee for whom you are withholding child support.  Enter the name as last name, first name and middle initial.  Example - Smith, John A
[3]
Optional: Enter the employee's social security number.  Just enter 9 digits including any leading zeroes
[4]
Select the county from the list where the court order resides. 
[5]
Enter the docket number as specified on the notice to withhold for child support. 
[6]
Enter the dollar amount of the withheld payment for the employee