CHILD SUPPORT WORKSHEET
CASE INFORMATION
Court Case Number: [CASE NUMBER]
Jurisdiction: [JURISDICTION]
Date of Filing: [FILING DATE]
Date of Worksheet Completion: [COMPLETION DATE]
I. BASIC INFORMATION
A. PARENTS' INFORMATION
Petitioner/Parent A:
- Full Legal Name: [PARENT A FULL LEGAL NAME]
- Physical Address: [PARENT A ADDRESS]
- Mailing Address (if different): [PARENT A MAILING ADDRESS]
- Phone Number: [PARENT A PHONE]
- Email Address: [PARENT A EMAIL]
- Social Security Number: [PARENT A SSN] (Last 4 digits: XXX-XX-[LAST 4 DIGITS])
- Date of Birth: [PARENT A DOB]
- Employer Name: [PARENT A EMPLOYER]
- Employer Address: [PARENT A EMPLOYER ADDRESS]
Respondent/Parent B:
- Full Legal Name: [PARENT B FULL LEGAL NAME]
- Physical Address: [PARENT B ADDRESS]
- Mailing Address (if different): [PARENT B MAILING ADDRESS]
- Phone Number: [PARENT B PHONE]
- Email Address: [PARENT B EMAIL]
- Social Security Number: [PARENT B SSN] (Last 4 digits: XXX-XX-[LAST 4 DIGITS])
- Date of Birth: [PARENT B DOB]
- Employer Name: [PARENT B EMPLOYER]
- Employer Address: [PARENT B EMPLOYER ADDRESS]
B. CHILDREN'S INFORMATION
Child's Full Legal Name | Date of Birth | Age | Social Security Number (Last 4 digits) |
---|
[CHILD 1 NAME] | [CHILD 1 DOB] | [CHILD 1 AGE] | XXX-XX-[CHILD 1 LAST 4 DIGITS] |
[CHILD 2 NAME] | [CHILD 2 DOB] | [CHILD 2 AGE] | XXX-XX-[CHILD 2 LAST 4 DIGITS] |
[CHILD 3 NAME] | [CHILD 3 DOB] | [CHILD 3 AGE] | XXX-XX-[CHILD 3 LAST 4 DIGITS] |
[CHILD 4 NAME] | [CHILD 4 DOB] | [CHILD 4 AGE] | XXX-XX-[CHILD 4 LAST 4 DIGITS] |
II. CUSTODY ARRANGEMENT
A. PARENTING TIME DETERMINATION
Parent A Annual Overnights: [PARENT A OVERNIGHTS]
Parent B Annual Overnights: [PARENT B OVERNIGHTS]
Total Annual Overnights: 365 (366 in leap years)
Parent A Percentage of Parenting Time: [PARENT A PERCENTAGE]%
Parent B Percentage of Parenting Time: [PARENT B PERCENTAGE]%
B. CUSTODY CLASSIFICATION
Based on the parenting time allocation above, the custody arrangement is classified as:
Description of Custody Arrangement:
[DETAILED DESCRIPTION OF CUSTODY ARRANGEMENT]
III. INCOME CALCULATION
A. GROSS INCOME DOCUMENTATION
Parent A Monthly Gross Income
Income Source | Monthly Amount | Annual Amount | Documentation Provided |
---|
Wages/Salary | $[PARENT A WAGES] | $[PARENT A ANNUAL WAGES] | [ ] Pay stubs [ ] W-2 [ ] Tax returns |
Self-Employment | $[PARENT A SELF-EMPLOYMENT] | $[PARENT A ANNUAL SELF-EMPLOYMENT] | [ ] Schedule C [ ] P&L Statement [ ] Business tax returns |
Commissions/Bonuses | $[PARENT A COMMISSIONS] | $[PARENT A ANNUAL COMMISSIONS] | [ ] Pay records [ ] Employment contract [ ] Tax returns |
Overtime | $[PARENT A OVERTIME] | $[PARENT A ANNUAL OVERTIME] | [ ] Pay stubs [ ] Employer verification |
Investment Income | $[PARENT A INVESTMENTS] | $[PARENT A ANNUAL INVESTMENTS] | [ ] 1099-DIV/INT [ ] Account statements |
Rental Income | $[PARENT A RENTAL] | $[PARENT A ANNUAL RENTAL] | [ ] Schedule E [ ] Lease agreements |
Retirement/Pension | $[PARENT A RETIREMENT] | $[PARENT A ANNUAL RETIREMENT] | [ ] 1099-R [ ] Benefit statements |
Social Security | $[PARENT A SS] | $[PARENT A ANNUAL SS] | [ ] Benefit statements [ ] 1099-SSA |
Disability Benefits | $[PARENT A DISABILITY] | $[PARENT A ANNUAL DISABILITY] | [ ] Benefit statements [ ] Award letters |
Unemployment | $[PARENT A UNEMPLOYMENT] | $[PARENT A ANNUAL UNEMPLOYMENT] | [ ] Benefit statements [ ] 1099-G |
Workers' Compensation | $[PARENT A WORKERS COMP] | $[PARENT A ANNUAL WORKERS COMP] | [ ] Benefit statements [ ] Award letters |
Other Income | $[PARENT A OTHER] | $[PARENT A ANNUAL OTHER] | [ ] Documentation provided |
TOTAL GROSS INCOME | $[PARENT A TOTAL MONTHLY] | $[PARENT A TOTAL ANNUAL] | |
Parent B Monthly Gross Income
Income Source | Monthly Amount | Annual Amount | Documentation Provided |
---|
Wages/Salary | $[PARENT B WAGES] | $[PARENT B ANNUAL WAGES] | [ ] Pay stubs [ ] W-2 [ ] Tax returns |
Self-Employment | $[PARENT B SELF-EMPLOYMENT] | $[PARENT B ANNUAL SELF-EMPLOYMENT] | [ ] Schedule C [ ] P&L Statement [ ] Business tax returns |
Commissions/Bonuses | $[PARENT B COMMISSIONS] | $[PARENT B ANNUAL COMMISSIONS] | [ ] Pay records [ ] Employment contract [ ] Tax returns |
Overtime | $[PARENT B OVERTIME] | $[PARENT B ANNUAL OVERTIME] | [ ] Pay stubs [ ] Employer verification |
Investment Income | $[PARENT B INVESTMENTS] | $[PARENT B ANNUAL INVESTMENTS] | [ ] 1099-DIV/INT [ ] Account statements |
Rental Income | $[PARENT B RENTAL] | $[PARENT B ANNUAL RENTAL] | [ ] Schedule E [ ] Lease agreements |
Retirement/Pension | $[PARENT B RETIREMENT] | $[PARENT B ANNUAL RETIREMENT] | [ ] 1099-R [ ] Benefit statements |
Social Security | $[PARENT B SS] | $[PARENT B ANNUAL SS] | [ ] Benefit statements [ ] 1099-SSA |
Disability Benefits | $[PARENT B DISABILITY] | $[PARENT B ANNUAL DISABILITY] | [ ] Benefit statements [ ] Award letters |
Unemployment | $[PARENT B UNEMPLOYMENT] | $[PARENT B ANNUAL UNEMPLOYMENT] | [ ] Benefit statements [ ] 1099-G |
Workers' Compensation | $[PARENT B WORKERS COMP] | $[PARENT B ANNUAL WORKERS COMP] | [ ] Benefit statements [ ] Award letters |
Other Income | $[PARENT B OTHER] | $[PARENT B ANNUAL OTHER] | [ ] Documentation provided |
TOTAL GROSS INCOME | $[PARENT B TOTAL MONTHLY] | $[PARENT B TOTAL ANNUAL] | |
B. INCOME VERIFICATION
The following income verification documents have been provided and reviewed:
Parent A:
Parent B:
C. SELF-EMPLOYMENT INCOME CALCULATION
Parent A Self-Employment Income Calculation:
- Gross receipts/revenue: $[PARENT A GROSS RECEIPTS]
- Less ordinary and necessary business expenses: $[PARENT A BUSINESS EXPENSES]
- Plus depreciation, depletion, and amortization: $[PARENT A DEPRECIATION]
- Plus personal expenses paid by business: $[PARENT A PERSONAL EXPENSES]
- Less self-employment tax adjustment: $[PARENT A SE TAX ADJUSTMENT]
- Net Self-Employment Income: $[PARENT A NET SELF-EMPLOYMENT]
Parent B Self-Employment Income Calculation:
- Gross receipts/revenue: $[PARENT B GROSS RECEIPTS]
- Less ordinary and necessary business expenses: $[PARENT B BUSINESS EXPENSES]
- Plus depreciation, depletion, and amortization: $[PARENT B DEPRECIATION]
- Plus personal expenses paid by business: $[PARENT B PERSONAL EXPENSES]
- Less self-employment tax adjustment: $[PARENT B SE TAX ADJUSTMENT]
- Net Self-Employment Income: $[PARENT B NET SELF-EMPLOYMENT]
D. IMPUTED INCOME ASSESSMENT
Parent A:
- Is Parent A voluntarily unemployed or underemployed? [ ] Yes [ ] No
- If yes, explain basis for this determination: [EXPLANATION]
- Parent A's work history: [WORK HISTORY]
- Parent A's education and qualifications: [EDUCATION/QUALIFICATIONS]
- Available job opportunities and earning potential: [JOB OPPORTUNITIES]
- Imputed monthly income amount: $[PARENT A IMPUTED INCOME]
- Basis for imputed amount: [BASIS FOR IMPUTED AMOUNT]
Parent B:
- Is Parent B voluntarily unemployed or underemployed? [ ] Yes [ ] No
- If yes, explain basis for this determination: [EXPLANATION]
- Parent B's work history: [WORK HISTORY]
- Parent B's education and qualifications: [EDUCATION/QUALIFICATIONS]
- Available job opportunities and earning potential: [JOB OPPORTUNITIES]
- Imputed monthly income amount: $[PARENT B IMPUTED INCOME]
- Basis for imputed amount: [BASIS FOR IMPUTED AMOUNT]
E. SEASONAL OR FLUCTUATING INCOME
Parent A:
- Does Parent A have seasonal or fluctuating income? [ ] Yes [ ] No
- Method used to calculate average income: [METHOD]
- Period used for averaging: [PERIOD]
- Explanation of calculation: [EXPLANATION]
Parent B:
- Does Parent B have seasonal or fluctuating income? [ ] Yes [ ] No
- Method used to calculate average income: [METHOD]
- Period used for averaging: [PERIOD]
- Explanation of calculation: [EXPLANATION]
IV. INCOME ADJUSTMENTS
A. PRE-EXISTING CHILD SUPPORT OBLIGATIONS
Parent A:
- Monthly amount paid for other children: $[PARENT A OTHER SUPPORT]
- Court case number(s): [PARENT A CASE NUMBERS]
- Jurisdiction(s): [PARENT A JURISDICTIONS]
- Name(s) and age(s) of other children: [PARENT A OTHER CHILDREN]
- Documentation provided: [ ] Court order [ ] Payment records [ ] Other: [SPECIFY]
Parent B:
- Monthly amount paid for other children: $[PARENT B OTHER SUPPORT]
- Court case number(s): [PARENT B CASE NUMBERS]
- Jurisdiction(s): [PARENT B JURISDICTIONS]
- Name(s) and age(s) of other children: [PARENT B OTHER CHILDREN]
- Documentation provided: [ ] Court order [ ] Payment records [ ] Other: [SPECIFY]
B. ALIMONY/SPOUSAL SUPPORT
Parent A:
- Monthly alimony/spousal support paid: $[PARENT A ALIMONY PAID]
- Monthly alimony/spousal support received: $[PARENT A ALIMONY RECEIVED]
- Court case number(s): [PARENT A ALIMONY CASE NUMBERS]
- Jurisdiction(s): [PARENT A ALIMONY JURISDICTIONS]
- Documentation provided: [ ] Court order [ ] Payment records [ ] Other: [SPECIFY]
Parent B:
- Monthly alimony/spousal support paid: $[PARENT B ALIMONY PAID]
- Monthly alimony/spousal support received: $[PARENT B ALIMONY RECEIVED]
- Court case number(s): [PARENT B ALIMONY CASE NUMBERS]
- Jurisdiction(s): [PARENT B ALIMONY JURISDICTIONS]
- Documentation provided: [ ] Court order [ ] Payment records [ ] Other: [SPECIFY]
C. MANDATORY RETIREMENT CONTRIBUTIONS
Parent A:
- Monthly mandatory retirement contributions: $[PARENT A RETIREMENT CONTRIB]
- Employer: [PARENT A RETIREMENT EMPLOYER]
- Type of plan: [PARENT A RETIREMENT PLAN TYPE]
- Documentation provided: [ ] Pay stubs [ ] Employer verification [ ] Other: [SPECIFY]
Parent B:
- Monthly mandatory retirement contributions: $[PARENT B RETIREMENT CONTRIB]
- Employer: [PARENT B RETIREMENT EMPLOYER]
- Type of plan: [PARENT B RETIREMENT PLAN TYPE]
- Documentation provided: [ ] Pay stubs [ ] Employer verification [ ] Other: [SPECIFY]
D. HEALTH INSURANCE PREMIUM COSTS (CHILDREN'S PORTION ONLY)
Parent A:
- Monthly premium for children only: $[PARENT A CHILDREN HEALTH PREMIUM]
- Insurance provider: [PARENT A INSURANCE PROVIDER]
- Policy number: [PARENT A POLICY NUMBER]
- Calculation method for children's portion: [PARENT A CALCULATION METHOD]
- Documentation provided: [ ] Insurance statement [ ] Employer verification [ ] Other: [SPECIFY]
Parent B:
- Monthly premium for children only: $[PARENT B CHILDREN HEALTH PREMIUM]
- Insurance provider: [PARENT B INSURANCE PROVIDER]
- Policy number: [PARENT B POLICY NUMBER]
- Calculation method for children's portion: [PARENT B CALCULATION METHOD]
- Documentation provided: [ ] Insurance statement [ ] Employer verification [ ] Other: [SPECIFY]
E. UNION DUES AND MANDATORY DEDUCTIONS
Parent A:
- Monthly union dues: $[PARENT A UNION DUES]
- Union name: [PARENT A UNION NAME]
- Other mandatory deductions (specify): $[PARENT A OTHER DEDUCTIONS]
- Documentation provided: [ ] Pay stubs [ ] Union verification [ ] Other: [SPECIFY]
Parent B:
- Monthly union dues: $[PARENT B UNION DUES]
- Union name: [PARENT B UNION NAME]
- Other mandatory deductions (specify): $[PARENT B OTHER DEDUCTIONS]
- Documentation provided: [ ] Pay stubs [ ] Union verification [ ] Other: [SPECIFY]
F. SUMMARY OF INCOME ADJUSTMENTS
Adjustment Category | Parent A | Parent B |
---|
Pre-existing Child Support | $[PARENT A OTHER SUPPORT] | $[PARENT B OTHER SUPPORT] |
Alimony/Spousal Support Paid | $[PARENT A ALIMONY PAID] | $[PARENT B ALIMONY PAID] |
Alimony/Spousal Support Received | $[PARENT A ALIMONY RECEIVED] | $[PARENT B ALIMONY RECEIVED] |
Mandatory Retirement Contributions | $[PARENT A RETIREMENT CONTRIB] | $[PARENT B RETIREMENT CONTRIB] |
Health Insurance Premiums (Children) | $[PARENT A CHILDREN HEALTH PREMIUM] | $[PARENT B CHILDREN HEALTH PREMIUM] |
Union Dues and Mandatory Deductions | $[PARENT A UNION DUES + OTHER DEDUCTIONS] | $[PARENT B UNION DUES + OTHER DEDUCTIONS] |
TOTAL ADJUSTMENTS | $[PARENT A TOTAL ADJUSTMENTS] | $[PARENT B TOTAL ADJUSTMENTS] |
G. ADJUSTED MONTHLY INCOME
Income Calculation | Parent A | Parent B |
---|
Total Monthly Gross Income | $[PARENT A TOTAL MONTHLY] | $[PARENT B TOTAL MONTHLY] |
Total Monthly Adjustments | $[PARENT A TOTAL ADJUSTMENTS] | $[PARENT B TOTAL ADJUSTMENTS] |
ADJUSTED MONTHLY INCOME | $[PARENT A ADJUSTED MONTHLY] | $[PARENT B ADJUSTED MONTHLY] |
V. BASIC SUPPORT CALCULATION
A. COMBINED PARENTAL INCOME
Income Component | Amount |
---|
Parent A Adjusted Monthly Income | $[PARENT A ADJUSTED MONTHLY] |
Parent B Adjusted Monthly Income | $[PARENT B ADJUSTED MONTHLY] |
COMBINED ADJUSTED MONTHLY INCOME | $[COMBINED ADJUSTED MONTHLY] |
B. INCOME SHARES PERCENTAGE
Parent | Adjusted Monthly Income | Percentage of Combined Income |
---|
Parent A | $[PARENT A ADJUSTED MONTHLY] | [PARENT A INCOME PERCENTAGE]% |
Parent B | $[PARENT B ADJUSTED MONTHLY] | [PARENT B INCOME PERCENTAGE]% |
TOTAL | $[COMBINED ADJUSTED MONTHLY] | 100% |
C. BASIC SUPPORT OBLIGATION
Based on the combined adjusted monthly income of $[COMBINED ADJUSTED MONTHLY] and [NUMBER OF CHILDREN] child(ren), the basic support obligation according to the [JURISDICTION] Child Support Guidelines is:
Basic Monthly Support Obligation: $[BASIC MONTHLY SUPPORT]
D. PER-CHILD CALCULATION
Child's Name | Age | Percentage of Basic Support | Amount |
---|
[CHILD 1 NAME] | [CHILD 1 AGE] | [CHILD 1 PERCENTAGE]% | $[CHILD 1 AMOUNT] |
[CHILD 2 NAME] | [CHILD 2 AGE] | [CHILD 2 PERCENTAGE]% | $[CHILD 2 AMOUNT] |
[CHILD 3 NAME] | [CHILD 3 AGE] | [CHILD 3 PERCENTAGE]% | $[CHILD 3 AMOUNT] |
[CHILD 4 NAME] | [CHILD 4 AGE] | [CHILD 4 PERCENTAGE]% | $[CHILD 4 AMOUNT] |
TOTAL | | 100% | $[BASIC MONTHLY SUPPORT] |
VI. ADDITIONAL EXPENSES
A. CHILDCARE COSTS
Monthly Work-Related Childcare Expenses:
Child's Name | Provider Name | Monthly Cost | Documentation Provided |
---|
[CHILD 1 NAME] | [PROVIDER 1] | $[CHILD 1 CHILDCARE] | [ ] Receipts [ ] Provider statement [ ] Other |
[CHILD 2 NAME] | [PROVIDER 2] | $[CHILD 2 CHILDCARE] | [ ] Receipts [ ] Provider statement [ ] Other |
[CHILD 3 NAME] | [PROVIDER 3] | $[CHILD 3 CHILDCARE] | [ ] Receipts [ ] Provider statement [ ] Other |
[CHILD 4 NAME] | [PROVIDER 4] | $[CHILD 4 CHILDCARE] | [ ] Receipts [ ] Provider statement [ ] Other |
TOTAL MONTHLY CHILDCARE EXPENSES | | $[TOTAL CHILDCARE] | |
Allocation of Childcare Expenses:
- Parent A's share ([PARENT A INCOME PERCENTAGE]%): $[PARENT A CHILDCARE SHARE]
- Parent B's share ([PARENT B INCOME PERCENTAGE]%): $[PARENT B CHILDCARE SHARE]
B. HEALTH INSURANCE PREMIUMS
Monthly Health Insurance Premium Costs for Children:
Type of Insurance | Provider | Policy Number | Monthly Premium (Children Only) | Documentation Provided |
---|
Health Insurance | [HEALTH PROVIDER] | [HEALTH POLICY] | $[HEALTH PREMIUM] | [ ] Insurance statement [ ] Payroll deduction [ ] Other |
Dental Insurance | [DENTAL PROVIDER] | [DENTAL POLICY] | $[DENTAL PREMIUM] | [ ] Insurance statement [ ] Payroll deduction [ ] Other |
Vision Insurance | [VISION PROVIDER] | [VISION POLICY] | $[VISION PREMIUM] | [ ] Insurance statement [ ] Payroll deduction [ ] Other |
TOTAL MONTHLY INSURANCE PREMIUMS | | | $[TOTAL INSURANCE] | |
Parent Currently Providing Insurance: [ ] Parent A [ ] Parent B [ ] Both [ ] Neither
Allocation of Insurance Premium Costs:
- Parent A's share ([PARENT A INCOME PERCENTAGE]%): $[PARENT A INSURANCE SHARE]
- Parent B's share ([PARENT B INCOME PERCENTAGE]%): $[PARENT B INSURANCE SHARE]
C. UNINSURED MEDICAL EXPENSES
Allocation of Uninsured/Extraordinary Medical Expenses:
- Parent A's share ([PARENT A INCOME PERCENTAGE]%): [PARENT A INCOME PERCENTAGE]%
- Parent B's share ([PARENT B INCOME PERCENTAGE]%): [PARENT B INCOME PERCENTAGE]%
Threshold for Extraordinary Medical Expenses: $[MEDICAL THRESHOLD] per child per calendar year
Payment Procedure for Uninsured Medical Expenses:
The parent incurring the medical expense shall provide the other parent with documentation of the expense within [NUMBER] days of receipt. The non-incurring parent shall reimburse the incurring parent for their percentage share of the expense within [NUMBER] days of receiving documentation. Documentation shall include the date of service, service provider, description of service, amount charged, insurance payments or denials, and remaining balance due.
D. EDUCATIONAL EXPENSES
Monthly Educational Expenses:
Child's Name | Type of Expense | Institution/Provider | Monthly Cost | Documentation Provided |
---|
[CHILD 1 NAME] | [EXPENSE TYPE 1] | [PROVIDER 1] | $[CHILD 1 EDUCATION] | [ ] Tuition statement [ ] Receipts [ ] Other |
[CHILD 2 NAME] | [EXPENSE TYPE 2] | [PROVIDER 2] | $[CHILD 2 EDUCATION] | [ ] Tuition statement [ ] Receipts [ ] Other |
[CHILD 3 NAME] | [EXPENSE TYPE 3] | [PROVIDER 3] | $[CHILD 3 EDUCATION] | [ ] Tuition statement [ ] Receipts [ ] Other |
[CHILD 4 NAME] | [EXPENSE TYPE 4] | [PROVIDER 4] | $[CHILD 4 EDUCATION] | [ ] Tuition statement [ ] Receipts [ ] Other |
TOTAL MONTHLY EDUCATIONAL EXPENSES | | | $[TOTAL EDUCATION] | |
Allocation of Educational Expenses:
- Parent A's share ([PARENT A INCOME PERCENTAGE]%): $[PARENT A EDUCATION SHARE]
- Parent B's share ([PARENT B INCOME PERCENTAGE]%): $[PARENT B EDUCATION SHARE]
E. EXTRACURRICULAR ACTIVITIES
Monthly Extracurricular Activity Expenses:
Child's Name | Activity | Provider/Organization | Monthly Cost | Documentation Provided |
---|
[CHILD 1 NAME] | [ACTIVITY 1] | [ORGANIZATION 1] | $[CHILD 1 ACTIVITY] | [ ] Registration forms [ ] Receipts [ ] Other |
[CHILD 2 NAME] | [ACTIVITY 2] | [ORGANIZATION 2] | $[CHILD 2 ACTIVITY] | [ ] Registration forms [ ] Receipts [ ] Other |
[CHILD 3 NAME] | [ACTIVITY 3] | [ORGANIZATION 3] | $[CHILD 3 ACTIVITY] | [ ] Registration forms [ ] Receipts [ ] Other |
[CHILD 4 NAME] | [ACTIVITY 4] | [ORGANIZATION 4] | $[CHILD 4 ACTIVITY] | [ ] Registration forms [ ] Receipts [ ] Other |
TOTAL MONTHLY EXTRACURRICULAR EXPENSES | | | $[TOTAL ACTIVITIES] | |
Allocation of Extracurricular Activity Expenses:
- Parent A's share ([PARENT A INCOME PERCENTAGE]%): $[PARENT A ACTIVITIES SHARE]
- Parent B's share ([PARENT B INCOME PERCENTAGE]%): $[PARENT B ACTIVITIES SHARE]
F. TRANSPORTATION COSTS
Monthly Extraordinary Transportation Expenses:
Type of Transportation Expense | Description | Monthly Cost | Documentation Provided |
---|
[TRANSPORT TYPE 1] | [DESCRIPTION 1] | $[TRANSPORT COST 1] | [ ] Receipts [ ] Mileage logs [ ] Other |
[TRANSPORT TYPE 2] | [DESCRIPTION 2] | $[TRANSPORT COST 2] | [ ] Receipts [ ] Mileage logs [ ] Other |
TOTAL MONTHLY TRANSPORTATION EXPENSES | | $[TOTAL TRANSPORTATION] | |
Allocation of Transportation Expenses:
- Parent A's share ([PARENT A INCOME PERCENTAGE]%): $[PARENT A TRANSPORTATION SHARE]
- Parent B's share ([PARENT B INCOME PERCENTAGE]%): $[PARENT B TRANSPORTATION SHARE]
G. SUMMARY OF ADDITIONAL EXPENSES
Expense Category | Total Monthly Cost | Parent A's Share | Parent B's Share |
---|
Childcare | $[TOTAL CHILDCARE] | $[PARENT A CHILDCARE SHARE] | $[PARENT B CHILDCARE SHARE] |
Health Insurance | $[TOTAL INSURANCE] | $[PARENT A INSURANCE SHARE] | $[PARENT B INSURANCE SHARE] |
Educational Expenses | $[TOTAL EDUCATION] | $[PARENT A EDUCATION SHARE] | $[PARENT B EDUCATION SHARE] |
Extracurricular Activities | $[TOTAL ACTIVITIES] | $[PARENT A ACTIVITIES SHARE] | $[PARENT B ACTIVITIES SHARE] |
Transportation | $[TOTAL TRANSPORTATION] | $[PARENT A TRANSPORTATION SHARE] | $[PARENT B TRANSPORTATION SHARE] |
TOTAL ADDITIONAL EXPENSES | $[TOTAL ADDITIONAL] | $[PARENT A ADDITIONAL SHARE] | $[PARENT B ADDITIONAL SHARE] |
VII. ADJUSTMENTS AND DEVIATIONS
A. PARENTING TIME ADJUSTMENT
Parenting Time Adjustment Calculation:
- Custody arrangement: [CUSTODY ARRANGEMENT]
- Parent A's percentage of parenting time: [PARENT A PERCENTAGE]%
- Parent B's percentage of parenting time: [PARENT B PERCENTAGE]%
- Applicable adjustment formula per state guidelines: [ADJUSTMENT FORMULA]
- Calculation: [DETAILED CALCULATION]
- Resulting adjustment amount: $[PARENTING TIME ADJUSTMENT]
B. LOW-INCOME ADJUSTMENT
Parent A:
- Is Parent A eligible for low-income adjustment? [ ] Yes [ ] No
- Self-support reserve amount: $[SELF-SUPPORT RESERVE]
- Adjusted obligation after low-income adjustment: $[PARENT A LOW-INCOME ADJUSTED]
- Explanation of calculation: [EXPLANATION]
Parent B:
- Is Parent B eligible for low-income adjustment? [ ] Yes [ ] No
- Self-support reserve amount: $[SELF-SUPPORT RESERVE]
- Adjusted obligation after low-income adjustment: $[PARENT B LOW-INCOME ADJUSTED]
- Explanation of calculation: [EXPLANATION]
C. HIGH-INCOME CONSIDERATIONS
- Does combined parental income exceed the guideline maximum? [ ] Yes [ ] No
- Guideline income cap: $[GUIDELINE CAP]
- Amount of income exceeding cap: $[EXCESS INCOME]
- Method used to calculate support on income above cap: [METHOD]
- Additional support amount based on income above cap: $[ADDITIONAL SUPPORT]
- Justification for additional support amount: [JUSTIFICATION]
D. MULTIPLE FAMILY ADJUSTMENTS
Parent A:
- Does Parent A support children in other households? [ ] Yes [ ] No
- Number of other children legally supported: [NUMBER]
- Theoretical support obligation for other children: $[THEORETICAL OBLIGATION]
- Adjustment amount: $[PARENT A MULTIPLE FAMILY ADJUSTMENT]
- Calculation method: [CALCULATION METHOD]
Parent B:
- Does Parent B support children in other households? [ ] Yes [ ] No
- Number of other children legally supported: [NUMBER]
- Theoretical support obligation for other children: $[THEORETICAL OBLIGATION]
- Adjustment amount: $[PARENT B MULTIPLE FAMILY ADJUSTMENT]
- Calculation method: [CALCULATION METHOD]
E. DEVIATION FACTORS
Request for Deviation from Guideline Amount:
- Is a deviation from the guideline amount requested? [ ] Yes [ ] No
- Party requesting deviation: [ ] Parent A [ ] Parent B [ ] Both [ ] Court
- Reason(s) for requested deviation:
- Amount of requested deviation: $[DEVIATION AMOUNT]
- Detailed justification for deviation: [DETAILED JUSTIFICATION]
Court Finding on Deviation Request:
- Deviation granted? [ ] Yes [ ] No
- Amount of approved deviation: $[APPROVED DEVIATION]
- Court's reasoning: [COURT REASONING]
F. SUMMARY OF ADJUSTMENTS AND DEVIATIONS
Adjustment/Deviation Type | Amount | Applied To |
---|
Parenting Time Adjustment | $[PARENTING TIME ADJUSTMENT] | [ ] Parent A [ ] Parent B |
Low-Income Adjustment | $[LOW-INCOME ADJUSTMENT] | [ ] Parent A [ ] Parent B |
High-Income Consideration | $[HIGH-INCOME ADJUSTMENT] | [ ] Parent A [ ] Parent B |
Multiple Family Adjustment | $[MULTIPLE FAMILY ADJUSTMENT] | [ ] Parent A [ ] Parent B |
Approved Deviation | $[APPROVED DEVIATION] | [ ] Parent A [ ] Parent B |
TOTAL ADJUSTMENTS/DEVIATIONS | $[TOTAL ADJUSTMENTS DEVIATIONS] | |
VIII. FINAL CALCULATIONS
A. NET SUPPORT OBLIGATION
Basic Support Calculation:
- Basic monthly support obligation: $[BASIC MONTHLY SUPPORT]
- Parent A's share of basic support ([PARENT A INCOME PERCENTAGE]%): $[PARENT A BASIC SHARE]
- Parent B's share of basic support ([PARENT B INCOME PERCENTAGE]%): $[PARENT B BASIC SHARE]
Additional Expenses:
- Parent A's share of additional expenses: $[PARENT A ADDITIONAL SHARE]
- Parent B's share of additional expenses: $[PARENT B ADDITIONAL SHARE]
Credits for Direct Payments:
- Credit to Parent A for direct payments: $[PARENT A DIRECT PAYMENT CREDIT]
- Credit to Parent B for direct payments: $[PARENT B DIRECT PAYMENT CREDIT]
Adjustments and Deviations:
- Net adjustments/deviations to Parent A's obligation: $[PARENT A NET ADJUSTMENTS]
- Net adjustments/deviations to Parent B's obligation: $[PARENT B NET ADJUSTMENTS]
Final Monthly Support Obligation:
- Parent A pays to Parent B: $[PARENT A TO B PAYMENT]
- Parent B pays to Parent A: $[PARENT B TO A PAYMENT]
B. PAYMENT SCHEDULE
Payment Frequency:
Payment Method:
Payment Start Date: [START DATE]
C. ARREARS CALCULATION
Retroactive Support:
- Period covered: [START DATE] to [END DATE]
- Number of months: [NUMBER OF MONTHS]
- Monthly support amount during period: $[MONTHLY RETROACTIVE]
- Total retroactive support due: $[TOTAL RETROACTIVE]
- Credits for payments already made: $[RETROACTIVE CREDITS]
- Net retroactive support due: $[NET RETROACTIVE]
Payment Plan for Arrears:
- Monthly payment toward arrears: $[MONTHLY ARREARS PAYMENT]
- Total monthly payment (current support + arrears): $[TOTAL MONTHLY PAYMENT]
- Estimated payoff date: [PAYOFF DATE]
D. TAX CONSIDERATIONS
Dependency Exemptions:
Child Tax Credits:
Tax Benefit Adjustment to Support:
- Adjustment amount: $[TAX ADJUSTMENT]
- Explanation of calculation: [EXPLANATION]
IX. COMPLIANCE WITH STATE LAW
A. STATE-SPECIFIC GUIDELINES
This Child Support Worksheet has been prepared in accordance with the child support guidelines of [JURISDICTION] as set forth in [STATUTORY REFERENCE]. The calculations herein follow the [INCOME SHARES/PERCENTAGE OF INCOME/MELSON FORMULA] model adopted by this jurisdiction.
B. REQUIRED STATE FORMS
The following state-mandated forms have been completed and are attached:
C. JURISDICTION-SPECIFIC FACTORS
The following jurisdiction-specific factors have been considered in this calculation:
X. FUTURE MODIFICATIONS
A. MODIFICATION TRIGGERS
This child support order may be reviewed and modified upon the occurrence of any of the following events:
-
A substantial change in circumstances, including but not limited to:
- A change in either parent's income of 15% or more
- A change in the custody or parenting time arrangement
- A change in the needs of the child(ren)
- Emancipation of a child
- A child becoming disabled
-
As required by state law:
- Automatic review every [NUMBER] years
- Upon request of either parent after [NUMBER] years from the date of the last order
-
Other specific triggers:
- [SPECIFIC TRIGGER 1]
- [SPECIFIC TRIGGER 2]
- [SPECIFIC TRIGGER 3]
B. COST OF LIVING ADJUSTMENTS
- Automatic cost of living adjustment (COLA): [ ] Yes [ ] No
- Frequency of adjustment: [ ] Annual [ ] Biennial [ ] Other: [SPECIFY]
- Basis for adjustment: [ ] Consumer Price Index [ ] Other: [SPECIFY]
- Calculation method: [CALCULATION METHOD]
- Next scheduled adjustment date: [NEXT ADJUSTMENT DATE]
C. DURATION OF SUPPORT
Child support shall continue for each child until:
- The child reaches the age of [AGE] years; OR
- The child graduates from high school, whichever occurs later, but not beyond the age of [AGE] years; OR
- The child becomes emancipated through marriage, court order, or other operation of law; OR
- The child dies; OR
- Other: [SPECIFY]
For a child with disabilities that will prevent self-support beyond the age of majority:
XI. CERTIFICATION AND SIGNATURES
I/We certify under penalty of perjury that the information provided in this Child Support Worksheet is true and correct to the best of my/our knowledge and belief.
Parent A:
Signature: _________________________________ Date: _________________
Printed Name: [PARENT A FULL LEGAL NAME]
Parent B:
Signature: _________________________________ Date: _________________
Printed Name: [PARENT B FULL LEGAL NAME]
Attorney for Parent A (if applicable):
Signature: _________________________________ Date: _________________
Printed Name: [ATTORNEY A NAME] Bar Number: [BAR NUMBER]
Attorney for Parent B (if applicable):
Signature: _________________________________ Date: _________________
Printed Name: [ATTORNEY B NAME] Bar Number: [BAR NUMBER]
Prepared By (if not a party or attorney):
Signature: _________________________________ Date: _________________
Printed Name: [PREPARER NAME] Title: [TITLE]
XII. COURT APPROVAL
This Child Support Worksheet and the resulting child support obligation are hereby approved and incorporated into the Court's Order.
ORDERED this _______ day of ________________________, [YEAR].
JUDGE/MAGISTRATE
PRINTED NAME OF JUDGE/MAGISTRATE