Child Supp. Guid. Form 2
Date:_____________________ | |
Case no.: ___________ | Dependents: ___________________ |
Docket no.: ____________ | |
__________________________ Name: | __________________________ Name: |
______________________________ ( ) Noncustodial Parent [NCP] ( ) Custodial Parent [CP] ______________________________ | ______________________________ ( ) Noncustodial Parent [NCP] ( ) Custodial Parent [CP] ______________________________ |
______________________________ Method(s) used to determine income: | ______________________________ Method(s) used to determine income: |
( ) Parent's financial statement/verified income | ( ) Parent's financial statement/verified income |
( ) Other sources | ( ) Other sources |
( ) CSS median income | ( ) CSS median income |
I. Adjusted Net Monthly Income Computation
Custodial Parent ________ (name) | Noncustodial Parentfn-FR-2i-astr ________ (name) | |
A. Gross monthly income | $ ___________ | $ ___________ |
B. Federal income tax | $ ___________ | $ ___________ |
C. State income tax | $ ___________ | $ ___________ |
D. Social Security and Medicare tax / mandatory pension deduction | $ ___________ | $ ___________ |
E. Mandatory occupational license fees deduction | $ ___________ | $ ___________ |
F. Union dues | $ ___________ | $ ___________ |
G. Health insurance premium costs for other children not in the pending matter (See rule 9.5(2) (f).) | $ ___________ | $ ___________ |
H. Cash medical support and prior obligation of child support actually paid pursuant to court or administrative order for other children not in the pending matter | $ ___________ | $ ___________ |
I. Qualified additional dependent deductions | $ ___________ | $ ___________ |
J. Actual child care expenses, as defined in rule 9.11A, for the custodial parentfn-FR-2i-astr (No deduction allowed if variance granted under rule 9.11A.) | $ ___________ | $ ___________ |
K. Preliminary net income for each parent (Line A minus lines B through J for each parent.) | $ ___________ | $ ___________ |
L. Cash medical support, if ordered in this pending matter | $ ___________ | $ ___________ |
M. Adjusted net monthly income (Line K minus line L.) (Amount used to calculate the guideline amount of child support.) | $ ___________ | $ ___________ |
(In cases of joint physical care, use names only and designate both parents as custodial parents.)
II. Calculation of the Guideline Amount of Support (If applicable.)
Custodial Parent (CP) ________ (name) | Noncustodial Parent (NCP) ________ (name) | Combined | |
A. Adjusted net monthly income | $ ___________ | + $ ___________ | = $ ___________ |
B. Proportional share of income (Also used for uncovered medical expenses.) | ___________ % | + __________% | = 100% __________ |
C. Number of children for whom support is sought | |||
D. Basic support obligation using only NCP's adjusted net monthly income (If low-income adjustment does not apply, enter N/A.) | $ ___________ | ||
E. Basic support obligation using combined adjusted net monthly income (If low-income adjustment applies enter N/A; see rule 9.3(2) and grid in rule 9.14(2).) | $ ___________ | ||
F. Each parent's share of the basic support obligation using combined incomes (If low-income adjustment applies enter N/A.) | $ ___________ | $ ___________ | |
G. NCP's basic support obligation before health insurance (NCP's amount from line F or low-income adjustment amount from line D.) | $ ___________ | ||
H. Allowable child(ren)'s portion of health insurance premium (Calculated pursuant to rule 9.14(5).) | $ ___________ | $ ___________ | |
I. Health insurance add-on or deduction from NCP's obligation | +/- | $ ___________ | |
J. Guideline amount of child support for NCP (NCP's line G plus or minus NCP's line I.) | $ ___________ |
II. a. Extraordinary Visitation Credit
Complete only if noncustodial parent's court-ordered visitation exceeds 127 overnights per year.
K. NCP's basic support obligation before health insurance (Amount from NCP's line G.) | $ ___________ |
L. Number of court-ordered visitation overnights with the noncustodial parent | ___________ |
M. Extraordinary visitation credit percentage | ___________ % |
N. Extraordinary visitation credit (Line K multiplied by line M.) | $ ___________ |
O. Guideline amount of child support (after credit for extraordinary visitation) (Line J minus line N; not less than $50 for one child, or $75 for two children, or $100 for three or more children.) | ___________ $ ___________ |
II. b. Child Care Expense Variance under rule 9.11A
As agreed by the parties and approved or determined by the court.
P. NCP's guideline amount of child support (Amount from line J above [or line O, if applicable].) | $ ___________ |
Q. Amount of variance for child care expenses | $ ___________ |
R. Adjusted amount of child support (Line P plus line Q.) | $ ___________ |
III. Calculation of the Joint (Equally Shared) Physical Care Guideline Amount of Child Support (If applicable.)
CP 1 __________ (name) | CP 2 __________ (name) | Combined | |
A. Adjusted net monthly income | $ __________ | + $ __________ | = $ __________ |
B. Proportional share of income (Also used for uncovered medical expenses.) | __________ % | __________ % | = 100% __________ |
C. Number of children for whom support is sought | |||
D. Basic support obligation before health insurance (Use line A combined amount to find amount from Schedule of Basic Support Obligations. The low-income adjustment in the shaded area of the schedule does not apply to joint [equally shared] physical care support computations.) | $ __________ | ||
E. Each parent's basic primary care amount before health insurance (Line B multiplied by line D for each parent.) | $ __________ | $ __________ | |
F. Each parent's share of joint physical care support (Line E multiplied by 1.5 for each parent to account for extra costs for two residences.) | $ __________ | $ __________ | |
G. Each parent's joint physical care support obligation before health insurance (Line F multiplied by .5 for each parent to account for 50% of time spent with each parent.) | $ __________ | $ __________ | |
H. Allowable child(ren)'s portion of health insurance premium (Calculated pursuant to rule 9.14(5).) (If either parent's net income on line A falls within low-income shaded Area A of the Schedule of Basic Support Obligations, enter N/A. The health insurance adjustment does not apply.) | $ __________ | $ __________ | |
I. Health insurance add-on to each parent's obligation (See 9.14(3).) | $ __________ | $ __________ | |
J. Guideline amount of child support (Each parent's line G plus each parent's line I.) | $ __________ | $ __________ | |
K. Net amount of child support for joint physical care after offset (Subtract smaller amount on line J from larger amount on line J. Parent with larger amount on line J pays the other parent the difference, as a method of payment. If either parent receives assistance through the Family Investment Program [FIP], the other parent's obligation reverts to the amount on line J.) | $ __________ | $ __________ | |
IV. Deviations (See attachment.) | |||
V. a. Recommended Amount of Support | $ __________ | per ___________ | |
V. b. Recommended Amount of Accrued Support | $ __________ | (See attachment.) |
(All Line references are to Division II, Calculation of the Guideline Amount of Support section of the worksheet.)
VI. Changes in Child Support Obligation as Number of Children Entitled to Support Changes
(For cases with multiple children based on present income and applicable guidelines calculation method.)
VI. a. Basic Obligation (If applicable.)
Number of children | NCP's basic support obligation (NCP's line G)fn-FR-2iii-astr | Health insurance add-on or deduction (NCP's line I)fn-FR-2iii-astr | Extraordinary visitation credit (If applicable.) (Line N)fn-FR-2iii-astr | Guideline amount of child support (Line J or O)fn-FR-2iii-astr |
__________ | $ __________ | $ __________ | $ __________ | $ __________ |
__________ | $ __________ | $ __________ | $ __________ | $ __________ |
__________ | $ __________ | $ __________ | $ __________ | $ __________ |
__________ | $ __________ | $ __________ | $ __________ | $ __________ |
__________ | $ __________ | $ __________ | $ __________ | $ __________ |
VI. b. Joint (Equally Shared) Physical Care Obligation (If applicable.)
Number of children | Guideline amount of child support | Guideline amount of child support | Net amount of child support for joint physical care after offset (line K) |
__________________ (name) (CP 1 line J)fn-FR-2vi-astr | __________________ (name) (CP 2 line J)fn-FR-2vi-astr | ||
__________ | $ __________ | $ __________ | $ __________ |
__________ | $ __________ | $ __________ | $ __________ |
__________ | $ __________ | $ __________ | $ __________ |
__________ | $ __________ | $ __________ | $ __________ |
__________ | $ __________ | $ __________ | $ __________ |
(All line references are to Division III, Calculation of the Joint (Equally Shared) Physical Care Guideline Amount of Child Support section of the worksheet.)
VII. Qualified Additional Dependent Deduction (See guidelines for the definition of this term.)
Paternity Establishment Method | ||||||
Child's name | Whose child | Date of birth | Court/ admin. order | In court stmt. & consent | Paternity affidavit | Child born during marriage |
State of Iowa
ss:
County of ____________________
I certify under the penalty of perjury and pursuant to the laws of the state of Iowa that the preceding is true and correct.
Date: _____________________________ | ___________________________________ (Signature) |
___________________________________ (Printed name) |
The undersigned attorney for _______________________________ hereby certifies that this Child Support Guidelines Worksheet was prepared by me or at my direction in good faith reliance upon information available to me at this time.
Date: _____________________________ (Attorney signature) | ___________________________________ |
If Child Support Services prepared this form, CSS is not required to obtain signatures.
This Child Support Guidelines Worksheet was prepared by:
___________________________________
(CSS Printed name)
Date: _____________________________
Child Supp. Guid. Form 2