PARENT=S WORKSHEET FOR CHILD SUPPORT AMOUNT Petitioner (1) (3) Case No. Respondent (2) ATLAS No. Custodial Parent (4): Father [ ] Mother [ ] Prepared By (5): Father [ ] No. of Children (6): Mother [ ] Date Prepared (7) Father Gross Income (8) Estimated Father [ ] Mother [ ] Mother $ $ Spousal Maintenance Paid (9) $- $- Spousal Maintenance Received (10) $+ $+ Child Support Paid/Contributed (11) $- $- Support of Other Children (12) $- $- $ $ Attributed Father [ ] Mother [ ] Adjusted Gross Income (13) Combined Adjusted Gross Income (14) $ Basic Child Support Obligation (15) $ Plus Costs for: Medical/Dental/Vision Insurance (16) $ $ Childcare (17) for [ ] One Child [ ] or More Than One Child $ $ Education Expenses (18) $ $ Extraordinary Child (19) $ $ Subtotal (20) $ $ No. of Children Age 12 or Over Adj. % $ (21) Total Adjustments for Costs (22) $ Total Child Support Obligation (23) $ Each Parent=s % of Combined Income (24) % % Each Parent=s Share of the Total Support Obligation (25) $ $ Less Paying Parent=s Costs (26) $ $ Line (15) x ______% $ $ Adjustments Subtotal (28) $ $ Preliminary Child Support Amount (29) $ $ $ $ $ $ Costs Associated with Parenting Time (27): Table A [ ] Table B [ ] No. of Days Self Support Reserve Test for Payor (30) Line (13) $ Less Paid Arrears $ Less $775 Child Support Amount to be Paid By (31): Father [ ] Mother [ ] Travel Related to Parenting Time (32) % % Medical/Dental/Vision Costs Not Paid by Insurance (33) % % W FORM: PARENTS WS 03/22/05 Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com PARENT’S WORKSHEET FOR CHILD SUPPORT AMOUNT INSTRUCTIONS This worksheet provides the information the court needs to determine child support amounts in accordance with Arizona's Child Support Guidelines. You may download a copy of the Guidelines from the Internet at http://supreme.state.az.us/nav2/divorce.htm or see your county Clerk of Superior Court or Self Service Center for a copy. An automated child support calculator is also available on the Supreme Court’s website at http://www.supreme.state.az.us/childsup.htm. Assuming your computer is connected to a printer, the online calculator will provide you with a printout that you may use in place of this form. COMPLETE THIS WORKSHEET IF: You are a party to a court action to establish a child support obligation or to modify an existing order for child support. • TO COMPLETE THIS WORKSHEET YOU WILL NEED TO KNOW: • Your case number and the ATLAS number, if known. • The monthly gross income of both parents (actual, estimated or attributed). • The monthly cost of medical, dental and vision insurance for the children who are the subject of this action. • Monthly childcare amounts paid to others by each parent. • The number of days the child(ren) spends with the non-custodial parent. • Monthly obligations of each parent for child support or court-ordered spousal maintenance/support. DEFINITIONS • Custodial Parent – The parent designated by the court as having primary physical custody of the child(ren) or if a custody order has not been established, the parent with whom the child lives with most of the time. • Non-custodial Parent - The parent that has not been granted physical custody of the child(ren) or if a custody order has not been established, the parent who is not the primary caretaker of the child(ren). • Physical Custody - Rights and responsibilities to determine where the child lives and who cares for the child. HOW TO COMPLETE THIS FORM: TYPE OR PRINT NEATLY USING BLACK INK. Match each numbered item in the instructions with the same numbered item on the Parent’s Worksheet for Child Support Amount. The number in brackets after the instructions tells you where to look in the Guidelines for this item, for example, [Guidelines 5]. (1) (2) (3) (4) (5) (6) Type or print the name of the person shown as the Petitioner/Plaintiff on the original petition to establish support or on the Order that established support. Type or print the name of the person shown as the Respondent/Defendant on the original petition to establish support or on the Order that established support. Type or print the case number assigned to your case. If you do not have a case number, leave this item blank. Type or print the ATLAS number, if one has been assigned to your case; otherwise leave this item blank. Check the box indicating the custodial parent. [See definition above]. Check the box indicating which parent is preparing this form. Enter the number of children from this relationship for whom support is being requested. W INST: PARENT WS 03/22/05 Page 1 of 9 American LegalNet, Inc. www.USCourtForms.com (7) Type or print the date this Parent’s Worksheet for Child Support Amount is being completed. MONTHLY GROSS INCOME (8) Type or print the exact, estimated or attributed gross monthly income for each parent. [See Guidelines 5] Example of estimated income: The father was promoted to supervisor. Before this promotion he was making $2,000 per month and I believe he received a 20% increase, so I am estimating his income at $2,400 per month. Example of attributed income: My ex-wife was a secretary earning $1,500 per month. Now she has remarried and is staying home as a homemaker. She could be making $1,500 per month, so I am attributing her income at $1,500 per month. If you are estimating or attributing, check the appropriate box(es) in (8). • • • • Terms such as “gross income” and “adjusted gross income” as used here do not have the same meaning as when they are used for tax purposes. “Gross Income” is not your “take home pay”, it is the total amount before any deductions. To convert weekly “gross income” to “monthly gross income”, multiply the weekly amount by 4.33 (52 weeks divided by 12 months = 4.33 average weeks in a month). To convert bi-weekly “gross income” to “monthly gross income” multiply the bi-weekly amount by 2.165 (26 weeks divided by 12 months = 2.165 average pay periods in a month). Gross Income includes monies from: Salaries Bonuses Worker’s Compensation Benefits Wages Dividends Disability Insurance (including Security disability) Annuities Royalties Commissions Capital Gains Interest Social Self-employment Severance Pay Unemployment Insurance Benefits Income from a Business Pensions Rental Income Prizes Social Security Benefits [Guidelines 26] Trust Income Recurring Gifts For income from self-employment, rent, royalties, proprietorship of a business, joint ownership of a partnership or closely held corporation, gross income means gross receipts minus ordinary and necessary expenses required to produce income. What you include as “ordinary and necessary expenses” may be adjusted by the court, if deemed inappropriate for determining gross income for child support. Ordinary and necessary expenses also include one-half of the self-employment tax actually paid. Gross Income does not include: • Income of a parent’s new spouse. Only income of persons having a legal duty of support shall be treated as income under the Guidelines. • Benefits from public assistance programs such as Temporary Assistance for Needy Families (TANF), Supplemental Social Security Income (SSI), Food Stamps and General Assistance (GA). W INST: PARENT WS 03/22/05 Page 2 of 9 American LegalNet, Inc. www.USCourtForms.com • Child support payments received. If a parent is unemployed or underemployed, you may ask the court to attribute income to that parent by entering the amount of what you think that parent would be earning if he or she worked at full earning capacity. The court shall presume, in the absence of contrary testimony, that a non-custodial parent is capable of full-time employment at least at the federal adult minimum wage. [Guidelines 5.E.] This presumption does not apply to non-custodial parents under the age of eighteen who are attending high school. If gross income is attributed to the parent receiving support, appropriate childcare expenses may also be attributed in (17). If you are completing this Parent's Worksheet as part of a simplified modification proceeding and your income is different from the court's most recent findings, you must attach documentation to verify your current income. The documentation should include: your most recent tax return, W-2, or 1099 forms and your most recent paycheck stub showing year-to-date information. If these are not available, provide other documentation such as a statement of earnings from your employer showing year-to-date income. If you are completing this Parent's Worksheet as part of a simplified modification proceeding and the income you show for the other party is different from that listed on the court's most recent findings regarding income of that parent, you must attach documentation or explain the amount shown or mark the box in (8) to show that the income amount is estimated or attributed. ADJUSTMENTS TO MONTHLY GROSS INCOME [Guidelines 2.C., 6 and 6.A.] (9) Type or print the total monthly amount of court-ordered spousal maintenance/alimony each parent actually pays from any previous marriage and/or pays or will pay from this marriage. (10) Type or print the total monthly amount of court-ordered spousal maintenance/alimony each parent actually receives from any previous marriage and/or receives or will receive from this marriage. (11) If either parent has a child(ren) from another relationship who is the subject of a child support order, s/he is entitled to an adjustment as follows: For the non-custodial parent, the adjustment will be the amount of the court order if being paid. No adjustment will be made for court-ordered arrearage payments. For the custodial parent, the adjustment will be based upon a “simplified application” of the Guidelines as described below. Example of the “Simplified Application”: The parent has a gross monthly income of $2,000, and one child who is the subject of a child support order. To use the Simplified Application of the Guidelines, locate $2,000 in the Combined Adjusted Gross Income column of the Schedule of Basic Child Support Obligation. Select the amount in the column for one child, $420. The parent's income will be reduced by $420, resulting in an Adjusted Gross Income of $1,580. Type or print the adjustment. (12) If either parent has a natural or adopted child(ren) from another relationship who is not the subject of a child support order, s/he may ask the court to consider the financial obligation. If you choose to do this, W INST: PARENT WS 03/22/05 Page 3 of 9 American LegalNet, Inc. www.USCourtForms.com the adjustment amount you may request is determined by a “simplified application of the Guidelines”. Example of the “Simplified Application”: The parent has a gross monthly income of $3,000, and two children who are not the subject of a child support order. To use the Simplified Application of the Guidelines, locate $3,000 in the Combined Adjusted Gross Income column of the Schedule of Basic Child Support Obligation. Select the amount in the column for two children, $817. The parent's income may be reduced by up to $817, resulting in an Adjusted Gross Income of $2,183. Type or print the adjustment. ADJUSTED GROSS INCOME [Guidelines 7] (13) Add the amounts in (8) and (10), then subtract the amounts in (9), (11) and (12) for each parent. Type or print the answer. COMBINED ADJUSTED MONTHLY GROSS INCOME [Guidelines 7] (14) Add the two numbers in (13) together (the one for the father and the one for the mother). Type or print the amount. BASIC CHILD SUPPORT OBLIGATION [Guidelines 8] (15) On the Schedule of Basic Child Support Obligation, locate the amount that is closest to the Combined Adjusted Monthly Gross Income in (14). Go to the column for the number of children in (6). Type or print this amount. PLUS COSTS FOR: (Place in the column for the parent paying the expenses.) Medical/Dental/Vision Insurance [Guidelines 9.A.] (16) For each parent type or print the monthly dollar amount of that portion of the insurance premium that is or will be paid for court-ordered medical, dental and/or vision care insurance for the child(ren) in this case. Child Care [Guidelines 9.B.1] (17) If the custodial parent is working or if income is attributed to the custodial parent in (8), check the box indicating whether childcare is paid for one or more than one child; then type or print the monthly cost of work-related childcare the custodial parent pays. If these costs vary throughout the year, add the amounts for each month together and divide by 12 to annualize the cost. If appropriate, adjust for the federal child care tax credit. If the non-custodial parent pays for work-related childcare during periods of physical custody, the amount paid by that parent may also be typed or printed here. If these costs vary throughout the year, add the amounts for each month together and divide by 12 to annualize the cost. Education Expenses [Guidelines 9.B.2.] (18) Type or print the monthly reasonable and necessary expenses for special or private schools and special educational activities. These expenses must be agreed upon by both parents or ordered by the court. W INST: PARENT WS 03/22/05 Page 4 of 9 American LegalNet, Inc. www.USCourtForms.com Extraordinary Child [Guidelines 9.B.3.] (19) If any of the children for whom support is being requested are gifted or handicapped and have special needs, type or print the monthly costs of meeting those needs. (20) Add items (16) through (19) for each parent and type or print the answer. Children 12 and Over [Guidelines 9.B.4.] (21) If there are no children 12 or over, enter “0” and SKIP to (22). Average expenditures for children 12 or older are approximately 10% higher than those for younger children, therefore the Guidelines allow an adjustment of up to 10% to account for these higher costs. If support is being determined for children 12 or older, type or print the number of children 12 or older; then type or print the percentage of adjustment (1-10 percent) you are requesting. If all children are 12 or over: Multiply the Basic Child Support Obligation (15) by the percentage adjustment (1 – 10%), which results in the monthly dollar amount of increase. • Type or print this amount in the blank with the “$”. • If one or more, but not all children are 12 or older: • Divide the Basic Child Support Obligation (15) by the total number of children. • Multiply that amount by the number of children 12 or over. • Then multiply that amount by the percentage adjustment (1 – 10%), which results in the monthly dollar amount of increase. • Type or print this amount in the blank with the “$”. Example A: All children are 12 or older, Basic Child Support Obligation is $300 and a 10% Adjustment is being requested: Multiply Basic Child Support Obligation of $300 by the 10% adjustment which equals $30. $300 x .10 = $30 Example B: Support is being requested for three children, two of those children are 12 or older. The Basic Child Support Obligation is $300 and a 10% Adjustment is being requested: Divide Basic Child Support Obligation of $300 by 3 children which equals $100. $300 ÷ 3 = $100 Multiply the answer of $100 by 2 children which equals $200. $100 x 2 = $200 Multiply the answer of $200 by the 10% adjustment which equals $20. $200 x .10 = $20 TOTAL ADJUSTMENTS FOR COSTS (22) Add the amounts for both parents from (20) to the amount from (21). Type or print the answer. W INST: PARENT WS 03/22/05 Page 5 of 9 American LegalNet, Inc. www.USCourtForms.com TOTAL CHILD SUPPORT OBLIGATION (23) Add the amounts from (15) and (22). Type or print the total amount. EACH PARENT'S PERCENTAGE (%) OF COMBINED INCOME [Guidelines 10] (24) For each parent, divide the amount in (13) (Adjusted Gross Income) by the amount in (14) (Combined Adjusted Gross Income). Type or print each parent’s percentage. If one parent earns all of the income, this answer will be 100%. EXAMPLE: Adjusted Gross Income (13) Combined Adjusted Gross Income (14) Mother $600 $1000 Father $400 $600 ÷ $1,000 = .60 or 60% is Mother’s percentage $400 ÷ $1,000 = .40 or 40% is Father’s percentage EACH PARENT'S SHARE OF THE TOTAL CHILD SUPPORT OBLIGATION (25) For each parent, multiply the amount in (23) by the number for that parent in (24). This equals the dollar amount of each parent’s share of the total child support obligation. Type or print each parent’s share of the child support obligation. EXAMPLE: Total child support obligation (23) Percentage of combined income (24) Mother $189 60% Father 40% $189 x .60 = $113.40 is Mother’s share of the total support obligation $189 x .40 = $75.60 is Father’s share of the total support obligation LESS PAYING PARENT’S COSTS (26) For the parent who is or will be ordered to pay child support type or print the amount from (20). ADJUSTMENT FOR COSTS ASSOCIATED WITH PARENTING TIME [Guidelines 11] (27) If either of the following is true, neither party receives a parenting time adjustment, SKIP to (28): • Time with each parent is equal. • The non-custodial parent will not incur costs for the children during parenting time. To adjust for costs associated with parenting time, first determine the total number of parenting time days indicated in a court order or parenting plan or by the expectation or past practice of the parents. Using the definitions below, add together each block of parenting time to arrive at the total number of parenting time days per year. Only time spent with the non-custodial parent is considered; time that the child is in school or in childcare is not considered. For purposes of calculating parenting time days: A. A period of 12 hours or more counts as one day. B. A period of 6 to 11 hours counts as a half-day. C. A period of 3 to 5 hours counts as a quarter-day. D. Periods of less than 3 hours may count as a quarter day if, during those hours, the non-custodial parent pays for routine expenses of the child, such as meals. W INST: PARENT WS 03/22/05 Page 6 of 9 American LegalNet, Inc. www.USCourtForms.com Based on the information below, check the box to indicate whether “Parenting Time Table A” or “Parenting Time Table B” applies. “Parenting Time Table A” applies when the number of parenting time days approaches equal time sharing (143 days and above) and certain costs usually incurred only in the custodial household are assumed to be substantially or equally shared by both parents. These costs are for items such as the child’s clothing and personal care items, entertainment, and reading materials. Parenting Time Table A applies unless the court finds that costs are not substantially or equally shared in each household. “Parenting Time Table B” applies only when the custodial parent can prove to the court that the costs are not substantially or equally shared in each household. PARENTING TIME TABLE A Number of Adjustment Visitation Days Percentage Number of Visitation Days Adjustment Percentage 0–3 0 116 - 129 .195 4 – 20 .012 130 - 142 .253 21- 38 .031 143 – 152 .307 39 - 57 .050 153 – 162 .362 58 - 72 .085 163 - 172 .422 73 - 87 .105 173 – 182 .486 88 - 115 .161 PARENTING TIME TABLE B Number of Visitation Days 143 - 152 .275 153 – 162 .293 163 – 172 .312 173 - 182 • • • • Adjustment Percentage .331 Type or print total number of parenting time days in (27). Check the box to indicate whether Table A or Table B applies. Type or print the percentage adjustment from the appropriate table. Multiply the percentage by the amount listed for (15). Type or print the answer in the column for the non-custodial parent. W INST: PARENT WS 03/22/05 Page 7 of 9 American LegalNet, Inc. www.USCourtForms.com EXAMPLE The Basic Child Support Obligation (15) is $425. The non-custodial parent has parenting time with the children a total of 100 days. On “Parenting Time Table A”, the range of days for this amount of parenting time is 88 to 115 days. The corresponding adjustment percentage is .161. Multiply the $425 Basic Child Support Obligation by .161 (16.1%). The resulting amount of $68 is entered in (27) in the column for the non-custodial parent. $425 x .161 = $68 ADJUSTMENTS SUBTOTAL (28) For the paying parent, add the amounts in (26) and (27). Type or print the answer. PRELIMINARY CHILD SUPPORT AMOUNT (29) For non-custodial parent: Subtract the amount in (28) from (25). Type or print the answer. For custodial parent: Type or print the amount from (25). SELF SUPPORT RESERVE TEST FOR PAYING PARENT [Guidelines 15] (30) • Type or print the paying parent’s adjusted gross income from (13). • The court may subtract from the paying parent’s adjusted gross income (13) court-ordered arrears on child support for children of other relationships or spousal maintenance, if actually paid. If applicable, type or print that monthly amount. • Subtract paid arrears and $775 from (13). • Type or print the answer in the column for the paying parent. CHILD SUPPORT AMOUNT TO BE PAID (31) Check the box indicating which parent will be ordered to pay child support and type or print the dollar amount from (29) or (30) for the paying parent. If the resulting amount is less than the preliminary child support amount (29), the court may reduce the child support amount after considering the financial impact the reduction would have on the custodial household. RESPONSIBILITY FOR TRAVEL EXPENSES ASSOCIATED WITH PARENTING TIME [Guidelines 18] (32) Type or print the percentage you think each parent should pay toward the child(ren)’s travel expenses involving travel of more than 100 miles, one-way. The court will decide how to allocate the expense, but you may use the percentages listed in (24) as a guide. The allocation of expense does not change the amount of the support ordered in (31). RESPONSIBILITY FOR MEDICAL EXPENSES NOT PAID BY INSURANCE [Guidelines 9.A.] (33) Type or print the percentage you think each parent should pay toward uninsured medical, dental and/or vision expenses for the child(ren). The court will decide how to allocate the expense, but you may use the percentages listed in (24) as a guide. The allocation of expense does not change the amount of the support ordered in (31). NOTE: DEVIATION FROM THE GUIDELINES AMOUNT [Guidelines 20] If you believe the amount of child support shown on this worksheet is too low or too high, the court may deviate from the guidelines and order a different amount, if the amount on the worksheet is found to be unjust or inappropriate. A deviation can only be ordered if the court makes appropriate findings based W INST: PARENT WS 03/22/05 Page 8 of 9 American LegalNet, Inc. www.USCourtForms.com upon evidence presented by either party or agreement of the parties. WHEN YOU HAVE COMPLETED THIS WORKSHEET: W INST: PARENT WS 03/22/05 Page 9 of 9 American LegalNet, Inc. www.USCourtForms.com