Please follow these instructions to complete a Request for Determination of Support Arrears or Adjustment of Child Support Arrears Due to Incarceration or Involuntary Institutionalization (form FL-676). If you need free help completing form FL-676, you can contact the Family Law Facilitator's Office in your county. For more information on finding a family law facilitator, see the California Courts Online Self-Help Center at www.courts.ca.gov/selfhelp. Form FL-676 should be used only if you disagree with the past due support payments (arrears) that the local child support agency says are owed or if an adjustment of child support arrears due to incarceration or institutionalization is needed and you cannot reach an agreement with the local child support agency. Child support includes the basic amount plus any additional amounts for child care costs related to employment, or training needed to get job skills and reasonable uninsured health care costs for the children. Form FL-676 cannot be used if you want to change your child support order. When you have completed form FL-676, file the original and attachments with the court clerk. The court clerk's address is listed in the telephone directory under "County Government Offices" or online at www.courts.ca.gov /courts/find.htm. Keep three copies of the filed form and its attachments. Serve one copy on the local child support agency, one copy on the other parent, and keep the other for your records. (See Information Sheet for Service of Process (form FL-611).) INSTRUCTIONS FOR COMPLETING FORM FL-676 (TYPE OR PRINT IN BLACK INK): Front page, first box, top of form, left side: Print your name, address, and telephone number in this box. Front page, second box, left side: Print your county's name and the court's address in the box. Use the same address for the court that is on your most recent support order or judgment. If you do not have a copy of your most recent support order or judgment, you can get one from either the court clerk or the local child support agency. Front page, third box, left side: Print the names of the Petitioner/Plaintiff, Respondent/Defendant, and Other Parent/Party in this box. Use the same names listed in your most recent support order or judgment. If no name is listed for the Other Parent/Parent, leave that line blank. Front page, first box, top of form, right side: Leave this box blank for the court's use. Front page, second box, right side: Print your case number in this box. This number is also listed on your most recent support order or judgment. Front page, fourth box, left side: Check the box to indicate whether you are asking for a determination of support arrears or adjustment of child support arrears due to incarceration or involuntary institutionalization. Check both boxes if you are asking for both a determination of arrears and an adjustment of child support arrears. 1.a.­b You must contact the court clerk's office and ask that a hearing date be set for this motion. The court clerk will give you the information you need to complete this section. 2. 3. This section states that the local child support agency is handling your support case. Check the box if you do not agree with the local child support agency's statement of past due support payments (arrears) and want the court to make a final determination. INFORMATION SHEET: REQUEST FOR DETERMINATION OF SUPPORT ARREARS OR ADJUSTMENT OF CHILD SUPPORT ARREARS DUE TO INCARCERATION OR INVOLUNTARY INSTITUTIONALIZATION FL-676-INFO 3a. This section requires you to attach the statement or other document from the local child support agency that tells the amount of support arrears owed. 3b. This section requires you to attach your own statement of the amount of support arrears owed. Your statement must show a monthly breakdown of the amount of support ordered and the amount paid each month. You may use Declaration of Payment History (form FL-420) and Payment History Attachment (form FL-421) to complete your statement of arrears. 4. Check if this applies. Attach or bring to the court hearing proof of the dates of incarceration or involuntary institutionalization. If you have any evidence or documentation that you had no income or assets, in addition to your sworn statement on the form, please bring that to court with you. You must date the request, print your name, and sign the form under penalty of perjury. When you sign the form, you are stating that the information you have provided is true and correct. Top of second page, box on left side: Print the names of Petitioner/Plaintiff, Respondent/Defendant, and Other Parent/Party in this box. Use the same names listed on the front page. Top of second page, box on right side: Print your case number in this box. Use the same number as the one on the front page. Instructions for how to complete the Proof of Service section of the Request form are in the Information Sheet for Service of Process (form FL-611). The person who serves the request and its attachments must fill out this section of the form. You cannot serve your own form FL-676. Form Approved for Optional Use Judicial Council of California FL-676-INFO [Rev. January 1, 2017] Page 1 of 1 INFORMATION SHEET: REQUEST FOR DETERMINATION OF SUPPORT ARREARS OR ADJUSTMENT OF CHILD SUPPORT ARREARS DUE TO INCARCERATION OR INVOLUNTARY INSTITUTIONALIZATION (Governmental) www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com