FL-687 GOVERNMENTAL AGENCY (under Family Code, §§ 17400, 17406): OR ATTORNEY OR PARTY WITHOUT ATTORNEY (name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS: ATTORNEY FOR (name): FAX NO.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: ORDER AFTER HEARING 1. This matter proceeded as follows: Dept.: a. Date: Petitioner/plaintiff present b. c. Respondent/defendant present d. e. f. Uncontested CASE NUMBER: Other parent/party present Local child support agency attorney (Family Code, §§ 17400, 17406) by (name): Other (specify): By stipulation Judicial officer: Attorney present (name): Attorney present (name): Attorney present (name): Contested g. The parent ordered to pay support is the petitioner/plaintiff respondent/defendant other parent/party. 2. Attached is a computer printout showing the parents' income and percentage of time each parent spends with the children. The printout, which shows the calculation of child support payable, will become the court's findings. 3. This order is based on the attached documents (specify): THE COURT ORDERS 4. a. All orders previously made in this action remain in full force and effect except as specifically modified below. b. The parent ordered to pay support is the parent of and must pay current child support for the following children: Monthly support amount Name of child Date of birth (1) Mandatory additional child support. The parent ordered to pay support must pay additional monthly support for reasonable child-care costs, as follows: (a) per month of the costs. one-half or % or (specify amount): $ other parent Payments must be made to the State Disbursement Unit child-care provider. (b) The parent ordered to pay support must pay reasonable uninsured health-care costs for the children, as follows: per month of the costs. one-half or % or (specify amount): $ Payments must be made to the other parent State Disbursement Unit health-care provider. NOTICE: Any party required to pay child support must pay interest on overdue amounts at the legal rate, which is currently 10 percent per year. Page 1 of 3 Form Adopted for Alternative Mandatory Use Instead of Form FL-692 Judicial Council of California FL-687 [Rev. January 1, 2017] ORDER AFTER HEARING (Governmental) Family Code, §§ 17402, 17404,17400 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com FL-687 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: CASE NUMBER: 4. b. (2) Other (specify): (3) (4) day of each month beginning (date): The low-income adjustment applies. The low-income adjustment does not apply because (specify reasons): For a total of: $ payable on the: (5) Any support ordered will continue until further order of court, unless terminated by operation of law. (6) When a person who has been ordered to pay child support is in jail or prison or is involuntarily institutionalized for any period of more than 90 days in a row, the child support order is temporarily stopped. However, the child support order will not be stopped if the person who owes support has the financial ability to pay that support while in jail, prison, or an institution. It will also not be stopped if the reason the person is in jail, prison, or an institution is because the person didn't pay court ordered child support or committed domestic violence against the supported person or child. The child support order starts again on the first day of the month after the person is released from jail, prison, or an institution. c. The parent ordered to pay support The parent receiving support must (1) provide and maintain health insurance coverage for the children if available at no or reasonable cost, and keep the local child support agency informed of the availability of the coverage (the cost is presumed to be reasonable if it does not exceed 5 percent of gross income to add a child); (2) if health insurance is not available, provide coverage when it becomes available; (3) within 20 days of the local child support agency's request, complete and return a health insurance form; (4) provide to the local child support agency all information and forms necessary to obtain health-care services for the children; (5) present any claim to secure payment or reimbursement to the other parent or caretaker who incurs costs for health-care services for the children; and (6) assign any rights to reimbursement to the other parent or caretaker who incurs costs for health-care services for the children. The parent ordered to provide health insurance must seek continuation of coverage for the child after the child attains the age when the child is no longer considered eligible for coverage as a dependent under the insurance contract, if the child is incapable of self-sustaining employment because of a physically or mentally disabling injury, illness, or condition and is chiefly dependent upon the parent providing health insurance for support and maintenance. The parent ordered to pay support owes support arrears as follows, as of (date): (1) Child support: $ Spousal support: $ (2) (3) (4) e. Interest is not included and is not waived. on the: Payable: $ beginning (date): Interest accrues on the entire principal balance owing and not on each installment as it becomes due. No provision of this order may operate to limit any right to collect the principal (total amount of unpaid support) or to charge and collect interest and penalties as allowed by law. All payments ordered are subject to modification. day of each month Family support: $ d. f. All payments, unless specified in item 4b(1) above, must be made to the State Disbursement Unit at the address listed below (specify address): FL-687 [Rev. January 1, 2017] ORDER AFTER HEARING (Governmental) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com FL-687 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: CASE NUMBER: 4. g. An earnings assignment order is issued. h. In the event that there is a contract between a party receiving support and a private child support collector, the party ordered to pay support must pay the fee charged by the private child support collector. This fee must not exceed 33 1/3 percent of the total amount of past due support nor may it exceed 50 percent of any fee charged by the private child support collector. The money judgment created by this provision is in favor of