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Child Support Worksheet Form. This is a Kansas form and can be use in 10th Judicial District (Johnson County) Local District Court.
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Tags: Child Support Worksheet, Kansas Local District Court, 10th Judicial District (Johnson County)
Instructions to complete the Child Support Worksheet may be found on the Kansas Judicial Branch website,
http://www.kscourts.org/programs/Child-Support-Guidelines/default.asp, or by visiting your local law library.
The Child Support Worksheet must be completed prior to your hearing.
Child Support Worksheet
IN THE
JUDICIAL DISTRICT
COUNTY, KANSAS
IN THE MATTER OF:
and
CASE NO.
CHILD SUPPORT WORKSHEET OF
(name)
MOTHER
A.
B.
INCOME COMPUTATION – WAGE EARNER
1.
Domestic Gross Income
(Insert on Line C.1. below)*
$
Self-Employment Gross Income*
Reasonable Business Expenses
Domestic Gross Income
(Insert on Line C.1. below)
(-)
ADJUSTMENTS TO DOMESTIC GROSS INCOME
1.
2.
3.
4.
5.
D.
$
INCOME COMPUTATION – SELF-EMPLOYED
1.
2.
3.
C.
FATHER
Domestic Gross Income
Court-Ordered Child Support Paid
Court-Ordered Maintenance Paid
Court-Ordered Maintenance Received
Child Support Income
(Insert on Line D.1. below)
(-)
(-)
(+)
COMPUTATION OF CHILD SUPPORT
1.
Child Support Income
2.
Proportionate Shares of Combined Income
(Each parent’s income divided by combined income)
Gross Child Support Obligation**
(Using the combined income from Line D.1.,
find the amount for each child and enter total for
all children)
3.
Age of Children
Number Per Age Category
Total Amount
+
=
0-5
6-11
+
%
12-18
%
Total
+
=
* Interstate Pay Differential Adjustment?
Yes
No
**Multiple Family Application?
Yes
No
Rev. 02/09 by KSJC
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Case No.
MOTHER
4.
Health and Dental Insurance Premium
5.
Work-Related Child Care Costs
Formula: Amt. – ((Amt. X %) + (.25 x (Amt. x %)))
for each child care credit
Example: 200 – ((200 x .30%) + (.25 x (200 x .30%)))
Parents’ Total Child Support Obligation
6.
7.
8.
9.
E.
$
(Line D.3. plus Lines D.4. & D.5.)
Parental Child Support Obligation
(Line D.2. times Line D.6. for each parent)
Adjustment for Insurance and Child Care
(Subtract for actual payment made for items
D.4. and D.5.)
Basic Parental Child Support Obligation
(Line D.7. minus Line D.8.;
Insert on Line F.1. below)
FATHER
+ $
=
=
(-)
CHILD SUPPORT ADJUSTMENTS
APPLICABLE
N/A
AMOUNT ALLOWED
MOTHER
FATHER
CATEGORY
1.
2.
3.
4.
5.
6.
7.
Long Distance Parenting Time Costs
(+/-)
Parenting Time Adjustment (if b. %___) (+/-)
Income Tax Considerations
(+/-)
Special Needs
(+/-)
Agreement Past Majority
(+/-)
Overall Financial Condition
(+/-)
TOTAL (Insert on Line F.2. below)
F.
DEVIATION(S) FROM REBUTTABLE PRESUMPTION AMOUNT
(+/-)
(+/-)
(+/-)
(+/-)
(+/-)
(+/-)
AMOUNT ALLOWED
MOTHER
FATHER
1.
2.
3.
4.
5.
Basic Parental Child Support Obligation
(Line D.9. from above)
Total Child Support Adjustments
(+/-)
(Line E.7. from above)
Adjusted Subtotal (Line F.1. +/- Line F.2.)
Enforcement Fee Allowance**
Percentage
(Applied only to Nonresidential Parent) Flat Fee $
((Line F.3. x Collection Fee %) x .5)
or (Monthly Flat Fee x .5)
(+)
Net Parental Child Support Obligation
(Line F.3. + Line F.4.)
%
(+)
**Parent with nonprimary residency
Judge/Hearing Officer Signature
Date Signed
Prepared By
Rev. 02/09 by KSJC
Date Approved
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