Rev. 09/2017 by KSJC 1 of 2 Child Support Worksheet IN THE JUDICIAL DISTRICT COUNTY, KANSAS IN THE MATTER OF: and CASE NO. CHILD SUPPORT WORKSHEET OF (name) (Parent Name) (Parent Name) A. INCOME COMPUTATION 226 WAGE EARNER 1. Domestic Gross Income $ $ (Insert on Line C.1. below)* B. INCOME COMPUTATION 226 SELF-EMPLOYED 1. Self-Employment Gross Income* 2. Reasonable Business Expenses (-) 3. Domestic Gross Income (Insert on Line C.1. below) C. ADJUSTMENTS TO DOMESTIC GROSS INCOME 1. Domestic Gross Income 2. Court-Ordered Child Support Paid (-) 3. Court-Ordered Maintenance Paid (-) 4. Court-Ordered Maintenance Received (+) 5. Child Support Income (Insert on Line D.1. below) D. COMPUTATION OF CHILD SUPPORT 1. Child Support Income + = 2. Proportionate Shares of Combined Income % % (Each parent222s income divided by combined income) 3. Gross Child Support Obligation** (Using the combined income from Line D.1., find the amount for each child and enter total for all children) Age of Children 0-5 6-11 12-18 Total Number Per Age Category Total Amount + + = * Interstate Pay Differential Adjustment? Yes No **Multiple Family Application? Yes No Instructions to complet e the Child Support Worksheet may be found on the Kansas Judicial Branch website , http://www.kscourts.org/Rules-procedures-forms/Child-support-guidelines/default.asp, or by visiting your local law library. The Child Support Worksheet must be completed prior to your hearing. American LegalNet, Inc. www.FormsWorkFlow.com Rev. 09/2017 by KSJC 2 of 2 Case No. (Parent Name) (Parent Name) 4. Health and Dental Insurance Premium $ + $ = 5. Work-Related Child Care Costs Formula: Amt. 226 (Amt. X %) for each child care credit = Example: 200 226 (200 x .30%) 6. Parents222 Total Child Support Obligation (Line D.3. plus Lines D.4. & D.5.) 7. Parental Child Support Obligation (Line D.2. times Line D.6. for each parent) 8. Adjustment for Insurance and Child Care (-) (Subtract for actual payment made for items D.4. and D.5.) 9. Basic Parental Child Support Obligation (Line D.7. minus Line D.8.; Insert on Line F.1. below) E. CHILD SUPPORT ADJUSTMENTS AMOUNT ALLOWED APPLICABLE N/A CATEGORY (Parent Name) (Parent Name) 1. Long Distance Parenting Time Costs (+/-) (+/-) 2. Parenting Time Adjustment (if b. %) (+/-) (+/-) 3. Income Tax Considerations (+/-) (+/-) 4. Special Needs (+/-) (+/-) 5. Agreement Past Majority (+/-) (+/-) 6. Overall Financial Condition (+/-) (+/-) 7. TOTAL (Insert on Line F.2. below) F. DEVIATION(S) FROM REBUTTABLE PRESUMPTION AMOUNT AMOUNT ALLOWED (Parent Name) (Parent Name) 1. Basic Parental Child Support Obligation (Line D.9. from above) 2. Total Child Support Adjustments (+/-) (Line E.7. from above) 3. Adjusted Subtotal (Line F.1. +/- Line F.2.) 4. Equal Parenting Time Obligation (EPT worksheet Line 12 or 14) 5. 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) (+) (+) 6. Net Parental Child Support Obligation (Line F.3. + Line F.4.) **Parent with nonprimary residency. Use local percentage. Prepared By (Signature) Judge/Hearing Officer Signature Prepared By (Print Name) Date Submitted Date Approved American LegalNet, Inc. www.FormsWorkFlow.com