Nebraska Child Support Guidelines Worksheet 3 CALCULATION FOR JOINT PHYSICAL CUSTODY Mother 1. 2. 3. 4. 5. 6. 7. 8. 9. Father Each parent’s percent contribution (% from line 6, worksheet 1) _____ ______ Monthly support obligation from table 1 (from line 7, worksheet 1) _____ ______ Joint physical support obligation (line 2 times 1.5) _____ ______ Each parent’s share (line 1 times line 3) _____ ______ Number of days annually child(ren) is in custody of each parent _____ ______ Percentage of year child(ren) is in custody of each parent (line 5 divided by 365) _____ ______ Mother’s obligation to father (% line 4 mother column, times % on line 6 father column) _____ ______ Father’s obligation to mother (% line 4 father column, times % line 6 mother column) _____ ______ Father/mother obligation for support (difference between lines 7 and 8) ____________ (mother/father) Additional Adjustment for Child(ren)’s health insurance premium Mother Father Combined 10. Child(ren)’s health insurance premium* (from line 8, worksheet 1) 11. Combined health insurance premium(s) _____ ______ ______ - 6.11 American LegalNet, Inc. www.FormsWorkflow.com Nebraska Child Support Guidelines 12. 13. 14. Each parent’s share of premium (line 1 times line 11) _____ ______ Amount of premium paid (line 10) _____ ______ Amount owed to other parent for premium (line 12 minus line 13, if negative amount enter $0) _____ ______ 15.a. Which parent owes basic support on line 9? 15.b. Which parent owes support for health insurance on line 14? 15.c. 16. Does the same parent owe support on lines 15a and 15b? __________ (mother/father) __________ (mother/father) __________ (Yes/No) Total support to be paid by parent on line 15a (if YES on line 15c, line 9 plus line 14; if NO on line 15c, line 9 minus line 14) * The parent requesting an adjustment for health insurance premiums must submit proof of the cost of the premium for the child(ren). Worksheet 3 amended effective July 1, 2007; worksheet 3 amended October 24, 2007. - 6.12 American LegalNet, Inc. www.FormsWorkflow.com