Pennsylvania Child Support Guidelines Worksheet Form

Child Support Guidelines Worksheet.pdf After both spouses fill in and file this form with the clerk’s office. It will let the court know who is in a better financial situation in order to decide who w

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COUNTYD.R.S.Docket Date:Defendant C.O.

Plaintiff

Rule 1910.16-4 Support Guidelines. Calculation of Support Obligation. Formula

(a) The following formula shall be used to calculate the obligor’s share of the

basic guideline child support, spousal support and/or alimony pendente lite obligation:

PART I. BASIC CHILD SUPPORT

OBLIGOR OBLIGEE

1. Total Gross Income Per Pay Period

2. Less Deductions ( ) ( )

3. Net Income

4. Conversion to Monthly Amount

if pay period is other than monthly)

5. Combined Total Monthly Net Income

6. Plus Child’s Monthly Social Security,

Death, Retirement or Disability Derivative

Benefit, if any. (See Rule 1910.16-2(b)(2)) +

7. Adjusted Combined Monthly Net Income

8. PRELIMINARY BASIC CHILD SUPPORT

OBLIGATION (determined from schedule at

Rule 1910.16-3 based on number of children

and line 7 adjusted combined monthly net income)

9. Less Child’s Monthly Social Security Derivative

Benefit ( )

10. BASIC CHILD SUPPORT OBLIGATION

11. Net Income Expressed as a Percentage

Share of Income (divide line 4 by line

5 and multiply by 100) % %

12. Each Parent’s Monthly Share of the

Basic Child Support Obligation

(multiply line 10 and 11)

PART II. SUBSTANTIAL or SHARED PHYSICAL CUSTODY ADJUSTMENT, IF

APPLICABLE (See subdivision (c) of this rule)

13. a. Percentage of Time Spent with Children

(divide number of overnights with obligor

by 365 and multiply by 100)

b. Subtract 30% ( )

c. Obligor’s Adjusted Percentage Share

of the Basic Monthly Support Obligation

(subtract line 13b from line 11)

d. Obligor’s Adjusted Share of the Basic

Monthly Support Obligation

(multiply line 13c and line 10)

e. Further adjustment, if necessary

under subdivision (c)(2) of this rule

PART III. ADDITIONAL EXPENSES (See Rule 1910.16-6)

14. a. Obligor’s Share of Child Care Expenses

b. Obligor’s Share of Health Insurance Premium

(if the obligee is paying the premium)

c. Less Obligee’s Share of the Health Insurance

Premium (if the obligor is paying the premium) ( )

d. Obligor’s Share of Unreimbursed Medical Expenses

e. Other Additional Expenses

f. Total Additional Expenses

15. OBLIGOR’S TOTAL MONTHLY SUPPORT

OBLIGATION (add line 12 (or 13(d or e) (if

applicable) and line 14f)

PART IV. SPOUSAL SUPPORT OR APL

With Dependent Children

16. Obligor’s Monthly Net Income (line 4)

17. Less Obligor’s Support, Alimony Pendente

Lite or Alimony Obligations, if any, to Children

or Former Spouses who are not part of this action

(see Rule 1910.16-2(c)(2)) ( )

18. Less Obligee’s Monthly Net Income (Line 4) ( )

19. Difference

20. Less Obligor’s Total Monthly Child Support

Obligation Without Part II Substantial or Shared

Custody Adjustment (Obligor’s line 12 plus line 14f) ( )

21. Difference

22. Multiply by 30% .30

23. AMOUNT OF MONTHLY SPOUSAL SUPPORT

OR APL

Without Dependent Children

24. Obligor’s Monthly Net Income (line 4)

25. Less Obligor’s Support, Alimony Pendente Lite

or Alimony Obligations, if any, to Children or

Former Spouses who are not part of this action

(see Rule 1910.16-2(c)(2)) ( )

26. Less Obligee’s Monthly Net Income (Line 4) ( )

27. Difference

28. Multiply by 40% .40

29. PRELIMINARY AMOUNT OF MONTHLY

SPOUSAL SUPPORT OR APL

30. Adjustments for Other Expenses (see Rule 1910.16-6)

31. TOTAL AMOUNT OF MONTHLY SPOUSAL

SUPPORT OR APL