Michigan Disclosure of Income and Health Insurance Form

For verifying the employment and health insurance status of each of the spouses in order to determine the amount they will pay for child support and/or alimony in the State of Michigan, the Michigan Disclosure of Income and Health Insurance Form has to be used.

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NOTICE TO EMPLOYER
Pursuant to Michigan law, you are required to provide information relative to the custodial or absent parent as follows:
Sec. 18.(1) Subject to subsection (3) and (4), upon the request of the office of the friend of the court, any employer or former
employer of a parent  as defined in section 1 of the office of child support act, 1971 PA 174, MCL 400.231, who is or was employed
as an employee or independent contractor, shall provide the following information relative to the custodial parent or absent parent:
(a) Full name and address.
(b) Social security number (unless the parent is exempt under state or federal law).
(c) Date of birth.
(d) Amount of wages earned by or other income due the custodial parent or absent parent.  Both net and gross income shall
be reported, regardless of the method of payment.
(e) The following information concerning the person's current and former employment status:  whether or not the custodial
parent or absent parent is currently employed, laid off, or on sick, disability, or other leave of absence, or retired and the amount
of income due from an employment-related benefit plan, if any.
(f) Dependent health-care coverage available to the custodial parent or absent parent as a benefit of employment.	
Use this space for any necesesary explanations from the other side.