Pennsylvania Child Support Guidelines Worksheet Form

The Child Support Guidelines Worksheet form is used for letting the court know who of the spouses involved in a divorce is in a better financial situation. This form has to be completed by both spouses.

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COUNTY 
D.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