Chapter 9 Child Support Guidelines

Rule 9.27 Child Support Guidelines Worksheet

Docket No:

I. Net Monthly Income of Petitioner (Name)

Select one: Custodial Parent Noncustodial Parent Joint Physical Care

Petitioner claims child/children as tax dependents.

A. Sources and Amounts of Annual Income:

$

$

plus/minus spousal support payments per rule 9.5(1) $

Total: $

B. Federal Tax Deduction:

Gross annual taxable income ($ untaxed) $

less ½ self employment (FICA) tax

less federal adjustments to income

less personal exemptions: self + (list number of dependents claimed)

less standard deduction single head of household married filing separate

Net taxable income – federal $

Federal tax liability (from tax table)

Federal tax credit for dependent children +

Final federal tax liability

C. State Tax Deduction:

Gross annual taxable income $

less ½ self employment (FICA) tax

less state adjustments to income

less federal tax liability (adjusted for dependent tax credit)

less standard deduction single head of household married filing separate

Net taxable income – state $

State tax liability (from tax table) $

less personal and dependent credits

plus school district surtax (%)

Final state tax liability

D. Social Security and Medicare Tax / Mandatory Pension Deduction:

Annual earned income $

Applicable rate (7.65% or 15.3%, as adjusted) x

Annual Social Security and Medicare tax liability or mandatory pension

E. Other Deductions (Annual):

1. Mandatory occupational license fees

2. Union dues

3. Actual medical support paid pursuant to court order or administrative order in another order for other children, not the pending matter

4. Prior obligation of child support actually paid pursuant to court or administrative order

5. Deduction for additional qualified dependents

6. If a custodial parent, Petitioner’s child care expenses (present action) $

less federal child care tax credit

less state child care tax credit

less third party reimbursements

Actual child care expenses, as defined in rule 9.11A $

Preliminary Net Annual Income $

Preliminary Average Monthly Income of Petitioner $

7. Monthly cash medical support ordered in this pending action

Adjusted Net Monthly Income of Petitioner $

II. Net Monthly Income of Respondent (Name)

Select one: Custodial Parent Noncustodial Parent Joint Physical Care

Respondent claims child/children as tax dependents.

A. Sources and Amounts of Annual Income:

$

$

plus/minus spousal support payments per rule 9.5(1) $

Total: $

B. Federal Tax Deduction:

Gross annual taxable income ($ untaxed) $

less ½ self employment (FICA) tax

less federal adjustments to income

less personal exemptions: self + (list number of dependents claimed)

less standard deduction single head of household married filing separate

Net taxable income – federal $

Federal tax liability (from tax table)

Federal tax credit for dependent children +

Final federal tax liability

C. State Tax Deduction:

Gross annual taxable income $

less ½ self employment (FICA) tax

less state adjustments to income

less federal tax liability (adjusted for dependent tax credit)

less standard deduction single head of household married filing separate

Net taxable income – state $

State tax liability (from tax table) $

less personal and dependent credits

plus school district surtax (%)

Final state tax liability

D. Social Security and Medicare Tax / Mandatory Pension Deduction:

Annual earned income $

Applicable rate (7.65% or 15.3%, as adjusted) x

Annual Social Security and Medicare tax liability or mandatory pension

E. Other Deductions (Annual):

1. Mandatory occupational license fees

2. Union dues

3. Actual medical support paid pursuant to court order or administrative order in another order for other children, not the pending matter

4. Prior obligation of child support actually paid pursuant to court or administrative order

5. Deduction for additional qualified dependents

6. If a custodial parent, Respondent’s child care expenses (present action) $

less federal child care tax credit

less state child care tax credit

less third party reimbursements

Actual child care expenses, as defined in rule 9.11A $

Preliminary Net Annual Income $

Preliminary Average Monthly Income of Respondent $

7. Monthly cash medical support ordered in this pending action

Adjusted Net Monthly Income of Respondent $

III. Calculation of the Guideline Amount of Support (If applicable.)

Custodial Parent (CP): Petitioner Respondent

Noncustodial Parent (NCP): Petitioner Respondent

A. Adjusted net monthly income $ + $ = $

B. Proportional share of income % + % = 100%

C. Number of children for whom support is sought

D. Basic support obligation using only NCP’s adjusted net monthly income

E. Basic support obligation using combined adjusted net monthly income

F. Each parent’s share of the basic support obligation using combined incomes $ $

G. NCP’s basic support obligation before health insurance $

H. Allowable child(ren)’s portion of health insurance premium $

I. Health insurance add-on or deduction from NCP’s obligation + / - $

J. Guideline amount of child support for NCP $

Guideline amount of cash medical support (if ordered) $

III. a. Extraordinary Visitation Credit (Complete only if noncustodial parent’s court-ordered visitation exceeds 127 overnights per year.)

K. NCP’s basic support obligation before health insurance $

L. Number of court-ordered visitation overnights with the noncustodial parent

M. Extraordinary visitation credit percentage %

N. Extraordinary visitation credit $

O. Guideline amount of child support after credit for extraordinary visitation $

III. b. Child Care Expense Variance under rule 9.11A (As agreed by the parties and approved or determined by the court.)

P. NCP’s guideline amount of child support $

Q. Amount of variance for child care expenses $

Adjusted amount of child support $

IV. Calculation of the Joint (Equally Shared) Physical Care Guideline Amount of Child Support (If applicable.)

Petitioner CP 1 $ + Respondent CP 2 $ = Combined $

B. Proportional share of income % % = 100%

C. Number of children for whom support is sought

D. Basic support obligation before health insurance $

E. Each parent’s basic primary care amount before health insurance $ $

F. Each parent’s share of joint physical care support $ $

G. Each parent’s joint physical care support obligation before health insurance $ $

H. Allowable child(ren)’s portion of health insurance premium $ $

I. Health insurance add-on to each parent’s obligation $ $

J. Guideline amount of child support $ $

K. Net amount of child support for joint physical care after offset $ $

V. Special Findings

A. Income imputed to Petitioner

Income imputed to Respondent

B. Estimated income of Petitioner

Estimated income of Respondent

C. Deviations made from Child Support Guidelines

D. Requested amount of child support $ per month

E. Split or divided physical care summary and offset

VI. Changes in Child Support Obligation as Number of Children Entitled to Support Changes (For cases with multiple children based on present income and applicable guidelines calculation method.)

VI. a. Basic Obligation (If applicable.)

Number of children

NCP’s basic support obligation $ $ $ $ $

Health insurance add-on or deduction $ $ $ $ $

Extraordinary visitation credit $ $ $ $ $

Guideline amount of child support $ $ $ $ $

VI. b. Joint (Equally Shared) Physical Care Obligation (If applicable.)

Number of Children

Guideline amount of child support Petitioner $ $ $

Guideline amount of child support Respondent $ $ $

Net amount of child support for joint physical care after offset $ $ $

State of Iowa

ss:

County of

I certify under the penalty of perjury and pursuant to the laws of the state of Iowa that the preceding is true and correct.

The undersigned attorney for (Petitioner/Respondent) hereby certifies that this Child Support Guidelines Worksheet was prepared by me or at my direction in good faith reliance upon information available to me at this time.