Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet
( 09 /12 )
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM
12.902(e), CHILD SUPPORT GUIDELINES WORKSHEET (09/12)
When should this form be used?
You should complete this worksheet if child support
is being requested in your case. If you know the
income of the other party
, this worksheet should accompany your financial affidavit . If you do not
know the other party’s income, this form must be completed after the other party files his or her
financial affidavit, and serves
a copy on you.
This form should be typed or printed in black ink. You should file the original with the clerk of the circuit
court in the county where your case is filed and keep a copy for your records.
What should I do next?
A copy of this form must be served on the other party in your case. Service must be in accordance with
Florida Rule of Judicial Administration 2.516.
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants” found at the
beginning of these forms. The words that are in “bold underline
” in these instructions are defined
there. For further information, see section 61.30, Florida Statutes.
Special notes...
If you want to keep your address confidential because you are the victim of sexual battery, aggrav ated
child abuse, aggravated stalking, harassment, aggravated battery or domestic violence, do not enter the
address, telephone, and fax information at the bottom of this form. Instead, file Request for
Confidential Filing of Address , Florida Supreme Court Approved Family Law Form 12.980(h).
The chart below contains the guideline amounts that you should use when calculating child support.
This amount is based on the number of children and the combined income of the parents, and it is
divided between the parents in direct proportion to their income or earning capacity . From time to
time, some of the amounts in the child support guidelines chart will change. Be sure you have the most
recent version of the chart before using it.
Because the guidelines are based on monthly amounts, it may be necessary to convert some incom e and
expense figures from other frequencies to monthly. You should do this as follows:
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet
( 09 /12 )
If payment is twice per month
Payment amount x 2 = Monthly amount
If payment is every two weeks Payment amount x 26 = Yearly amount due
Yearly amount ÷ 12 = Monthly amount
If payment is weekly Weekly amount x 52 = Yearly amount due
Yearly amount ÷ 12 = Monthly amount
If you or the other parent request that the court award an amount that is different than the gu ideline
amount, you must also complete and attach a Motion to Deviate from Child Support Guidelines , Florida
Supreme Court Approved Family Law Form 12.943.
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonla wyer helps you fill out
these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules
of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms
also must put his or her name, address, and telephone number on the bottom of the last pag e of every
form he or she helps you complete.
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines
Worksheet ( 09/12) CHILD SUPPORT GUIDELINES CHART
Combined
Monthly
Available
Income One
Child Two
Children Three
Children Four
Children Five
Children Six
Children
800.00 190 211 213 216 218 220
850.00 202 257 259 262 265 268
900.00 213 302 305 309 312 315
950.00 224 347 351 355 359 363
1000.00 235 365 397 402 406 410
1050.00 246 382 443 448 453 458
1100.00 258 400 489 495 500 505
1150.00 269 417 522 541 547 553
1200.00 280 435 544 588 594 600
1250.00 290 451 565 634 641 648
1300.00 300 467 584 659 688 695
1350.00 310 482 603 681 735 743
1400.00 320 498 623 702 765 790
1450.00 330 513 642 724 789 838
1500.00 340 529 662 746 813 869
1550.00 350 544 681 768 836 895
1600.00 360 560 701 790 860 920
1650.00 370 575 720 812 884 945
1700.00 380 591 740 833 907 971
1750.00 390 606 759 855 931 996
1800.00 400 622 779 877 955 1022
1850.00 410 638 798 900 979 1048
1900.00 421 654 818 923 1004 1074
1950.00 431 670 839 946 1029 1101
2000.00 442 686 859 968 1054 1128
2050.00 452 702 879 991 1079 1154
2100.00 463 718 899 1014 1104 1181
2150.00 473 734 919 1037 1129 1207
2200.00 484 751 940 1060 1154 1234
2250.00 494 767 960 1082 1179 1261
2300.00 505 783 980 1105 1204 1287
2350.00 515 799 1000 1128 1229 1314
2400.00 526 815 1020 1151 1254 1340
2450.00 536 831 1041 1174 1279 1367
2500.00 547 847 1061 1196 1304 1394
2550.00 557 864 1081 1219 1329 1420
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines
Worksheet ( 09/12)
Combined
Monthly
Available
Income One
Child Two
Children Three
Children Four
Children Five
Children Six
Children
2600.00
2650.00
2700.00
2750.00
2800.00
2850.00 568
578
588
597
607
616 880
896
912
927
941
956 1101
1121
1141
1160
1178
1197 1242
1265
1287
1308
1328
1349 1354
1379
1403
1426
1448
1471 1447
1473
1500
1524
1549
1573
2900.00 626 971 1215 1370 1494 1598
2950.00 635 986 1234 1391 1517 1622
3000.00 644 1001 1252 1412 1540 1647
3050.00 654 1016 1271 1433 1563 1671
3100.00 663 1031 1289 1453 1586 1695
3150.00 673 1045 1308 1474 1608 1720
3200.00 682 1060 1327 1495 1631 1744
3250.00 691 1075 1345 1516 1654 1769
3300.00 701 1090 1364 1537 1677 1793
3350.00 710 1105 1382 1558 1700 1818
3400.00 720 1120 1401 1579 1723 1842
3450.00 729 1135 1419 1599 1745 1867
3500.00 738 1149 1438 1620 1768 1891
3550.00 748 1164 1456 1641 1791 1915
3600.00 757 1179 1475 1662 1814 1940
3650.00 767 1194 1493 1683 1837 1964
3700.00 776 1208 1503 1702 1857 1987
3750.00 784 1221 1520 1721 1878 2009
3800.00 793 1234 1536 1740 1899 2031
3850.00 802 1248 1553 1759 1920 2053
3900.00 811 1261 1570 1778 1940 2075
3950.00 819 1275 1587 1797 1961 2097
4000.00 828 1288 1603 1816 1982 2119
4050.00 837 1302 1620 1835 2002 2141
4100.00 846 1315 1637 1854 2023 2163
4150.00 854 1329 1654 1873 2044 2185
4200.00 863 1342 1670 1892 2064 2207
4250.00 872 1355 1687 1911 2085 2229
4300.00 881 1369 1704 1930 2106 2251
4350.00 889 1382 1721 1949 2127 2273
4400.00 898 1396 1737 1968 2147 2295
4450.00 907 1409 1754 1987 2168 2317
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines
Worksheet ( 09/12)
Combined
Monthly
Available
Income One
Child Two
Children Three
Children Four
Children Five
Children Six
Children
4500.00 916 1423 1771 2006 2189 2339
4550.00 924 1436 1788 2024 2209 2361
4600.00 933 1450 1804 2043 2230 2384
4650.00 942 1463 1821 2062 2251 2406
4700.00 951 1477 1838 2081 2271 2428
4750.00 959 1490 1855 2100 2292 2450
4800.00 968 1503 1871 2119 2313 2472
4850.00 977 1517 1888 2138 2334 2494
4900.00 986 1530 1905 2157 2354 2516
4950.00 993 1542 1927 2174 2372 2535
5000.00 1000 1551 1939 2188 2387 2551
5050.00 1006 1561 1952 2202 2402 2567
5100.00 1013 1571 1964 2215 2417 2583
5150.00 1019 1580 1976 2229 2432 2599
5200.00 1025 1590 1988 2243 2447 2615
5250.00 1032 1599 2000 2256 2462 2631
5300.00 1038 1609 2012 2270 2477 2647
5350.00 1045 1619 2024 2283 2492 2663
5400.00 1051 1628 2037 2297 2507 2679
5450.00 1057 1638 2049 2311 2522 2695
5500.00 1064 1647 2061 2324 2537 2711
5550.00 1070 1657 2073 2338 2552 2727
5600.00 1077 1667 2085 2352 2567 2743
5650.00 1083 1676 2097 2365 2582 2759
5700.00 1089 1686 2109 2379 2597 2775
5750.00 1096 1695 2122 2393 2612 2791
5800.00 1102 1705 2134 2406 2627 2807
5850.00 1107 1713 2144 2418 2639 2820
5900.00 1111 1721 2155 2429 2651 2833
5950.00 1116 1729 2165 2440 2663 2847
6000.00 1121 1737 2175 2451 2676 2860
6050.00 1126 1746 2185 2462 2688 2874
6100.00 1131 1754 2196 2473 2700 2887
6150.00 1136 1762 2206 2484 2712 2900
6200.00 1141 1770 2216 2495 2724 2914
6250.00 1145 1778 2227 2506 2737 2927
6300.00 1150 1786 2237 2517 2749 2941
6350.00 1155 1795 2247 2529 2761 2954
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines
Worksheet ( 09/12)
Combined
Monthly
Available
Income One
Child Two
Children Three
Children Four
Children Five
Children Six
Children
6400.00 1160 1803 2258 2540 2773 2967
6450.00 1165 1811 2268 2551 2785 2981
6500.00 1170 1819 2278 2562 2798 2994
6550.00 1175 1827 2288 2573 2810 3008
6600.00 1179 1835 2299 2584 2822 3021
6650.00 1184 1843 2309 2595 2834 3034
6700.00 1189 1850 2317 2604 2845 3045
6750.00 1193 1856 2325 2613 2854 3055
6800.00 1196 1862 2332 2621 2863 3064
6850.00 1200 1868 2340 2630 2872 3074
6900.00 1204 1873 2347 2639 2882 3084
6950.00 1208 1879 2355 2647 2891 3094
7000.00 1212 1885 2362 2656 2900 3103
7050.00 1216 1891 2370 2664 2909 3113
7100.00 1220 1897 2378 2673 2919 3123
7150.00 1224 1903 2385 2681 2928 3133
7200.00 1228 1909 2393 2690 2937 3142
7250.00 1232 1915 2400 2698 2946 3152
7300.00 1235 1921 2408 2707 2956 3162
7350.00 1239 1927 2415 2716 2965 3172
7400.00 1243 1933 2423 2724 2974 3181
7450.00 1247 1939 2430 2733 2983 3191
7500.00 1251 1945 2438 2741 2993 3201
7550.00 1255 1951 2446 2750 3002 3211
7600.00 1259 1957 2453 2758 3011 3220
7650.00 1263 1963 2461 2767 3020 3230
7700.00 1267 1969 2468 2775 3030 3240
7750.00 1271 1975 2476 2784 3039 3250
7800.00 1274 1981 2483 2792 3048 3259
7850.00 1278 1987 2491 2801 3057 3269
7900.00 1282 1992 2498 2810 3067 3279
7950.00 1286 1998 2506 2818 3076 3289
8000.00 1290 2004 2513 2827 3085 3298
8050.00 1294 2010 2521 2835 3094 3308
8100.00 1298 2016 2529 2844 3104 3318
8150.00 1302 2022 2536 2852 3113 3328
8200.00 1306 2028 2544 2861 3122 3337
8250.00 1310 2034 2551 2869 3131 3347
Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines
Worksheet ( 09/12)
Combined
Monthly
Available
Income One
Child Two
Children Three
Children Four
Children Five
Children Six
Children
8300.00 1313 2040 2559 2878 3141 3357
8350.00 1317 2046 2566 2887 3150 3367
8400.00 1321 2052 2574 2895 3159 3376
8450.00 1325 2058 2581 2904 3168 3386
8500.00 1329 2064 2589 2912 3178 3396
8550.00 1333 2070 2597 2921 3187 3406
8600.00 1337 2076 2604 2929 3196 3415
8650.00 1341 2082 2612 2938 3205 3425
8700.00 1345 2088 2619 2946 3215 3435
8750.00 1349 2094 2627 2955 3224 3445
8800.00 1352 2100 2634 2963 3233 3454
8850.00 1356 2106 2642 2972 3242 3464
8900.00 1360 2111 2649 2981 3252 3474
8950.00 1364 2117 2657 2989 3261 3484
9000.00 1368 2123 2664 2998 3270 3493
9050.00 1372 2129 2672 3006 3279 3503
9100.00 1376 2135 2680 3015 3289 3513
9150.00 1380 2141 2687 3023 3298 3523
9200.00 1384 2147 2695 3032 3307 3532
9250.00 1388 2153 2702 3040 3316 3542
9300.00 1391 2159 2710 3049 3326 3552
9350.00 1395 2165 2717 3058 3335 3562
9400.00 1399 2171 2725 3066 3344 3571
9450.00 1403 2177 2732 3075 3353 3581
9500.00 1407 2183 2740 3083 3363 3591
9550.00 1411 2189 2748 3092 3372 3601
9600.00 1415 2195 2755 3100 3381 3610
9650.00 1419 2201 2763 3109 3390 3620
9700.00 1422 2206 2767 3115 3396 3628
9750.00 1425 2210 2772 3121 3402 3634
9800.00 1427 2213 2776 3126 3408 3641
9850.00 1430 2217 2781 3132 3414 3647
9900.00 1432 2221 2786 3137 3420 3653
9950.00 1435 2225 2791 3143 3426 3659
10000.00 1437 2228 2795 3148 3432 3666
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (09/12 )
IN THE CIRCUIT COURT OF THE
JUDICIAL CIRCUIT,
IN AND FOR
COUNTY, FLORIDA
Case No.:
Division:
,
Petitioner,
and
,
Respondent.
NOTICE OF FILING CHILD SUPPORT GUIDELINES WORKSHEET
PLEASE TAKE NOTICE, that {name} _______
, is filing his/her
Child Support Guidelines Worksheet attached and labeled Exhibit 1.
CERTIFICATE OF SERVICE
I certify that a copy of this Notice of Filing with the Child Support Guidelines Worksheet was
[ check all used ]: ( ) e-mailed ( ) mailed ( ) faxed ( ) hand delivered to the person(s) listed
below on {date} __________
.
Other party or his/her attorney:
Name: _____________________________
Address: ____________________________
City, State, Zip: _______________________
Fax Number: _________________________
E-mail Address(es): _____________________
Signature of Party or his/her Attorney
Printed Name: _________________________
Address: ____________________________
City, State, Zip: _______________________
Fax Number: _________________________
E-mail Address(es): _____________________
Florida Bar Number: ____________________
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (09/12 )
CHILD SUPPORT GUIDELINES WORKSHEET
A. FATHER
B. MOTHER
TOTAL
1. Present Net Monthly Income
Enter the amount from line 27, Section I of
Florida Family Law Rules of Procedure Form
12.902(b) or (c), Financial Affidavit.
2. Basic Monthly Obligation
There is (are) {number}_____ minor child(ren)
common to the parties.
Using the total amount from line 1, enter the
appropriate amount from the child support
guidelines chart.
3. Percent of Financial Responsibility
Divide the amount on line 1A by the total
amount on line 1 to get Father’s percentage of
financial responsibility. Enter answer on line 3A.
Divide the amount on line 1B by the total
amount on line 1 to get Mother’s percentage of
financial responsibility. Enter answer on line 3B.
% %
4. Share of Basic Monthly Obligation
Multiply the number on line 2 by the
percentage on line 3A to get Father’s share
of basic obligation. Enter answer on line 4A.
Multiply the number on line 2 by the
percentage on line 3B to get Mother’s share
of basic obligation. Enter answer on line 4B.
Additional Support — Health Insurance, Child Care & Other
5. a. 100% of Monthly Child Care Costs
[Child care costs should not exceed the level
required to provide quality care from a
licensed source. See section 61.30(7), Florida
Statutes, for more information.]
b. Total Monthly Child(ren)’ s Health Insurance
Cost
[This is only amounts actually paid for
health insurance on the child(ren).]
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (09/12 )
CHILD SUPPORT GUIDELINES WORKSHEET
A. FATHER
B. MOTHER
TOTAL
c. Total Monthly Child(ren)’s Noncovered
Medical, Dental and Prescription
Medication Costs
d. Total Monthly Child Care & Health Costs
[Add lines 5a + 5b +5c].
6. Additional Support Payments
Multiply the number on line 5d by the
percentage on line 3A to determine the Father’ s
share. Enter answer on line 6A. Multiply the
number on line 5d by the percentage on line 3B
to determine the Mother’s share.
Enter answer on line 6B.
Statutory Adjustments/Credits
7. a. Monthly child care payments actually made
b. Monthly health insurance payments actually ma de
c. Other payments/credits actually made for
any noncovered medical, dental and
prescription medication expenses of the
child(ren) not ordered to be separately paid
on a percentage basis.
(See section 61.30 (8), Florida Statutes)
8. Total Support Payments actually made
(Add 7a though 7c)
9. MINIMUM CHILD SUPPORT OBLIGATION FOR
EACH PARENT
[Line 4 plus line 6; minus line 8]
Substantial Time-Sharing (GROSS UP METHOD) If each parent exercises time-sharing at least 20
percent of the overnights in the year (73 overnights in the ye ar), complete Nos. 10 through 21
A. FATHER B. MOTHER TOTAL
10. Basic Monthly Obligation x 150%
[Multiply line 2 by 1.5]
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (09/12 )
CHILD SUPPORT GUIDELINES WORKSHEET
A. FATHER
B. MOTHER
TOTAL
11. Increased Basic Obligation for each parent.
Multiply the number on line 10 by the
percentage on line 3A to determine the
Father’s share. Enter answer on line 11A.
Multiply the number on line 10 by the
percentage on line 3B to determine the
Mother’s share. Enter answer on line 11B.
12. Percentage of overnight stays with each parent.
The child(ren) spend(s) ______overnight stays
with the Father each year. Using the number
on the above line, multiply it by 100 and divide
by 365. Enter this number on line 12A.
The child(ren) spend(s) _____ overnight stays
with the Mother each year. Using the number
on the above line, multiply it by 100 and divide
by 365. Enter this number on line 12B.
%
%
13. Parent’s support multiplied by other Parent’s
percentage of overnights.
[Multiply line 11A by line 12B. Enter this
number in 13A. Multiply line 11B by line 12A.
Enter this number in 13B.]
Additional Support — Health Insurance, Child Care & Other 14. a. Total Monthly Child Care Costs
[Child care costs should not exceed the level
required to provide quality care from a
licensed source. See section 61.30(7),
Florida Statutes, for more information.]
b. Total Monthly Child(ren)’s Health Insurance
Cost
[This is only amounts actually paid for hea lth
insurance on the child(ren).]
c. Total Monthly Child(ren)’s Noncovered
Medical, Dental and Prescription
Medication Costs.
d. Total Monthly Child Care & Health Costs
[Add lines 14a + 14b + 14c.]
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (09/12 )
CHILD SUPPORT GUIDELINES WORKSHEET
A. FATHER
B. MOTHER
TOTAL
15. Additional Support Payments.
Multiply the number on line 14d by the
percentage on line 3A to determine the
Father’s share. Enter answer on line 15A.
Multiply the number on line 14d by the
percentage on line 3B to determine the
Mother’s share. Enter answer on line 15B.
Statutory Adjustments/Credits
16. a. Monthly child care payments actually
made
b. Monthly health insurance payments
actually made
c. Other payments/credits actually made
for any noncovered medical, dental and
prescription medication expenses of the
child(ren) not ordered to be separately
paid on a percentage basis.
[See section 61.30(8), Florida Statutes]
17. Total Support Payments actually made
[Add 16a though 16c]
18. Total Additional Support Transfer Amount
[Line 15 minus line 17; enter any negative
number as zero)
19. Total Child Support Owed from Father to
Mother [Add line 13A plus line 18A]
20. Total Child Support Owed from Mother to
Father [Add line 13B plus line 18B]
21. Actual Child Support to Be Paid.
[Comparing lines 19 and 20, Subtract the
smaller amount owed from the larger amount
owed and enter the result in the column for
the parent that owes the larger amount of
support]
$
ADJUSTMENTS TO GUIDELINES AMOUNT. If you or the other parent is requesting the Court to award a
child support amount that is more or less than the child support guidelines, you mu st complete and file
Motion to Deviate from Child Support Guidelines, Florida Supreme Court App roved Family Law Form
12.943.
Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (09/12 )
[check
one only]
a. ____ Deviation from the guidelines amount is requested. The Motion to Deviate from Child
Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is at tached.
b. ____ Deviation from the guidelines amount is NOT requested. The Motion to Deviate from
Child Support Guidelines, Florida Supreme Court Approved Family Law Form 1 2.943, is not
attached.
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) Petitioner ( ) Respondent
This form was completed with the assistance of:
{name of individual}
,
{name of business} _________________________________________________________________,
{address} ____________________________________________________________________
,
{city} _______
______________, {state} ,______ {telephone number} ________________________ .
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