Fill and Sign the New Jersey Workers Compensation 497319386 Form

SUPPLEMENTARY WORKSHEET #      Name of Obligor             Obligor's Social Security Number       NET AWARD $       Total Obligation (same as on Primary Worksheet) = TO =       New Total Arrears (NTA) = arrears after payment, from preceding worksheet       NTA/TO=             New Number of Weeks of Arrears =                         Maximum payable = $       New Total Arrears = $       Amount to be paid ( the smaller of the two amounts ) = $       Net Arrears After Payment = $       TO CALCULATE AMOUNT TO BE PAID TO PROBATION WHEN MORE THAN ONE QUALIFYING AWARD IS MADE THE SAME DAY Date/ = If the obligor is currently supporting a child or spouse not under a court order, and if the New Number of Weeks of Arrears above is 12 or less, the maximum payable to probation is 50 percent of the net award. If the obligor is currently supporting a child or spouse not under a court order, and if the New Number of Weeks of Arrears above is more than 12, the maximum payable to probation is 55 percent of the net award. If the obligor is not currently supporting a child or spouse not under a court order, and if the New Number of Weeks of Arrears above is 12 or less, the maximum payable to probation is 60 percent of the net award. If the obligor is not currently supporting a child or spouse not under a court order, and if the New Number of Weeks of Arrears above is more than 12, the maximum payable to probation is 65 percent of the net award. Calculate the maximum payable to Probation by taking the appropriate percentage ( 50, 55, 60 or 65 percent, determined above) of the NET AWARD. For example, if the percentage is 50 percent and the NET AWARD is $5,000, the maximum payable would be (.50) x ($5,000) or $2,500. x $ = $ = Maximum payable . The amount to be paid to Probation is the smaller of the maximum payable amount and the NET AWARD. For example, if the maximum payable is $2,500 and the total arrears are $1,500, only $1,500 must be paid.