Fill and Sign the Nj Workers Compensation Form

NET AWARD $      Name of Obligor             Obligor's Social Security Number       Is the Obligor supporting a child or spouse not under court order (yes or no)       Child Support Case Numbers       Current Obligations ($)       Obligation Frequencies (Weekly, Biweekly, Semi-monthly or Monthly)       Weekly Obligations ($) (calculate each)       Current Arrears ($) (from Glink)       Total Obligation (add the Weekly Obligations above) = TO =       Total Arrears (add the Current Arrears above) = TA =       TA/TO=             Number of Weeks of Arrears =                         Maximum payable = MP = $       Total Arrears = TA = $       Amount to be paid to Probation ( the smaller of the two amounts) = AP = $       New Total Arrears after the payment = TA minus (AP) = $       PRIMARY WORKSHEET # I - TO CALCULATE THE AMOUNT TO BE PAID TO PROBATION FROM A QUALIFYING NET AWARD Date / - If the obligor is currently supporting a child or spouse not under a court order, and if the Number of Weeks of Arrears above is 12 or less, the maximum payable to probation is 50 per cent of the net award. If the obligor is currently supporting a child or spouse not under a court order, and if the 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 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 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 55 percent and the Net Award is $10,000, the maximum payable would be (.55) x ($ 10,000) or $5,500. x $ = $ = Maximum Payable The amount to be paid to Probation is the smaller of the maximum payable amount and the Total Arrears, For example, if the maximum payable is $5,500 and the total arrears are $7,000, only $5,500 must be paid.