Child Support Summary Form (Page 2 of 2) in pdf

Child Support Summary Form Page 2

UCS-111 (rev:08/11)

NEW YORK STATE UNIFIED COURT SYSTEM

SUPPORT SUMMARY FORM: FAMILY & SUPREME COURT

INSTRUCTION SHEET

Prepare one report for each proposed judgment or final order granted pursuant to Article 4 or 5 of the Family Court Act and

DRL §240 and §236 B(9)(b) which includes a provision for child support (including modification of order).

SUBMIT COMPLETED FORM TO:

Office of Court Administration

Office of Court Research

25 Beaver Street, Room 975

New York, New York 10004

GENERAL INSTRUCTIONS:

ALL ITEMS MUST BE ANSWERED

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If a number or amount in dollars is required and the answer is none, write 0.

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If a certain item is not applicable, write NA.

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If the information is unknown or not known to the party filling out the form, write UK.

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“mm/dd/yy” means “month/day/year”.

SPECIAL INSTRUCTIONS FOR PARTICULAR ITEMS:

Use gross income figures from the last complete calendar year. Do not include maintenance or child support as income.

If the child support award is calculated weekly, multiply it by 52 for the annual amount; if biweekly, multiply it by 26,

if monthly, multiply it by 12.

If the maintenance award is calculated weekly, multiply it by 52 for the annual amount; if biweekly, multiply it by 26;

if monthly, multiply it by 12. If the maintenance award calls for decreasing or increasing amounts (for example, a

certain amount for five years and half that amount for another three years), then provide the average of the awards (total

amount for all years divided by the number of years).

NOTE:

THIS INFORMATION IS CONFIDENTIAL AND WILL BE USED FOR STATISTICAL PURPOSES ONLY.

IT WILL NOT BE RETAINED IN THE CASE FILE.

Child Support Summary Form Page 2