Worksheet A - Child Support Obligation: Sole Physical Care Page 2
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1
2e. Extraordinary Expenses - Agreed to by parents or by order of
$
$
the Court pursuant to §14-10-115(11)(a), C.R.S.
f. Minus Extraordinary Adjustments pursuant to §14-10-115(11)(b),
$
$
C.R.S.
7. Total Adjustments
$
$
$
(For each column, add 6a, 6b, 6c, 6d and
6e. Subtract line 6f then add two totals for Combined column
amount
)
8. Each Parent’s Fair Share of Adjustments
$
$
(Line 7
Combined column times line 3 for each parent)
$
$
9. Each Parent’s Share of Total Child Support
Obligation
(Add lines 4b (or line 5 if less) and line 8 for each
parent)
10. Paying Parent’s Adjustment
$
$
(Enter line 7 for parent
with less parenting time only)
11. Recommended Child Support Order
$
$
(Subtract line 10
from line 9 for the paying parent only.
Leave receiving parent
column blank)
Comments:
*The children reside with one parent for 273 or more overnights per year. If this is not the case, use Worksheet B.
**
This adjustment applies only to modification of child support orders entered between 7/1/91 and 7/1/97 that provide
for post-secondary education expenses pursuant to § 14-10-115(15)(c), C.R.S.
Prepared by:
Date:
Signature: ________________________________Print Name: ___________________________
Low-Income Adjustment Worksheet
I
f the parents’ combined monthly adjusted gross income is more than $850.00 and the monthly adjusted gross income
of the parent with fewer overnights per year is less than $1850.00, use this calculation worksheet to determine the
adjustment allowed for that parent.
Low-income Adjustment Calculation
Adjusted monthly gross income of parent with fewer overnights (paying parent) from line 2
$
minus $900.00 = $
times 40% (.40) =
$
Plus one of the following, according to number of children
1 child = $75.00
2 children = $150.00
3 children = $225.00
4 children = $275.00
5 children = $325.00
6 or more children = $350.00
+
$
Low-income adjustment amount (#5 on worksheet)
$
If this amount is less than the amount on line 4b (on page 1) for the parent with fewer overnights per year, this parent
qualifies for the Low-income Adjustment. Enter this amount on line 5 in that parent’s column on page 1. If this
number is a negative or zero, enter zero.
Heath Insurance Premium Calculation
If the actual amount of the health insurance premium that is attributable to the child(ren) who are the subject of
this order is not available or cannot be verified, the total cost of the premium should be divided by the number of
persons covered by the policy to determine a per person cost. This amount is then multiplied by the number of
children who are the subject of this order and are covered by the policy. This amount is then entered on line 6c on
page 1 of this form.
$
÷
= $
x
=
otal
Number of
Per Person Cost
Number of
Children’s Portion of
T
Premium
Persons Covered
Children Who
Cost of Health
by the Policy
Are the Subject
Insurance Premium
of this Order
(Enter on line 6c)
JDF 1820M R1/08 WORKSHEET A – CHILD SUPPORT OBLIGATION: SOLE PHYSICAL CARE
Page 2 of 2
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