Request For Income Review Form - 2013
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1REQUEST FOR INCOME REVIEW
YOUR NAME: _________________ _______________________ PHONE #: __________________
FIRST
LAST
YOUR ADDRESS: _________________________________________________________________
STREET
CITY
STATE
ZIP
CASE/DOCKET #: _________________ OTHER PARTY’S NAME: _________________________
YOUR GROSS INCOME: $_____________/week $_______________/month $_____________/year
Please first consider the following:
Do you need an adjustment in your withholding order on your pay check rather than a review of the child support order?
o
If so, contact your case manager.
A support review can result in a recommendation for an increase, decrease, or no change to the current support
o
obligation. A program used for calculating child support recommendations is available on the computer in our lobby or at
Please note the results you calculate may differ from our recommendations.
If you request the review and fail to return the requested information within 14 days, your review may be terminated.
o
IT HAS BEEN MORE THAN THREE YEARS SINCE MY LAST REVIEW/MODIFICATION
AND MY CASE HAS A CURRENT SUPPORT CHARGE (NOT ARREARS ONLY).
If the above box ↑ is checked, then you do not need to complete the remainder of the form.
If you are unsure of the date of your last review then you must complete the below box. ↓
IT HAS BEEN LESS THAN THREE YEARS SINCE MY LAST REVIEW
AND MY CIRCUMSTANCES HAVE SIGNIFICANTLY CHANGED.
AND
I HAVE ATTACHED EVIDENCE OF THE SIGNIFICANT CHANGE.
Please note if you have not attached evidence of the significant change and Friend of the Court is unable to
verify a significant change, your request may not be processed.
What is the significant change in circumstance since your last order?
A significant increase/decrease in income such as job loss or large change in pay
Explain: __________________________________________________________
A change in custody
Explain: __________________________________________________________
Application for or receipt of public assistance
Explain: __________________________________________________________
Health care coverage becoming newly available to a party
Explain: __________________________________________________________
Other: ___________________________________________________________
____________________________________________________________________
Examples of changes that do NOT qualify include:
•
The custodial parent’s income has changed (unless it is a substantial change)
•
Your bills/expenses have increased
•
A minor increase/decrease in the number of overnights
If Friend of the Court denies your request for a review you may choose to file a motion with the court and ask for a
review. If you need assistance in doing this, please contact an attorney or the Legal Assistance Center (LAC) at 180
th
th
Ottawa Ave NW, 5
Floor of the 17
Circuit Court. Please note the LAC is closed on Mondays.
SIGN HERE: ____________________________________________ DATE: ___________________
Calculations use the Michigan Child Support Formula, which can be found at:
June 2013
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