BASIC FINANCIAL INFORMATION FOR CHILD SUPPORT GUIDELINES WORKSHEET
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.902(e), CHILD SUPPORT GUIDELINES WORKSHEET (01/11) When should this form be used?

You should complete this worksheet if child support is being requested in your case.  If you know the income of the other party, this worksheet should accompany your financial affidavit.  If you do not know the other party’s income, this form must be completed after the other party files his or her financial affidavit, and serves a copy on you.

This form should be typed or printed in black ink.  You should file the original with the clerk of the circuit court in the county where your case is filed and keep a copy for your records.

What should I do next?

A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found at the beginning of these forms.  The words that are in bold underline in these instructions are defined there.  For further information, see section 61.30, Florida Statutes.

Special notes...

If this is a domestic violence case and you want to keep your address confidential for safety reasons, do not enter the address, telephone, and fax information at the bottom of this form.  Instead, file Petitioner’s Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).

The chart below contains the guideline amounts that you should use when calculating child support.  This amount is based on the number of children and the combined income of the parents, and it is divided between the parents in direct proportion to their income or earning capacity.  From time to time, some of the amounts in the child support guidelines chart will change.  Be sure you have the most recent version of the chart before using it.
Because the guidelines are based on monthly amounts, it may be necessary to convert some income and expense figures from other frequencies to monthly.  You should do this as follows:

If payment is twice per month  Payment amount  x  2  = Monthly amount

If payment is every two weeks  Payment amount   x   26    =    Yearly amount due
Yearly amount  ÷  12  =  Monthly amount

If payment is weekly Weekly amount  x   52    =   Yearly amount due
Yearly amount ÷ 12  =  Monthly amount

If you or the other parent request that the court award an amount that is different than the guideline amount, you must also complete and attach a Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943.

Remember, a person who is NOT an attorney is called a nonlawyer.  If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you.  A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.

CHILD SUPPORT GUIDELINES CHART

Combined
Monthly
Available
Income

One
Child

Two
Children

Three
Children

Four
Children

Five
Children

Six
Children

800.00

190

211

213

216

218

220

850.00

202

257

259

262

265

268

900.00

213

302

305

309

312

315

950.00

224

347

351

355

359

363

1000.00

235

365

397

402

406

410

1050.00

246

382

443

448

453

458

1100.00

258

400

489

495

500

505

1150.00

269

417

522

541

547

553

1200.00

280

435

544

588

594

600

1250.00

290

451

565

634

641

648

1300.00

300

467

584

659

688

695

1350.00

310

482

603

681

735

743

1400.00

320

498

623

702

765

790

1450.00

330

513

642

724

789

838

1500.00

340

529

662

746

813

869

1550.00

350

544

681

768

836

895

1600.00

360

560

701

790

860

920

1650.00

370

575

720

812

884

945

1700.00

380

591

740

833

907

971

1750.00

390

606

759

855

931

996

1800.00

400

622

779

877

955

1022

1850.00

410

638

798

900

979

1048

1900.00

421

654

818

923

1004

1074

1950.00

431

670

839

946

1029

1101

2000.00

442

686

859

968

1054

1128

2050.00

452

702

879

991

1079

1154

2100.00

463

718

899

1014

1104

1181

2150.00

473

734

919

1037

1129

1207

2200.00

484

751

940

1060

1154

1234

2250.00

494

767

960

1082

1179

1261

2300.00

505

783

980

1105

1204

1287

2350.00

515

799

1000

1128

1229

1314

2400.00

526

815

1020

1151

1254

1340

2450.00

536

831

1041

1174

1279

1367

2500.00

547

847

1061

1196

1304

1394

2550.00

557

864

1081

1219

1329

1420

2850.00

616

956

1197

1349

1471

1573

2900.00

626

971

1215

1370

1494

1598

2950.00

635

986

1234

1391

1517

1622

3000.00

644

1001

1252

1412

1540

1647

3050.00

654

1016

1271

1433

1563

1671

3100.00

663

1031

1289

1453

1586

1695

3150.00

673

1045

1308

1474

1608

1720

3200.00

682

1060

1327

1495

1631

1744

3250.00

691

1075

1345

1516

1654

1769

3300.00

701

1090

1364

1537

1677

1793

3350.00

710

1105

1382

1558

1700

1818

3400.00

720

1120

1401

1579

1723

1842

3450.00

729

1135

1419

1599

1745

1867

3500.00

738

1149

1438

1620

1768

1891

3550.00

748

1164

1456

1641

1791

1915

3600.00

757

1179

1475

1662

1814

1940

3650.00

767

1194

1493

1683

1837

1964

3700.00

776

1208

1503

1702

1857

1987

3750.00

784

1221

1520

1721

1878

2009

3800.00

793

1234

1536

1740

1899

2031

3850.00

802

1248

1553

1759

1920

2053

3900.00

811

1261

1570

1778

1940

2075

3950.00

819

1275

1587

1797

1961

2097

4000.00

828

1288

1603

1816

1982

2119

4050.00

837

1302

1620

1835

2002

2141

4100.00

846

1315

1637

1854

2023

2163

4150.00

854

1329

1654

1873

2044

2185

4200.00

863

1342

1670

1892

2064

2207

4250.00

872

1355

1687

1911

2085

2229

4300.00

881

1369

1704

1930

2106

2251

4350.00

889

1382

1721

1949

2127

2273

4400.00

898

1396

1737

1968

2147

2295

4450.00

907

1409

1754

1987

2168

2317

4500.00

916

1423

1771

2006

2189

2339

4550.00

924

1436

1788

2024

2209

2361

4600.00

933

1450

1804

2043

2230

2384

4650.00

942

1463

1821

2062

2251

2406

4700.00

951

1477

1838

2081

2271

2428

4750.00

959

1490

1855

2100

2292

2450

4800.00

968

1503

1871

2119

2313

2472

4850.00

977

1517

1888

2138

2334

2494

4900.00

986

1530

1905

2157

2354

2516

4950.00

993

1542

1927

2174

2372

2535

5000.00

1000

1551

1939

2188

2387

2551

5050.00

1006

1561

1952

2202

2402

2567

5100.00

1013

1571

1964

2215

2417

2583

5150.00

1019

1580

1976

2229

2432

2599

5200.00

1025

1590

1988

2243

2447

2615

5250.00

1032

1599

2000

2256

2462

2631

5300.00

1038

1609

2012

2270

2477

2647

5350.00

1045

1619

2024

2283

2492

2663

5400.00

1051

1628

2037

2297

2507

2679

5450.00

1057

1638

2049

2311

2522

2695

5500.00

1064

1647

2061

2324

2537

2711

5550.00

1070

1657

2073

2338

2552

2727

5600.00

1077

1667

2085

2352

2567

2743

5650.00

1083

1676

2097

2365

2582

2759

5700.00

1089

1686

2109

2379

2597

2775

5750.00

1096

1695

2122

2393

2612

2791

5800.00

1102

1705

2134

2406

2627

2807

5850.00

1107

1713

2144

2418

2639

2820

5900.00

1111

1721

2155

2429

2651

2833

5950.00

1116

1729

2165

2440

2663

2847

6000.00

1121

1737

2175

2451

2676

2860

6050.00

1126

1746

2185

2462

2688

2874

6100.00

1131

1754

2196

2473

2700

2887

6150.00

1136

1762

2206

2484

2712

2900

6200.00

1141

1770

2216

2495

2724

2914

6250.00

1145

1778

2227

2506

2737

2927

6300.00

1150

1786

2237

2517

2749

2941

6350.00

1155

1795

2247

2529

2761

2954

6400.00

1160

1803

2258

2540

2773

2967

6450.00

1165

1811

2268

2551

2785

2981

6500.00

1170

1819

2278

2562

2798

2994

6550.00

1175

1827

2288

2573

2810

3008

6600.00

1179

1835

2299

2584

2822

3021

6650.00

1184

1843

2309

2595

2834

3034

6700.00

1189

1850

2317

2604

2845

3045

6750.00

1193

1856

2325

2613

2854

3055

6800.00

1196

1862

2332

2621

2863

3064

6850.00

1200

1868

2340

2630

2872

3074

6900.00

1204

1873

2347

2639

2882

3084

6950.00

1208

1879

2355

2647

2891

3094

7000.00

1212

1885

2362

2656

2900

3103

7050.00

1216

1891

2370

2664

2909

3113

7100.00

1220

1897

2378

2673

2919

3123

7150.00

1224

1903

2385

2681

2928

3133

7200.00

1228

1909

2393

2690

2937

3142

7250.00

1232

1915

2400

2698

2946

3152

7300.00

1235

1921

2408

2707

2956

3162

7350.00

1239

1927

2415

2716

2965

3172

7400.00

1243

1933

2423

2724

2974

3181

7450.00

1247

1939

2430

2733

2983

3191

7500.00

1251

1945

2438

2741

2993

3201

7550.00

1255

1951

2446

2750

3002

3211

7600.00

1259

1957

2453

2758

3011

3220

7650.00

1263

1963

2461

2767

3020

3230

7700.00

1267

1969

2468

2775

3030

3240

7750.00

1271

1975

2476

2784

3039

3250

7800.00

1274

1981

2483

2792

3048

3259

7850.00

1278

1987

2491

2801

3057

3269

7900.00

1282

1992

2498

2810

3067

3279

7950.00

1286

1998

2506

2818

3076

3289

8000.00

1290

2004

2513

2827

3085

3298

8050.00

1294

2010

2521

2835

3094

3308

8100.00

1298

2016

2529

2844

3104

3318

8150.00

1302

2022

2536

2852

3113

3328

8200.00

1306

2028

2544

2861

3122

3337

8250.00

1310

2034

2551

2869

3131

3347

8300.00

1313

2040

2559

2878

3141

3357

8350.00

1317

2046

2566

2887

3150

3367

8400.00

1321

2052

2574

2895

3159

3376

8450.00

1325

2058

2581

2904

3168

3386

8500.00

1329

2064

2589

2912

3178

3396

8550.00

1333

2070

2597

2921

3187

3406

8600.00

1337

2076

2604

2929

3196

3415

8650.00

1341

2082

2612

2938

3205

3425

8700.00

1345

2088

2619

2946

3215

3435

8750.00

1349

2094

2627

2955

3224

3445

8800.00

1352

2100

2634

2963

3233

3454

8850.00

1356

2106

2642

2972

3242

3464

8900.00

1360

2111

2649

2981

3252

3474

8950.00

1364

2117

2657

2989

3261

3484

9000.00

1368

2123

2664

2998

3270

3493

9050.00

1372

2129

2672

3006

3279

3503

9100.00

1376

2135

2680

3015

3289

3513

9150.00

1380

2141

2687

3023

3298

3523

9200.00

1384

2147

2695

3032

3307

3532

9250.00

1388

2153

2702

3040

3316

3542

9300.00

1391

2159

2710

3049

3326

3552

9350.00

1395

2165

2717

3058

3335

3562

9400.00

1399

2171

2725

3066

3344

3571

9450.00

1403

2177

2732

3075

3353

3581

9500.00

1407

2183

2740

3083

3363

3591

9550.00

1411

2189

2748

3092

3372

3601

9600.00

1415

2195

2755

3100

3381

3610

9650.00

1419

2201

2763

3109

3390

3620

9700.00

1422

2206

2767

3115

3396

3628

9750.00

1425

2210

2772

3121

3402

3634

9800.00

1427

2213

2776

3126

3408

3641

9850.00

1430

2217

2781

3132

3414

3647

9900.00

1432

2221

2786

3137

3420

3653

9950.00

1435

2225

2791

3143

3426

3659

10000.00

1437

2228

2795

3148

3432

3666

Your full legal name:
I am the:

Your Information:
Address:
City, state, zip:
Phone (area code and number):
Fax (area code and number):

You are required to give notice of this Filing and a copy of the Child Support Guidelines Worksheet to the other party.
I, , certify that a copy of this Notice of Filing with the Child Support Guidelines Worksheet was

on {date}

to:
Notice was sent to
Other Party's Information:
This is the address for serving notice to the other party. If the other party's attorney receives the notice, put the attorney's contact information here. Otherwise, put the other party's contact information here.

Attorney (if known):
Address:
City, state, zip:
Fax (area code and number):



IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR  COUNTY, FLORIDA

,
,
,
Petitioner,

and

.
Respondent.


Present Net Monthly Income Enter your Net Income (from line number 27, Section I of Florida Family Law Rules of Procedure Form 12.902(b) or (c), Financial Affidavit).
Father: $
Mother: $
Total Net Income: $ 0.00

Basic Monthly Obligation

There is (are) {number}  minor child(ren) common to the parties. 
Using the total Net income above, find the appropriate amount from the child support guidelines chart. (under the "guidelines" tab on this page) and enter it here:
Basic monthly obligation: $





Percent of Financial Responsibility

This is your percentage of financial responsibility based on your net income (your net income divided by the total net income available).
Father: 0.00 %
Mother: 0.00 %

Share of Basic Monthly Obligation

This is your share of the basic monthly child support obligation based on your percentage of financial responsibilty
Father's share: $ 0.00
Mother's share: $ 0.00

Additional Support — Health Insurance, Child Care & Other

Total Monthly Child Care Costs
[Child care costs should not exceed the level required to provide quality care from a licensed source.  See section 61.30(7), Fla. Stat. for more information.]
$

Total Monthly Child(ren)’s Health Insurance Cost
[This is only amounts actually paid for health insurance on the child(ren).]
$

Total Monthly Child(ren)’s Noncovered Medical, Dental and Prescription Medication Costs
$





Total Monthly Child Care & Health Costs
$ 0.00

Statutory Adjustments/Credits Additional Support Payments

Monthly child care payments actually made
Father: $
Mother: $
Total: $ 0.00

Monthly health insurance payments actually made
Father: $
Mother: $
Total: $ 0.00

Other payments/credits actually made for any noncovered medical, dental and prescription medication expenses of the child(ren) not ordered to be separately paid on a percentage basis. [See § 61.30 (8), Florida Statutes]
Father: $
Mother: $
Total: $ 0.00

Total Support Payments actually made
[add childcare and healthcare payments]
Father: $ 0.00
Mother: $ 0.00
Total: $ 0.00

Your share of the additional childcare and healthcare costs:
Father's share of child care and medical costs: $ 0.00
Mother's share of child care and medical costs: $ 0.00

MINIMUM CHILD SUPPORT OBLIGATION FOR EACH PARENT [Basic Child Support required, plus childcare and health costs, minus amounts already paid]
Father: $ 0.00
Mother: $ 0.00
Total: $ 0.00

Substantial Time-Sharing (GROSS UP METHOD)
Complete this section if each parent exercises time-sharing at least 20 percent of the overnights in the year (73 overnights in the year)

Increased Basic Monthly Obligation [Total Basic Monthly Obligation multiplied by 1.5]
$ 0.00

Increased Basic Obligation for each parent
Multiply the increased basic obligation above by your percentage of financial responsibility
Father: $ 0.00
Mother: $ 0.00

Percentage of overnight stays with each parent
The child(ren) spend(s)  overnight stays with the father each year. 
Percentage of overnight stays with the father: 0.00 %

The child(ren) spend(s)  overnight stays with the mother each year. 
Percentage of overnight stays with the mother: 0.00  %

Your support share (increased support amount multiplied by the other parent's over night percentage)

Father's support: $ 0.00

Mother's support: $ 0.00

Statutory Adjustments/Credits
Total Additional Support Transfer Amount [Your share minus expenses being paid]
Father: $ 0.00
Mother: $ 0.00

Parents using the Time Sharing Gross Up Method Total child support owed to each other [Your share plus the transfer amount]
Father to Mother: $ 0.00
Mother to Father: $ 0.00

Actual Child Support to Be Paid Under Time Sharing Method
[Comparing what the father and mother owe above, subtract the smaller amount owed from the larger amount owed and enter the result in the column for the parent that owes the larger amount of support]
Father: $ 0
Mother: $ 0



IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks]

{full legal name of Non-Lawyer}
Street:
City:
State:
Phone:

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