Fillable Child Support Guidelines Sole Parenting Worksheet - Rule Appendix IX-C (NJ Judiciary)

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Child Support Guidelines Sole Parenting Worksheet - Rule Appendix IX-C (NJ Judiciary)

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Amended July 30, 2021 to be effective September 1, 2021, CN 10788 page 1 of 2
Appendix IX-C
Child Support Guidelines - Sole Parenting Worksheet
Case Name:
v.
County:
Plaintiff
Defendant
Docket #:
Custodial Parent is the: ☐ Plaintiff ☐ Defendant
Number of Children:
All amounts must be weekly
Custodial
Combined
1. Gross Taxable Income
$
1a. Mandatory Retirement Contributions (non-taxable)
-$
1b. Tax-Deductible Alimony Paid (Current and/or Past Relationships)
-$
1c. Taxable Alimony Received (Current and/or Past Relationships)
+$
2. Adjusted Gross Taxable Income ((L1 - L1a - L1b) + L1c)
$
2a. Federal, State and Local Income Tax Withholding
-$
2b. Mandatory Union Dues
-$
2c. Child Support Orders for Other Dependents
-$
2d. Other Dependent Deduction (from L14 of a separate worksheet)
-$
3. Net Taxable Income (L2 - L2a - L2b - L2c - L2d)
$
4. Non-Taxable Income
(source: )
+$
4a. Non-Tax-Deductible Alimony Paid (Current and/or Past Relationships)
-$
4b. Non-Taxable Alimony Received (Current and/or Past Relationships)
+$
5. Government (Non-Means Tested) Benefits for the Child
+$
6. Net Income (L3 + L4 + L5)
$
$
7. Each Parent’s Share of Income (L6 Each Parent ÷ L6 Combined)
0.
1.00
8. Basic Child Support Amount (from Appendix IX-F Schedules)
$
9. Net Work Related Child Care (from Appendix IX-E Worksheet)
+$
10. Child's Share of Health Insurance Premium
+$
11. Unreimbursed Health Care Expenses over $250 per child per year
+$
12. Court-Approved Extraordinary Expenses
+$
13. Total Child Support Amount (L8 + L9 + L10 + L11 + L12)
$
14. Each Parent's Share of Support Obligation (L7 x L13)
$
15. Government Benefits for the Child Based on Contribution of NCP
16. Net Work-Related Child Care Paid
17. Health Insurance Premium for the Child Paid
18. Unreimbursed Health Care Expenses Paid (>$250/child/year)
19. Court-Approved Extraordinary Expenses Paid
20. Adjustment for Parenting Time Expenses (L8 x L20b for Non-Custodial
Parent x 0.37)
Note: Not presumptive in some low income situations (see App IX-A., ¶13)
20a. Number of Annual Overnights with Each Parent
20b. Each Parent’s Share of Overnights with the Child (L20a for Parent ÷
L20a Combined)
0.
1.00
21. Net Child Support Obligation (L14 - L15 - L16 - L17 - L18 - L19 - L20)
Continued on Page 2
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Amended July 30, 2021 to be effective September 1, 2021, CN 10788 page 2 of 2
Child Support Guidelines – Sole Parenting Worksheet – Page 2
If there is no adjustment for other dependents, go to line 25
22. Child Support Order WITH Other Dependent Deduction (L2d)
and Child Support Orders for Other Dependents (L2c)
$
23. Child Support Order WITHOUT Other Dependent Deduction
and Child Support Orders for Other Dependents
$
24. Adjusted Child Support Order ((L22 + L23) ÷ 2)
$
25. Self-Support Reserve Test: (L6 - L21 or L24 for NCP; L6 - L14
for CP) If L25 for NCP is greater than 150% of the federal
poverty guideline for one-person (pg) L25 for CP is less than
pg, enter L21 or L24 amount on L27. If NCP L25 is less than
the pg and CP L25 is greater than the pg, go to L26.
$
$
26. Obligor Parent's Maximum Child Support Obligation. (L6 NCP
income - 150% of federal poverty guideline for one person).
Enter result here and on Line 27.
$
27. Child Support Order
$
Comments, Rebuttals, and Justification for Deviations
1. This child support order for this case ☐ was ☐ was not based on the child support guidelines award.
2. If different from the child support guidelines award (Line 27), enter amount ordered:
3. The child support guidelines were not used, or the guidelines award was adjusted because:
4. The following court-approved extraordinary expenses were added to the basic support obligation:
5. Custodial Taxes:
☐ App IX-H
☐ Circ E
☐ Other
# Eligible Dependents:
Marital:
Non-Custodial Taxes:
☐ App IX-H
☐ Circ E
☐ Other
# Eligible Dependents:
Marital:
Prepared By:
Title:
Date:
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Child Support Guidelines Sole Parenting Worksheet - Rule Appendix IX-C (NJ Judiciary)

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Completed 21 January 2022

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