FL-630
PETITIONER/PLAINTIFF:
RESPONDENT/DEFENDANT:
OTHER PARENT/PARTY:
CASE NUMBER:
(3)
Any support ordered will continue until further order of court, unless terminated by operation of law.
(4)
6.
(5)
The parent ordered to pay support must pay child support for the past periods and in the amounts set forth below:
Name of child Date of birth Period of support Amount
d.
Page 2 of 3
FL-630 [Rev. January 1, 2017]
JUDGMENT REGARDING PARENTAL OBLIGATIONS
(Governmental)
(1)b.
c.
The parent ordered to pay support
The parent receiving support must (1) provide and maintain health insurance
(2)
coverage for the children if available at no or reasonable cost and keep the local child support agency informed of the
availability of the coverage (the cost is presumed to be reasonable if it does not exceed 5 percent of gross income to add
a child); (2) if health insurance is not available, provide coverage when it becomes available; (3) within 20 days of the
local child support agency’s request, complete and return a health insurance form; (4) provide to the local child support
agency all information and forms necessary to obtain health-care services for the children; (5) present any claim to secure
payment or reimbursement to the other parent or caretaker who incurs costs for health-care services for the children; and
(6) assign any rights to reimbursement to the other parent or caretaker who incurs costs for health-care services for the
children. The parent ordered to provide health insurance must seek continuation of coverage for the child after the child
attains the age when the child is no longer considered eligible for coverage as a dependent under the insurance contract,
if the child is incapable of self-sustaining employment because of a physically or mentally disabling injury, illness, or
condition and is chiefly dependent upon the parent providing health insurance for support and maintenance.
When a person who has been ordered to pay child support is in jail or prison or is involuntarily institutionalized for any
period of more than 90 days in a row, the child support order is temporarily stopped. However, the child support order will
not be stopped if the person who owes support has the financial ability to pay that support while in jail, prison, or an
institution. It will also not be stopped if the reason the person is in jail, prison, or an institution is because the person didn't
pay court ordered child support or committed domestic violence against the supported person or child. The child support
order starts again on the first day of the month after the person is released from jail, prison, or an institution.
(6)
day of each monthFor a total of: $ payable on the:
beginning (date):
Other (specify):
The low-income adjustment applies.
The low-income adjustment does not apply because (specify reasons):
Mandatory additional child support.
one-half or % or
other parent
State Disbursement Unit child-care provider.
(specify amount): $
per month of the costs.
Payments must be made to the
The parent ordered to pay support must pay reasonable uninsured health-care costs for the children, as follows:
Payments must be made to the other parent
State Disbursement Unit
health-care provider.
one-half or % or
(specify amount): $
per month of the costs.
The parent ordered to pay support must pay additional monthly support for reasonable child-care costs, as follows:
(b)
(a)