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Child Support Guidelines Worksheet


Parent A: IV-D Case Number: Number of Joint Children:
Parent B: Court File Number: Date:

  Parent A Parent B Combined
Income 1a. Monthly Income Received
1b. Child(ren)'s Social Security/Veterans' Benefits Derived From a Parent's Eligibility
1c. Potential Income
1d. Spousal Maintenance Orders Obligated to be Paid
1e. Child Support Order(s) Obligated to be Paid for Nonjoint Child(ren)
1f. Monthly Gross Income (1a+1b+1c-1d-1e)
Adjustments 2a. Number of Nonjoint Child(ren) in the Home (Maximum number allowed is 2)
2b. Deduction for Nonjoint Child(ren) in the Home
3. Parental Income for Determining Child Support (PICS)
4. Percentage Share of Combined PICS
5. Combined Basic Support Obligation
6. Pro Rata Basic Support Obligation
Basic Child Support Obligation 7. Basic Support Obligation After Parenting Expense Adjustment (if applicable)
Child Care Obligation 8. Child Care Support Obligation for Joint Child(ren)
Medical Support Obligation 9a. Monthly Cost of Health Care Coverage for Joint Child(ren)
9b. Pro Rata Share of Health Care Coverage Costs
Appropriate Coverage Available 9c. Contribution to Health Care Coverage
9d. Monthly Cost of Dental Coverage for Joint Child(ren)
9e. Pro Rata Share of Dental Coverage Costs
9f. Contribution to Dental Coverage
9g. Medical Support Obligation-Appropriate Coverage Available
No Appropriate Insurance Available 10. Medical Support Obligation for Public Coverage
Uninsured/Unreimbursed Expenses 11. Share of Uninsured and/or Unreimbursed Medical Expenses
12. Net Child Support Obligation
Benefits Adjustment 13. Child(ren)'s Social Security/Veterans' Benefits Derived from Parent's Eligibility
Computing a Final Obligation 14. Total Child Support Obligation
15a. Monthly Gross Income
Ability to Pay Calculation 15b. Income Available for Support
16. Monthly Child Support Obligation - No Adjustment Necessary
17. Amount of Reduction
Child Support Obligation Adjustment 18. Medical Support      
      Original Obligation
      Amount of Reduction
      New Obligation
 
19. Child Care Support      
      Original Obligation
      Amount of Reduction
      New Obligation
 
20. Basic Support      
      Original Obligation
      Amount of Reduction
      New Obligation
 
21. Monthly Child Support Obligation After Adjustment
Presumptive Minimum Order/Basic Support Only 22a. Presumptive Minimum Order for 1 or 2 Joint Children
22b. Presumptive Minimum Order for 3 or 4 Joint Children
22c. Presumptive Minimum Order for 5 or More Joint Children

Calculated by the Minnesota Child Support Guidelines Calculator on 11/30/2021 at 3:00 AM