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Parent A |
Parent B |
Combined |
| Income |
1a. Monthly Income Received |
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| 1b. Child(ren)'s Social
Security/Veterans' Benefits Derived From a Parent's Eligibility |
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| 1c. Potential Income |
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| 1d. Spousal Maintenance Orders
Obligated to be Paid |
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| 1e. Monthly Gross Income
(1a+1b+1c-1d) |
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| Adjustments |
2a. Number of Nonjoint Child(ren) without a support order (Maximum number allowed is 6) |
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| 2b. Deduction for Nonjoint Child(ren) without a support order |
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| 2c. Child Support Order(s) Obligated to be
Paid for Nonjoint Child(ren) |
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| 3. Parental Income for Determining
Child Support (PICS) |
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| 4. Percentage Share of Combined PICS |
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| 5. Combined Basic Support Obligation |
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| 6. Pro Rata Basic Support Obligation |
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| Basic Child Support Obligation |
7. Basic Support Obligation After
Parenting Expense Adjustment (if applicable) |
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| Child Care Obligation |
8. Child Care Support Obligation for
Joint Child(ren) |
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| Medical Support Obligation |
9a. Monthly Cost of Health Care
Coverage for Joint Child(ren) |
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| 9b. Pro Rata Share of Health Care
Coverage Costs |
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| Appropriate
Coverage Available |
9c. Contribution to Health Care
Coverage |
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| 9d. Monthly Cost of Dental Coverage
for Joint Child(ren) |
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| 9e. Pro Rata Share of Dental
Coverage Costs |
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| 9f. Contribution to Dental Coverage |
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| 9g. Medical Support
Obligation-Appropriate Coverage Available |
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| No Appropriate Insurance
Available |
10. Medical Support Obligation for
Public Coverage |
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| Uninsured/Unreimbursed
Expenses |
11. Share of Uninsured and/or
Unreimbursed Medical Expenses |
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| 12. Net Child Support Obligation |
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| Benefits Adjustment |
13. Child(ren)'s Social
Security/Veterans' Benefits Derived from Parent's Eligibility |
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| Computing a
Final Obligation |
14. Total Child Support Obligation |
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| 15a. Parental Income for Determining Child Support (PICS) |
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| Amount Minnesota law allows to support yourself |
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| Ability to Pay
Calculation |
15b. Income Available for Support
(Line 15a - 120% of monthly FPG) |
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| 16. Monthly Child Support Obligation
- No Adjustment Necessary |
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| 17. Amount of Reduction |
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| Child Support
Obligation Adjustment |
18. Medical Support |
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Original Obligation |
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| Amount of Reduction |
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New Obligation |
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| 19. Child Care Support |
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Original Obligation |
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| Amount of Reduction |
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New Obligation |
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| 20. Basic Support |
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Original Obligation |
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| Amount of Reduction |
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New Obligation |
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| 21. Monthly Child Support Obligation
After Adjustment |
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| Presumptive
Minimum Order/Basic Support Only |
22. Presumptive Minimum Order based on the number of joint children |
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