Section 3119.022 | Child support computation worksheet - sole residential parent or shared parenting order.
When a court or child support enforcement agency calculates the amount of child support to be paid pursuant to a child support order in a proceeding in which one parent is the residential parent and legal custodian of all of the children who are the subject of the child support order or in which the court issues a shared parenting order, the court or agency shall use a worksheet identical in content and form to the following:
CHILD SUPPORT COMPUTATION WORKSHEETSOLE RESIDENTIAL PARENT OR SHARED PARENTING ORDER
Name of parties ................................................Case No. .......................................................Number of minor children .......................................
The following parent was designated as residential parent and legal custodian: ...... mother ...... father ...... shared
Column IColumn IIColumn IIIFatherMotherCombined
INCOME:
1.a.Annual gross incomefrom employment or,when determinedappropriate by thecourt or agency,average annual grossincome from employmentover a reasonableperiod of years.(Exclude overtime,bonuses,self-employment income,or commissions)
$......$......
b.Amount of overtime,bonuses, andcommissions (year 1representing the mostrecent year)
FatherMotherYr. 3 $..........Yr. 3 $..........(Three years ago)(Three years ago)Yr. 2 $..........Yr. 2 $..........(Two years ago)(Two years ago)Yr. 1 $..........Yr. 1 $..........(Last calendar year)(Last calendar year)Average $.........Average $.........
(Include in Col. Iand/or Col. II theaverage of the threeyears or the year 1amount, whichever isless, if there existsa reasonableexpectation that thetotal earnings fromovertime and/orbonuses during thecurrent calendar yearwill meet or exceedthe amount that isthe lower of theaverage of the threeyears or the year 1amount. If, however,there exists areasonable expectationthat the totalearnings fromovertime/bonuses duringthe current calendaryear will be lessthan the lower of theaverage of the 3years or the year 1amount, include onlythe amount reasonablyexpected to be earnedthis year.)
$......$......
2.For self-employmentincome:
a.Gross receipts frombusiness
$......$......
b.Ordinary and necessarybusiness expenses
$......$......
c.5.6% of adjusted grossincome or the actualmarginal differencebetween the actualrate paid by theself-employedindividual and theF.I.C.A. rate
$......$......
d.Adjusted gross incomefrom self-employment(subtract the sum of2b and 2c from 2a)
$......$......
3.Annual income frominterest anddividends (whether ornot taxable)
$......$......
4.Annual income fromunemploymentcompensation
$......$......
5.Annual income fromworkers' compensation,disability insurancebenefits, or socialsecuritydisability/retirementbenefits
$......$......
6.Other annual income(identify)
$......$......
7.a.Total annual grossincome (add lines 1a,1b, 2d, and 3-6)
$......$......
b.Health insurance$......$......maximum (multiplyline 7a by 5%)
ADJUSTMENTS TO INCOME:
8.Adjustment for minorchildren born to oradopted by eitherparent and anotherparent who are livingwith this parent;adjustment does notapply to stepchildren(number of childrentimes federal incometax exemption lesschild supportreceived, not toexceed the federaltax exemption)
$......$......
9.Annual court-orderedsupport paid forother children
$.....$......
10.Annual court-orderedspousal support paidto any spouse orformer spouse
$......$......
11.Amount of localincome taxes actuallypaid or estimated tobe paid
$......$......
12.Mandatory work-relateddeductions such asunion dues, uniformfees, etc. (notincluding taxes,social security, orretirement)
$......$......
13.Total gross incomeadjustments (addlines 8 through 12)
$......$......
14.a.Adjusted annual grossincome (subtract line13 from line 7a)
$......$......
b.Cash medical supportmaximum (If the amounton line 7a, Col. I,is under 150% of thefederal poverty levelfor an individual,enter $0 on line 14b,Col. I. If the amounton line 7a, Col. I,is 150% or higher ofthe federal povertylevel for anindividual, multiplythe amount on line14a, Col. I, by 5%and enter this amounton line 14b, Col. I.If the amount on line7a, Col. II, is under150% of the federalpoverty level for anindividual, enter $0on line 14b, Col. II.If the amount on line7a, Col. II, is 150%or higher of thefederal poverty levelfor an individual,multiply the amounton line 14a, Col. II,by 5% and enter thisamount on line 14b,Col. II.)
$......$......
15.Combined annualincome that is basisfor child supportorder (add line 14a,Col. I and Col. II)
$......
16.Percentage ofparent's income tototal income
a.Father (divide line14a, Col. I, by line15, Col. III) ......%
b.Mother (divide line14a, Col. II, by line15, Col. III) ......%
17.Basic combined childsupport obligation(refer to schedule,first column, locatethe amount nearest tothe amount on line 15,Col. III, then referto column for numberof children in thisfamily. If the incomeof the parents ismore than one sum butless than another,you may calculate thedifference.)
$......
18.Annual supportobligation per parent
a.Father (multiply line17, Col. III, byline 16a)
$......
b.Mother (multiply line17, Col. III, byline 16b)
$......
19.Annual child careexpenses for childrenwho are the subjectof this order thatare work-, employmenttraining-, oreducation-related, asapproved by the courtor agency (deduct taxcredit from annualcost, whether or notclaimed)
$......$......
20.a.Marginal,out-of-pocket costs,necessary to providefor health insurancefor the children whoare the subject ofthis order(contributing cost ofprivate family healthinsurance, minus thecontributing cost ofprivate single healthinsurance, divided bythe total number ofdependents covered bythe plan, includingthe children subjectof the support order,times the number ofchildren subject ofthe support order)
$......$......
b.Cash medical supportobligation (enter theamount on line 14b orthe amount of annualhealth careexpenditures estimatedby the United StatesDepartment ofAgriculture anddescribed in section3119.30 of the RevisedCode, whichever amountis lower)
$......$......
21.ADJUSTMENTS TO CHILD SUPPORT WHEN HEALTH INSURANCE IS PROVIDED:
Father (only if obligorMother (only if obligoror shared parenting)or shared parenting)a.Additions: line 16a timesb.Additions: line 16bthe sum of amounts showntimes the sum of amountson line 19, Col. II andshown on line 19, Col. Iline 20a, Col. IIand line 20a, Col. I$......................$......................c.Subtractions: line 16bd.Subtractions: line 16atimes sum of amountstimes sum of amountsshown on line 19, Col. Ishown on line 19, Col.and line 20a, Col. III and line 20a, Col. II$.......................$.......................
22.OBLIGATION AFTER ADJUSTMENTS TO CHILD SUPPORT WHEN HEALTH INSURANCE IS PROVIDED:
a.Father: line 18a plusor minus thedifference betweenline 21a minusline 21c
$......
b.Mother: line 18b plusor minus thedifference betweenline 21b minusline 21d
$......
23.ACTUAL ANNUAL OBLIGATION WHEN HEALTH INSURANCE IS PROVIDED:
a.(Line 22a or 22b,$......whichever linecorresponds to theparent who is theobligor).
b.Any non-means-testedbenefits, includingsocial security andveterans' benefits,paid to and receivedby a child or aperson on behalf ofthe child due todeath, disability, orretirement of theparent
$......
c.Actual annualobligation (subtractline 23b from line 23a)
$......
24.ADJUSTMENTS TO CHILD SUPPORT WHEN HEALTH INSURANCE IS NOT PROVIDED:
Father (only if obligorMother (only if obligoror shared parenting)or shared parenting)a.Additions: line 16a timesb.Additions: line 16bthe sum of the amountstimes the sum of theshown on line 19, Col. IIamounts shown on lineand line 20b, Col. II19, Col. I and line 20b, Col. I$......................$......................c.Subtractions: line 16bd.Subtractions: linetimes the sum of the16a times the sum of theamounts shown on line 19,amounts shown on lineCol. I and line 20b,19, Col. II and lineCol. I20b, Col. II$.......................$.......................
25.OBLIGATION AFTER ADJUSTMENTS TO CHILD SUPPORT WHEN HEALTH INSURANCE IS NOT PROVIDED:
a.Father: line 18a plusor minus thedifference betweenline 24a minusline 24c
$......
b.Mother: line 18b plusor minus thedifference betweenline 24b and 24d
$......
26.ACTUAL ANNUAL OBLIGATION WHEN HEALTH INSURANCE IS NOT PROVIDED:
a.(Line 25a or 25b,$......whichever linecorresponds to theparent who is theobligor)
b.Any non-means-tested$......benefits, includingsocial security andveterans' benefits,paid to and receivedby a child or aperson on behalf ofthe child due todeath, disability, orretirement of theparent
c.Actual annual$......obligation (subtractline 26b fromline 26a
27.a.Deviation from sole residential parent support amount shown on line 23c if amount would be unjust or inappropriate: (see section 3119.23 of the Revised Code.) (Specific facts and monetary value must be stated.)
b.Deviation from shared parenting order: (see sections 3119.23 and 3119.24 of the Revised Code.) (Specific facts including amount of time children spend with each parent, ability of each parent to maintain adequate housing for children, and each parent's expenses for children must be stated to justify deviation.)
WHENWHENHEALTHHEALTHINSURANCEINSURANCEISIS NOTPROVIDEDPROVIDED
28.FINAL CHILD SUPPORTFIGURE: (This amountreflects final annualchild supportobligation; in Col. I,enter line 23c plusor minus any amountsindicated in line 27aor 27b; in Col. II,enter line 26c plus orminus any amountsindicated in line 27aor 27b)
$......$...... Father/Mother,
OBLIGOR
29.FOR DECREE: Childsupport per month(divide obligor'sannual share, line 28,by 12) plus anyprocessing charge
$......$......
30.FINAL CASH MEDICALSUPPORT FIGURE: (thisamount reflects thefinal annual cashmedical support to bepaid by the obligorwhen neither parentprovides healthinsurance coveragefor the child; enterobligor's cash medicalsupport amount fromline 20b
$......
31.FOR DECREE: Cashmedical support permonth (divide line 30by 12)
$......
Prepared by:Counsel: ....................Pro se: .................(For mother/father)CSEA: .......................Other: ..................
Worksheet Has Been Reviewed and Agreed To:
......................................................MotherDate
......................................................FatherDate
Last updated December 8, 2023 at 12:30 PM
Available Versions of this Section
- June 30, 2007 – House Bill 119 - 127th General Assembly [ View June 30, 2007 Version ]
- March 28, 2019 – House Bill 366 - 132nd General Assembly [ View March 28, 2019 Version ]