In Re: Amendments to Florida Family Law Rules of Procedure - Form 12.902(e)

• Court: Supreme Court of Florida
• Decided: January 13, 2022
• Docket: SC21-1174
• Status: Published

Opinion

Supreme Court of Florida ____________

No. SC21-1174 ____________

IN RE: AMENDMENTS TO FLORIDA FAMILY LAW RULES OF PROCEDURE—FORM 12.902(e).

January 13, 2022

PER CURIAM.

This matter is before the Court for consideration of proposed

amendments to Florida Family Law Rule of Procedure Form

12.902(e) (Child Support Guidelines Worksheet). See Fla. R. Gen.

Prac. & Jud. Admin. 2.140(b)(1). We have jurisdiction. See art. V, §

2(a), Fla. Const.

The Florida Bar’s Family Law Rules Committee (Committee)

filed a report proposing amendments to form 12.902(e). The

Committee and the Board of Governors of The Florida Bar approved

the proposed amendments. The Committee published its proposal

for comment prior to filing it with the Court and received one

comment in support of the proposed amendments. After the

Committee filed its report, the Court published the proposal for comment. One comment was received in support of the proposed

amendments, and the Committee filed a response.

Having considered the proposed amendments, the comment,

and the Committee’s response, the Court hereby amends Florida

Family Law Rule of Procedure Form 12.902(e) (Child Support

Guidelines Worksheet) as proposed by the Committee, with a minor

modification.

First, a sentence is added to the instructions for form

12.902(e) providing that if the parties’ combined monthly net

income is not listed on the Child Support Guidelines Chart, child

support is to be calculated as provided by law. However, we modify

the sentence to specifically reference section 61.30(6), Florida

Statutes (Child support guidelines; retroactive child support), which

explains how to calculate the child support amount if the obligor

parent’s net income is less than the amount in the guidelines

schedule or if the parties’ combined monthly net income is greater

than the amount in the guidelines schedule.

Additionally, throughout the form’s instructions, references to

the Rules of Judicial Administration are amended to reflect the

updated name, the Rules of General Practice and Judicial -2- Administration. See In re Amends. to Fla. Rules of Jud. Admin.—

2020 Regular-Cycle Report, 310 So. 3d 374 (Fla. 2021).

Accordingly, Form 12.902(e) is hereby amended as set forth in

the appendix to this opinion. The form is fully engrossed and ready

for use. The form may also be accessed and downloaded from the

Florida State Courts’ website at

https://www.flcourts.org/Resources-Services/Court-

Improvement/Family-Courts/Family-Law-Self-Help-

Information/Family-Law-Forms. The amendments shall become

effective April 1, 2022, at 12:01 a.m.

It is so ordered.

CANADY, C.J., and POLSTON, LABARGA, LAWSON, MUÑIZ, COURIEL, and GROSSHANS, JJ., concur.

THE FILING OF A MOTION FOR REHEARING SHALL NOT ALTER THE EFFECTIVE DATE OF THESE AMENDMENTS.

Original Proceeding – Florida Family Law Rules of Procedure

Ashley Elizabeth Taylor, Chair, Family Law Rules Committee, Tampa, Florida, Joshua E. Doyle, Executive Director, and Mikalla Andies Davis, Staff Liaison, The Florida Bar, Tallahassee, Florida,

for Petitioner

Heather L. Apicella, Chair, Family Law Section of The Florida Bar, Boca Raton, Florida, Kristin R.H. Kirkner, Co-Chair, Rules and Forms Committee, Family Law Section of The Florida Bar, Tampa, -3- Florida, and Jack A. Moring, Co-Chair, Rules and Forms Committee, Family Law Section of The Florida Bar, Crystal River, Florida,

Responding with comments

-4- APPENDIX

INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE FORM 12.902(e) CHILD SUPPORT GUIDELINES WORKSHEET (04/22)

When should this form be used?

You should complete this worksheet if child support is being requested in your case. If you know the income of the other party, this worksheet should accompany your financial affidavit. If you do not know the other party’s income, this form must be completed after the other party files his or her financial affidavit, and serves a copy on you.

This form should be typed or printed in black ink. You should file this document with the clerk of the circuit court in the county where your case is filed and keep a copy for your records.

What should I do next?

A copy of this form must be filed with the court and served on the other party or his or her attorney. The copy you are serving to the other party must be either mailed, emailed, or hand-delivered to the opposing party or his or her attorney on the same day indicated on the certificate of service. If it is mailed, it must be postmarked on the date indicated in the certificate of service. Service must be in accordance with Florida Rule of General Practice and Judicial Administration 2.516.

IMPORTANT INFORMATION REGARDING E-FILING

The Florida Rules of General Practice and Judicial Administration now require that all petitions, pleadings, and documents be filed electronically except in certain circumstances. Self-represented litigants may file petitions or other pleadings or documents electronically; however, they are not required to do so. If you choose to file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of General Practice and Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures should be carefully read and followed.

IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION

After the initial service of process of the petition or supplemental petition by the Sheriff or certified process server, the Florida Rules of General Practice and Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e- mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Florida Rules of General Practice and Judicial Administration. If you elect to participate in electronic service, which means serving or receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of General Practice and Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link to the Rules of General

Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) -5- Practice and Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the A-Z Topical Index.

SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by email, the procedures must always be followed once the initial election is made.

To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of General Practice and Judicial Administration 2.516.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found at the beginning of these forms. The words that are in “bold underline” in these instructions are defined there. For further information, see section 61.30, Florida Statutes.

Special notes. . .

If you want to keep your address confidential because you have been found by a judge to be the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery or domestic violence, do not enter the address, telephone, and fax information at the bottom of this form. Instead, file Request for Confidential Filing of Address, Florida Supreme Court Approved Family Law Form 12.980(h).

The chart below contains the guideline amounts that you should use when calculating child support. This amount is based on the number of children and the combined income of the parents, and it is divided between the parents in direct proportion to their income or earning capacity. From time to time, some of the amounts in the child support guidelines chart will change. Be sure you have the most recent version of the chart before using it. If the parties’ combined monthly net income is not listed on the below chart, then calculate child support as provided by law in section 61.30(6), Florida Statutes. Because the guidelines are based on monthly amounts, it may be necessary to convert some income and expense figures from other frequencies to monthly. You should do this as follows:

If payment is twice per month Payment amount x 2 = Monthly amount If payment is every two weeks Payment amount x 26 = Yearly amount due Yearly amount ÷ 12 = Monthly amount

Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) -6- If payment is weekly Weekly amount x 52 = Yearly amount due Yearly amount ÷ 12 = Monthly amount

If you or the other parent request that the court award an amount that is different than the guideline amount, you must also complete and attach a Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.

Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) -7- CHILD SUPPORT GUIDELINES CHART Combined One Two Three Four Five Six Monthly Child Children Children Children Children Children Available Income

800.00 190 211 213 216 218 220 850.00 202 257 259 262 265 268 900.00 213 302 305 309 312 315 950.00 224 347 351 355 359 363 1000.00 235 365 397 402 406 410 1050.00 246 382 443 448 453 458 1100.00 258 400 489 495 500 505 1150.00 269 417 522 541 547 553 1200.00 280 435 544 588 594 600 1250.00 290 451 565 634 641 648 1300.00 300 467 584 659 688 695 1350.00 310 482 603 681 735 743 1400.00 320 498 623 702 765 790 1450.00 330 513 642 724 789 838 1500.00 340 529 662 746 813 869 1550.00 350 544 681 768 836 895 1600.00 360 560 701 790 860 920 1650.00 370 575 720 812 884 945 1700.00 380 591 740 833 907 971 1750.00 390 606 759 855 931 996 1800.00 400 622 779 877 955 1022 1850.00 410 638 798 900 979 1048 1900.00 421 654 818 923 1004 1074 1950.00 431 670 839 946 1029 1101 2000.00 442 686 859 968 1054 1128 2050.00 452 702 879 991 1079 1154 2100.00 463 718 899 1014 1104 1181 2150.00 473 734 919 1037 1129 1207 2200.00 484 751 940 1060 1154 1234 2250.00 494 767 960 1082 1179 1261 2300.00 505 783 980 1105 1204 1287 2350.00 515 799 1000 1128 1229 1314 2400.00 526 815 1020 1151 1254 1340 2450.00 536 831 1041 1174 1279 1367 2500.00 547 847 1061 1196 1304 1394 2550.00 557 864 1081 1219 1329 1420 2600.00 568 880 1101 1242 1354 1447 2650.00 578 896 1121 1265 1379 1473 2700.00 588 912 1141 1287 1403 1500 2750.00 597 927 1160 1308 1426 1524 2800.00 607 941 1178 1328 1448 1549

Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) -8- Combined One Two Three Four Five Six Monthly Child Children Children Children Children Children Available Income

2850.00 616 956 1197 1349 1471 1573 2900.00 626 971 1215 1370 1494 1598 2950.00 635 986 1234 1391 1517 1622 3000.00 644 1001 1252 1412 1540 1647 3050.00 654 1016 1271 1433 1563 1671 3100.00 663 1031 1289 1453 1586 1695 3150.00 673 1045 1308 1474 1608 1720 3200.00 682 1060 1327 1495 1631 1744 3250.00 691 1075 1345 1516 1654 1769 3300.00 701 1090 1364 1537 1677 1793 3350.00 710 1105 1382 1558 1700 1818 3400.00 720 1120 1401 1579 1723 1842 3450.00 729 1135 1419 1599 1745 1867 3500.00 738 1149 1438 1620 1768 1891 3550.00 748 1164 1456 1641 1791 1915 3600.00 757 1179 1475 1662 1814 1940 3650.00 767 1194 1493 1683 1837 1964 3700.00 776 1208 1503 1702 1857 1987 3750.00 784 1221 1520 1721 1878 2009 3800.00 793 1234 1536 1740 1899 2031 3850.00 802 1248 1553 1759 1920 2053 3900.00 811 1261 1570 1778 1940 2075 3950.00 819 1275 1587 1797 1961 2097 4000.00 828 1288 1603 1816 1982 2119 4050.00 837 1302 1620 1835 2002 2141 4100.00 846 1315 1637 1854 2023 2163 4150.00 854 1329 1654 1873 2044 2185 4200.00 863 1342 1670 1892 2064 2207 4250.00 872 1355 1687 1911 2085 2229 4300.00 881 1369 1704 1930 2106 2251 4350.00 889 1382 1721 1949 2127 2273 4400.00 898 1396 1737 1968 2147 2295 4450.00 907 1409 1754 1987 2168 2317 4500.00 916 1423 1771 2006 2189 2339 4550.00 924 1436 1788 2024 2209 2361 4600.00 933 1450 1804 2043 2230 2384 4650.00 942 1463 1821 2062 2251 2406 4700.00 951 1477 1838 2081 2271 2428 4750.00 959 1490 1855 2100 2292 2450 4800.00 968 1503 1871 2119 2313 2472 4850.00 977 1517 1888 2138 2334 2494 4900.00 986 1530 1905 2157 2354 2516 4950.00 993 1542 1927 2174 2372 2535

Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) -9- Combined One Two Three Four Five Six Monthly Child Children Children Children Children Children Available Income

5000.00 1000 1551 1939 2188 2387 2551 5050.00 1006 1561 1952 2202 2402 2567 5100.00 1013 1571 1964 2215 2417 2583 5150.00 1019 1580 1976 2229 2432 2599 5200.00 1025 1590 1988 2243 2447 2615 5250.00 1032 1599 2000 2256 2462 2631 5300.00 1038 1609 2012 2270 2477 2647 5350.00 1045 1619 2024 2283 2492 2663 5400.00 1051 1628 2037 2297 2507 2679 5450.00 1057 1638 2049 2311 2522 2695 5500.00 1064 1647 2061 2324 2537 2711 5550.00 1070 1657 2073 2338 2552 2727 5600.00 1077 1667 2085 2352 2567 2743 5650.00 1083 1676 2097 2365 2582 2759 5700.00 1089 1686 2109 2379 2597 2775 5750.00 1096 1695 2122 2393 2612 2791 5800.00 1102 1705 2134 2406 2627 2807 5850.00 1107 1713 2144 2418 2639 2820 5900.00 1111 1721 2155 2429 2651 2833 5950.00 1116 1729 2165 2440 2663 2847 6000.00 1121 1737 2175 2451 2676 2860 6050.00 1126 1746 2185 2462 2688 2874 6100.00 1131 1754 2196 2473 2700 2887 6150.00 1136 1762 2206 2484 2712 2900 6200.00 1141 1770 2216 2495 2724 2914 6250.00 1145 1778 2227 2506 2737 2927 6300.00 1150 1786 2237 2517 2749 2941 6350.00 1155 1795 2247 2529 2761 2954 6400.00 1160 1803 2258 2540 2773 2967 6450.00 1165 1811 2268 2551 2785 2981 6500.00 1170 1819 2278 2562 2798 2994 6550.00 1175 1827 2288 2573 2810 3008 6600.00 1179 1835 2299 2584 2822 3021 6650.00 1184 1843 2309 2595 2834 3034 6700.00 1189 1850 2317 2604 2845 3045 6750.00 1193 1856 2325 2613 2854 3055 6800.00 1196 1862 2332 2621 2863 3064 6850.00 1200 1868 2340 2630 2872 3074 6900.00 1204 1873 2347 2639 2882 3084 6950.00 1208 1879 2355 2647 2891 3094 7000.00 1212 1885 2362 2656 2900 3103 7050.00 1216 1891 2370 2664 2909 3113 7100.00 1220 1897 2378 2673 2919 3123

Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 10 - Combined One Two Three Four Five Six Monthly Child Children Children Children Children Children Available Income

7150.00 1224 1903 2385 2681 2928 3133 7200.00 1228 1909 2393 2690 2937 3142 7250.00 1232 1915 2400 2698 2946 3152 7300.00 1235 1921 2408 2707 2956 3162 7350.00 1239 1927 2415 2716 2965 3172 7400.00 1243 1933 2423 2724 2974 3181 7450.00 1247 1939 2430 2733 2983 3191 7500.00 1251 1945 2438 2741 2993 3201 7550.00 1255 1951 2446 2750 3002 3211 7600.00 1259 1957 2453 2758 3011 3220 7650.00 1263 1963 2461 2767 3020 3230 7700.00 1267 1969 2468 2775 3030 3240 7750.00 1271 1975 2476 2784 3039 3250 7800.00 1274 1981 2483 2792 3048 3259 7850.00 1278 1987 2491 2801 3057 3269 7900.00 1282 1992 2498 2810 3067 3279 7950.00 1286 1998 2506 2818 3076 3289 8000.00 1290 2004 2513 2827 3085 3298 8050.00 1294 2010 2521 2835 3094 3308 8100.00 1298 2016 2529 2844 3104 3318 8150.00 1302 2022 2536 2852 3113 3328 8200.00 1306 2028 2544 2861 3122 3337 8250.00 1310 2034 2551 2869 3131 3347 8300.00 1313 2040 2559 2878 3141 3357 8350.00 1317 2046 2566 2887 3150 3367 8400.00 1321 2052 2574 2895 3159 3376 8450.00 1325 2058 2581 2904 3168 3386 8500.00 1329 2064 2589 2912 3178 3396 8550.00 1333 2070 2597 2921 3187 3406 8600.00 1337 2076 2604 2929 3196 3415 8650.00 1341 2082 2612 2938 3205 3425 8700.00 1345 2088 2619 2946 3215 3435 8750.00 1349 2094 2627 2955 3224 3445 8800.00 1352 2100 2634 2963 3233 3454 8850.00 1356 2106 2642 2972 3242 3464 8900.00 1360 2111 2649 2981 3252 3474 8950.00 1364 2117 2657 2989 3261 3484 9000.00 1368 2123 2664 2998 3270 3493 9050.00 1372 2129 2672 3006 3279 3503 9100.00 1376 2135 2680 3015 3289 3513 9150.00 1380 2141 2687 3023 3298 3523 9200.00 1384 2147 2695 3032 3307 3532 9250.00 1388 2153 2702 3040 3316 3542

Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 11 - Combined One Two Three Four Five Six Monthly Child Children Children Children Children Children Available Income

9300.00 1391 2159 2710 3049 3326 3552 9350.00 1395 2165 2717 3058 3335 3562 9400.00 1399 2171 2725 3066 3344 3571 9450.00 1403 2177 2732 3075 3353 3581 9500.00 1407 2183 2740 3083 3363 3591 9550.00 1411 2189 2748 3092 3372 3601 9600.00 1415 2195 2755 3100 3381 3610 9650.00 1419 2201 2763 3109 3390 3620 9700.00 1422 2206 2767 3115 3396 3628 9750.00 1425 2210 2772 3121 3402 3634 9800.00 1427 2213 2776 3126 3408 3641 9850.00 1430 2217 2781 3132 3414 3647 9900.00 1432 2221 2786 3137 3420 3653 9950.00 1435 2225 2791 3143 3426 3659 10000.00 1437 2228 2795 3148 3432 3666

Instructions for Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22) - 12 - IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT, IN AND FOR COUNTY, FLORIDA

Case No.: Division: , Petitioner, and

, Respondent.

NOTICE OF FILING CHILD SUPPORT GUIDELINES WORKSHEET PLEASE TAKE NOTICE, that {name} _______, is filing his/her Child

Support Guidelines Worksheet attached and labeled Exhibit 1.

CERTIFICATE OF SERVICE

I certify that a copy of this Notice of Filing with the Child Support Guidelines Worksheet was [check all used]: ( ) e-mailed ( ) mailed ( ) faxed ( ) hand delivered to the person(s) listed below on {date} __________.

Other party or his/her attorney: Name: _____________________________ Address: ____________________________ City, State, Zip: _______________________ Telephone Number: ___________________ Fax Number: _________________________ E-mail Address(es): ____________________

Signature of Party or his/her Attorney Printed Name: _________________________ Address: ______________________________ City, State, Zip: _________________________ Telephone Number: _____________________ Fax Number: ___________________________ E-mail Address(es): ______________________ Florida Bar Number: _____________________

Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22)

- 13 - CHILD SUPPORT GUIDELINES WORKSHEET

A. PETITIONER B. RESPONDENT TOTAL

1. Present Net Monthly Income Enter the amount from line 27, Section I of Florida Family Law Rules of Procedure Form 12.902(b) or (c), Financial Affidavit.

2. Basic Monthly Obligation There is (are) {number}_____ minor child(ren) common to the parties. Using the total amount from line 1, enter the appropriate amount from the child support guidelines chart.

3. Percent of Financial Responsibility % % Divide the amount on line 1A by the total amount on line 1 to get Petitioner’s percentage of financial responsibility. Enter answer on line 3A. Divide the amount on line 1B by the total amount on line 1 to get Respondent’s percentage of financial responsibility. Enter answer on line 3B.

4. Share of Basic Monthly Obligation Multiply the number on line 2 by the percentage on line 3A to get Petitioner’s share of basic obligation. Enter answer on line 4A. Multiply the number on line 2 by the percentage on line 3B to Respondent’s share of basic obligation. Enter answer on line 4B.

Additional Support — Health Insurance, Child Care & Other

Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22)

- 14 - CHILD SUPPORT GUIDELINES WORKSHEET

5. a. 100% of Monthly Child Care Costs [Child care costs should not exceed the level required to provide quality care from a licensed source. See section 61.30(7), Florida Statutes, for more information.]

b. Total Monthly Child(ren)’s Health Insurance Cost [This is only amounts actually paid for health insurance on the child(ren).] c. Total Monthly Child(ren)’s Noncovered Medical, Dental and Prescription Medication Costs

d. Total Monthly Child Care & Health Costs [Add lines 5a + 5b +5c.]

6. Additional Support Payments Multiply the number on line 5d by the percentage on line 3A to determine the Petitioner’s share. Enter answer on line 6A. Multiply the number on line 5d by the percentage on line 3B to determine the Respondent’s share.

Enter answer on line 6B.

Statutory Adjustments/Credits

7. a. Monthly child care payments actually made.

b. Monthly health insurance payments actually made.

Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22)

- 15 - CHILD SUPPORT GUIDELINES WORKSHEET

A. PETITIONER B. RESPONDENT TOTAL c. Other payments/credits actually made for any noncovered medical, dental and prescription medication expenses of the child(ren) not ordered to be separately paid on a percentage basis. (See section 61.30 (8), Florida Statutes.)

8. Total Support Payments actually made (Add 7a though 7c.)

9. MINIMUM CHILD SUPPORT OBLIGATION FOR EACH PARENT [Line 4 plus line 6; minus line 8.]

Substantial Time-Sharing (GROSS UP METHOD) If each parent exercises time-sharing at least 20 percent of the overnights in the year (73 overnights in the year), complete Nos. 10 through 21. 10. Basic Monthly Obligation x 150%

[Multiply line 2 by 1.5]

11. Increased Basic Obligation for each parent. Multiply the number on line 10 by the percentage on line 3A to determine the Petitioner’s share. Enter answer on line 11A. Multiply the number on line 10 by the percentage on line 3B to determine the Respondent’s share. Enter answer on line 11B.

Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22)

- 16 - CHILD SUPPORT GUIDELINES WORKSHEET

A. PETITIONER B. RESPONDENT TOTAL 12. Percentage of overnight stays with % % each parent. The child(ren) spend(s) ____overnight stays with the Petitioner each year. Using the number on the above line, multiply it by 100 and divide by 365. Enter this number on line 12A. The child(ren) spend(s) _____ overnight stays with the Respondent each year. Using the number on the above line, multiply it by 100 and divide by 365. Enter this number on line 12B. 13. Parent’s support multiplied by other Parent’s percentage of overnights. [Multiply line 11A by line 12B. Enter this number in 13A. Multiply line 11B by line 12A. Enter this number in 13B.] Additional Support — Health Insurance, Child Care & Other 14. a. Total Monthly Child Care Costs [Child care costs should not exceed the level required to provide quality care from a licensed source. See section 61.30(7), Florida Statutes, for more information.] b. Total Monthly Child(ren)’s Health Insurance Cost. [This is only amounts actually paid for health insurance on the child(ren).]

c. Total Monthly Child(ren)’s Noncovered Medical, Dental and Prescription Medication Costs. d. Total Monthly Child Care & Health Costs [Add lines 14a + 14b + 14c.]

Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22)

- 17 - CHILD SUPPORT GUIDELINES WORKSHEET

A. PETITIONER B. RESPONDENT TOTAL 15. Additional Support Payments. Multiply the number on line 14d by the percentage on line 3A to determine the Petitioner’s share. Enter answer on line 15A. Multiply the number on line 14d by the percentage on line 3B to determine the Respondent’s share. Enter answer on line 15B.

Statutory Adjustments/Credits 16. a. Monthly child care payments actually made. b. Monthly health insurance payments actually made. c. Other payments/credits actually made for any noncovered medical, dental and prescription medication expenses of the child(ren) not ordered to be separately paid on a percentage basis. [See section 61.30(8), Florida Statutes.] 17. Total Support Payments actually made [Add 16a though 16c.]

18. Total Additional Support Transfer Amount [Line 15 minus line 17; enter any negative number as zero.] 19. Total Child Support Owed from Petitioner to Respondent [Add line 13A plus 18A.] 20. Total Child Support Owed from Respondent to Petitioner. [Add line 13B plus line 18B.]

Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22)

- 18 - CHILD SUPPORT GUIDELINES WORKSHEET

A. PETITIONER B. RESPONDENT TOTAL 21. Presumptive Child Support to Be Paid. [Comparing lines 19 and 20, $ Subtract the smaller amount owed from the larger amount owed and enter the result in the column for the parent that owes the larger amount of support.] ]

ADJUSTMENTS TO GUIDELINES AMOUNT. If you or the other parent is requesting the Court to award a child support amount that is more or less than the child support guidelines, you must complete and file Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943.

[check one only] a. ____ Deviation from the guidelines amount is requested. The Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is attached. b. ____ Deviation from the guidelines amount is NOT requested. The Motion to Deviate from Child Support Guidelines, Florida Supreme Court Approved Family Law Form 12.943, is not attached.

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fill in all blanks] This form was prepared for the: {choose only one} ____ Petitioner ____ Respondent This form was completed with the assistance of: {name of individual} , {name of business} ____________________________________________________________, {address} ____________________________________________________________________, {city} __________________, {state} ____, {zip code} ______, {telephone number} _________

Florida Family Law Rules of Procedure Form 12.902(e), Child Support Guidelines Worksheet (04/22)

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