Ct Child Form PDF Details

Connecticut is one of the states in the US that requires parents or guardians to provide a child's form to the state government. This document is used to track the growth and development of children in the state. The form can be filled out online or through paper submissions. Parents are responsible for updating the form with any changes in their child's information. Failing to do so may result in penalties from the state government. For more information on how to fill out and submit a Connecticut Child Form, please visit our website. Thank you for your time.

QuestionAnswer
Form NameCt Child Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesct child form, connecticut child support arrearage, connecticut child guidelines, connecticut child form

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CCSG-1 Rev. 7-15

C.G.S. §46b-215a

§46b - 215a - 6, Regulations of

Connecticut State Agencies

STATE OF CONNECTICUT

COMMISSION FOR CHILD SUPPORT GUIDELINES

WORKSHEET for the Connecticut Child Support and Arrearage Guidelines

PARENT A

COURT

PARENT B

CUSTODIAN

PARENT A

PARENT B

OTHER:

D.N./CASE NO.

 

 

NUMBER OF CHILDREN

 

 

 

 

CHILD’S NAME

DATE OF BIRTH

CHILD’S NAME

DATE OF BIRTH

CHILD’S NAME

DATE OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All money amounts in this worksheet may be rounded to the nearest dollar

 

I. NET WEEKLY INCOME

 

 

 

 

PARENT A

PARENT B

1.

Gross income (attach verification)

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

1a.

Number of hours used in calculation: Parent A: ______

Parent B: ______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

Federal income tax (based on all allowable exemptions, deductions and credits)

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

3.

Social Security tax or mandatory retirement

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

4.

Medicare tax

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

5.

State and local income tax (based on all allowable exemptions, deductions and credits)

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

6.

Medical/hospital/dental insurance premiums (including HUSKY) for parent and all legal dependents

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

7.

Court-ordered life insurance for benefit of child

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

8.

Court-ordered disability insurance

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

9.

Mandatory union dues or fees (only if deducted by employer)

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

10.

Mandatory uniforms and tools (only if deducted by employer)

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

11.

Non-arrearage payments on court ordered alimony and child support (for other than parent/child(ren) of this

$

 

$

 

 

order)

 

 

 

 

 

 

 

 

 

12.

Amount reserved to support qualified child(ren) (line 12f x line 12a)

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

Qualified Child Deduction Section:

PARENT A

 

PARENT B

 

 

 

 

 

12a.

Number of qualified children

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12b.

Total number of children for qualified child calculation:

 

 

 

 

 

 

 

 

 

 

Number of children on this order + line 12a =

 

 

 

 

 

 

 

 

 

12c.

Add lines 2 through 11

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12d.

Line 1 – line 12c =

$

 

$

 

 

 

 

 

 

12e.

Enter amount from the schedule based on the parent’s line

$

 

$

 

 

 

 

 

 

 

12d income and the total number of children (line 12b)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12f.

Line 12e ÷ line 12b =

$

 

$

 

 

 

 

 

13.

Add lines 2 through 12 and enter amount here

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

14.

Net weekly income (line 1 – line 13 = )

 

 

 

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

II. CURRENT SUPPORT

 

 

 

 

 

 

 

 

15.

Combined net weekly income (Add together both parents’ line 14 income. Round to the nearest $10)

 

$

 

 

 

 

 

 

 

 

 

 

16.

Basic child support obligation (from Schedule of Basic Child Support Obligations)

 

 

 

$

 

 

 

 

 

 

 

 

 

 

17.

Each parent’s percentage share of line 15 (line 14 for each parent ÷ line 15)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(If noncustodial parent is a low-income obligor, skip this line and enter line 16 amount in noncustodial parent’s column on line 18.)

18.

Each parent’s share of the basic child support obligation (line 17 x line 16 for each parent)

$

$

 

 

 

 

 

19.

Social Security dependency benefits adjustment

 

$

$

 

 

 

 

 

20.

Presumptive current support amount (line 18 - line 19 = )

(Rounded to the nearest dollar)

$

$

 

(Enter noncustodial parent’s amount on line 30.)

 

 

 

 

 

 

 

 

 

 

 

III. NET DISPOSABLE INCOME

PARENT A

 

PARENT B

 

21.

Line 14 + line 30 (for custodial parent); line 14 - line 30 (for noncustodial parent)

$

 

 

$

 

 

 

 

 

 

 

 

 

 

22.

Noncustodial parent’s line 19 amount (Social Security dependency benefits for child)

 

$

 

 

 

 

 

 

 

 

 

 

 

23.

Line 21 + line 22 (for custodial parent); line 21 - line 22 (for noncustodial parent)

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

IV. UNREIMBURSED MEDICAL EXPENSE

 

 

 

 

 

 

24.

Add both parents’ line 23 amounts and enter it here: (combined net disposable income)

 

$

 

 

 

 

 

 

 

 

 

 

 

 

25.

Each parent’s percentage share of combined net disposable income

%

 

%

 

 

(Line 23 for each parent % line 24; then x 100 and round to the nearest whole %)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If the noncustodial parent is a low-income obligor (based on line 14 Net Weekly Income), go to line 26. If the noncustodial parent is

 

 

not a low-income obligor (based on line 14 Net Weekly Income), enter these percentages on line 33b.

 

 

 

 

 

 

26.Compare the noncustodial parent’s line 25 amount to 50%. Enter the lower percentage on line 33b for the noncustodial parent. Then take 100 – line 33b for the noncustodial parent and enter the amount on line 33b for the custodial parent.

V. CHILD CARE CONTRIBUTION

27.Does the noncustodial parent’s line 23 amount fall within the shaded area of the schedule? If yes, go to line 28. If no, skip line 28 and enter the noncustodial parent’s line 25 percentage on line 34b.

28.Does the custodial parent’s line 23 amount fall within the shaded area of the schedule? If no, enter 20% on line 34b as the noncustodial parent’s child care contribution.

If yes, compare the line 25 amount for the noncustodial parent to 50% and enter the lower amount on line 34b.

VI. ARREARAGE PAYMENT (Enter line 29 amount on line 31.)

29.

Line 30 x .20 = $

OR amount determined in A, B, C or D, below (check box that applies and enter amount here):

$

A. If noncustodial parent is a low- income obligor, enter the greater of 10% of line 30 or $1 per week, unless paragraph B below applies.

B. If the child is living with the obligor, enter: (1) $1 per week if the obligor’s gross income is less than or equal to 250% of poverty level, OR (2) 20% of an imputed support obligation for the child if the obligor’s gross income is greater than 250% of poverty level.

C. If there is no current support order and paragraph B above does not apply, enter: (1) 20% of an imputed support obligation if the parents have a present duty to provide support for the child, OR (2) 100% of an imputed support obligation if the parents have no present duty to provide support for the individual.

D. If paragraphs A, B and C above, do not apply and the sum of the current support and arrearage payments would exceed 55% of the noncustodial parent’s line 14 amount, enter 55% of the noncustodial parent’s line 14 amount - line 30 amount.

VII. SUMMARY OF WORKSHEET

30.

Presumptive current support (from line 20): $

 

 

Total Child Support Award Calculation:

 

 

 

 

 

Line 30 Amount:

$

31.

Arrearage payment (from line 29): $

 

 

 

 

 

 

 

 

 

 

 

 

 

Line 31 Amount:

$

32.

Total arrearage: $ _____________

(broken down as noted below:)

 

 

Line 33a. Amount:

$

 

State arrearage: $ _____________

Family arrearage: $ ____________

 

 

 

Line 34 Amounts:

 

 

 

 

 

 

 

33.

a. Cash medical : $

 

 

 

 

 

 

 

a. Cash child care amount:

$

 

 

 

 

 

 

b. Unreimbursed medical expenses: Parent A

% / Parent B

%

b. $ equivalent of % (if known)

+ $ _______

 

 

 

 

 

34.

a. Child Care Contribution: $

 

 

 

Total Child Support Award

$

 

b. Child Care Contribution:

%

 

 

(enter this amount on line 35a.)

 

 

 

 

 

 

 

 

35.a. Total child support award (excluding % amounts for unknown costs): $________________

b. Total child support award as a % of the obligor’s net income: ______________% (line 35a ÷ line 14 of the obligor; then x 100)

VIII. DEVIATION CRITERIA (Attach additional sheet if necessary.)

36.

Reason(s) for deviation from presumptive support amounts:

check here if requesting a deviation by agreement

(Check all boxes that apply.)

 

 

 

 

 

 

Parent’s other financial resources

Extraordinary parental expenses

Coordination of total family support

substantial assets

significant visitation expenses

division of assets and liabilities

parent’s earning capacity

unreimbursed employment expenses

provision of alimony

parental support provided to a minor obligor

unreimbursed medical/disability expenses

tax planning considerations

recurring gifts of spouse or domestic partner

 

Needs of parent’s other dependents

 

Special circumstances

 

 

 

 

 

employment over 45 hours per week

 

resources available to qualified child

 

shared physical custody

 

 

child care expenses for qualified child

 

extraordinary disparity in parental income

Extraordinary expenses for child

 

 

 

 

 

 

education expenses

 

verified support for non-resident child

 

best interests of the child

 

 

 

 

unreimbursable medical expenses

 

significant and essential needs of a spouse

 

total award exceeds 55% of obligor’s net

special needs

 

 

 

other equitable factors (explain):

PREPARED BY

TITLE

DATE

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2. After the previous segment is completed, you'll want to add the essential particulars in Mandatory union dues or fees only, Mandatory uniforms and tools only, Nonarrearage payments on court, order, Amount reserved to support, Qualified Child Deduction Section, PARENT A, PARENT B, a Number of qualified children, b Total number of children for, Number of children on this order, c Add lines through, Line line c, e Enter amount from the schedule, and d income and the total number of in order to move on to the 3rd stage.

child support ct calculator writing process described (part 2)

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