CHILD SUPPORT CALCULATION WORKSHEET

State of North Carolina -- Income Shares Model

N.C.G.S. S 50-13.4

Table of Contents

1. Case Information
2. Identification of Children
3. Worksheet Selection
4. Gross Income Determination
5. Adjustments to Gross Income
6. Basic Support Obligation
7. Additional Expenses
8. Shared Custody Adjustment (Worksheet B)
9. Deviation Factors
10. Duration and Modification
11. Certification and Signatures
12. Sources and References

1. Case Information

2. Identification of Children

Total Number of Children Subject to This Order: [____]

3. Worksheet Selection

☐ Worksheet A -- Primary Custody (noncustodial parent has fewer than 123 overnights/year)

☐ Worksheet B -- Shared Custody (each parent has 123 or more overnights/year)

Custodial Parent: ☐ Parent 1 ☐ Parent 2

Noncustodial Parent: ☐ Parent 1 ☐ Parent 2

4. Gross Income Determination

4A. Monthly Gross Income

4B. Imputed Income (If Applicable)

☐ Parent 1 voluntarily unemployed/underemployed -- Imputed income: $[________]/month

☐ Parent 2 voluntarily unemployed/underemployed -- Imputed income: $[________]/month

5. Adjustments to Gross Income

Adjusted Monthly Gross Income:

Combined Adjusted Gross Income: $[________]

Parent 1's Income Share: [________]%

Parent 2's Income Share: [________]%

6. Basic Support Obligation

Self-Support Reserve

☐ Not applicable -- Income is above the shaded area of the schedule

☐ Applicable -- Obligor's income falls within the self-support reserve (shaded area)

• ☐ Minimum order of $50/month applies

7. Additional Expenses

Health Insurance Reasonableness Check:

☐ Premium does not exceed 5% of providing parent's gross income -- reasonable

☐ Premium exceeds 5% -- court to determine reasonableness

Total Obligation (Basic + Additional):

8. Shared Custody Adjustment (Worksheet B)

☐ Not applicable -- Worksheet A used

☐ Worksheet B applies:

9. Deviation Factors

☐ No deviation requested

☐ Deviation requested -- Check all applicable factors:

• ☐ Application would not meet the reasonable needs of the child
• ☐ Application would exceed the reasonable needs of the child
• ☐ Relative ability of each parent to provide support
• ☐ Guidelines are unjust or inappropriate in this case
• ☐ Obligor's income falls within the self-support reserve and payment of childcare/health insurance is at issue
• ☐ Extraordinary child-related expenses (special schooling, transportation between homes)
• ☐ Childcare tax credits received
• ☐ Other: [________________________________]

Requested deviation amount: $[________]/month

Justification: [________________________________]

10. Duration and Modification

Support Commencement Date: [__/__/____]

Termination Events:

• ☐ Child reaches age 18
• ☐ Child graduates secondary school or reaches age 20 (whichever is first, if still in school at 18)
• ☐ Child becomes emancipated
• ☐ Child marries
• ☐ Child enters military service
• ☐ Child dies
• ☐ Other: [________________________________]

Final Monthly Child Support Amount: $[________]

Payable by: ☐ Parent 1 ☐ Parent 2

Payment Method: ☐ Income Withholding ☐ NC Centralized Collections ☐ Direct Payment

11. Certification and Signatures

I declare under penalty of perjury under the laws of the State of North Carolina that the foregoing information is true and correct to the best of my knowledge and belief.

Parent 1:

Signature: [________________________________]
Printed Name: [________________________________]
Date: [__/__/____]

Parent 2:

Signature: [________________________________]
Printed Name: [________________________________]
Date: [__/__/____]

Attorney for Parent 1 (if applicable):

Signature: [________________________________]
Bar Number: [________________________________]
Date: [__/__/____]

Attorney for Parent 2 (if applicable):

Signature: [________________________________]
Bar Number: [________________________________]
Date: [__/__/____]

12. Sources and References

• N.C.G.S. S 50-13.4 (Child Support)
• N.C.G.S. S 50-13.11(a1) (Guidelines Adoption)
• North Carolina Child Support Guidelines (Conference of Chief District Court Judges)
• NC Schedule of Basic Support Obligations
• NC Department of Health and Human Services, Child Support Services: https://www.ncdhhs.gov/divisions/social-services/child-support-services

North Carolina's self-support reserve provides a minimum $50 monthly order for low-income obligors. The shared custody adjustment (Worksheet B) multiplies the basic obligation by 1.5 before allocation when each parent has 123+ overnights. Health insurance is considered reasonable if it does not exceed 5% of the providing parent's gross income. Incarceration is generally not treated as voluntary unemployment.