IMPORTANT: THIS IS A PREPARATION GUIDE — NOT THE OFFICIAL COURT WORKSHEET

Pennsylvania requires the use of the official Support Guidelines Worksheet under Pa.R.C.P. 1910.16-4 for child support calculations.
This template provides the substantive content and calculation methodology to help you
prepare — but you must transfer your figures to the official worksheet before filing.
The official guidelines are available at https://www.pacodeandbulletin.gov (search Pa.R.C.P. 1910.16).
Do not file this document directly with the court.

CHILD SUPPORT CALCULATION WORKSHEET

Commonwealth of Pennsylvania -- Income Shares Model

23 Pa.C.S. S 4322; Pa.R.C.P. 1910.16-1 et seq.

Table of Contents

1. Case Information
2. Identification of Children
3. Gross Income Determination
4. Deductions and Net Income
5. Basic Support Obligation
6. Additional Expenses
7. Shared or Partial Custody Adjustment
8. Deviation Factors
9. Duration and Modification
10. Certification and Signatures
11. Sources and References

1. Case Information

2. Identification of Children

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

3. Gross Income Determination

3A. Monthly Gross Income

3B. Imputed Income (If Applicable)

☐ Parent 1 voluntarily unemployed/underemployed -- Earning capacity: $[________]/month

☐ Parent 2 voluntarily unemployed/underemployed -- Earning capacity: $[________]/month

4. Deductions and Net Income

Net Monthly Income:

Combined Net Monthly Income: $[________]

Parent 1's Percentage of Combined Net Income: [________]%

Parent 2's Percentage of Combined Net Income: [________]%

5. Basic Support Obligation

☐ Low-Income Obligor: Computed Allowance Minimum (CAM) applies

Adjusted obligor's share: $[________]

6. Additional Expenses

Total Obligation (Basic + Additional):

7. Shared or Partial Custody Adjustment

☐ Not applicable -- Obligor has fewer than 40% of overnights

☐ Shared custody adjustment applies:

Adjusted Monthly Child Support After Shared Custody Calculation: $[________]

8. Deviation Factors

☐ No deviation requested

☐ Deviation requested -- Check all applicable factors:

• ☐ Unusual needs and unusual fixed obligations
• ☐ Other support obligations of the parties
• ☐ Other income in the household
• ☐ Ages of the children
• ☐ Assets of the parties
• ☐ Medical expenses not covered by insurance
• ☐ Standard of living of the parties and children
• ☐ Best interests of the child
• ☐ Other relevant and appropriate factors: [________________________________]

Requested deviation amount: $[________]/month

Justification: [________________________________]

9. Duration and Modification

Support Commencement Date: [__/__/____]

Termination Events:

• ☐ Child reaches age 18 or graduates high school (whichever is later)
• ☐ Child becomes emancipated
• ☐ Child marries
• ☐ Child enters military service
• ☐ Child dies
• ☐ Other: [________________________________]

Total Monthly Child Support Amount: $[________]

Payable by: ☐ Parent 1 ☐ Parent 2

Payment Method: ☐ Income Attachment ☐ Pennsylvania SCDU ☐ Direct Payment

10. Certification and Signatures

I declare under penalty of law that the information contained in this worksheet 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: [________________________________]
Attorney ID: [________________________________]
Date: [__/__/____]

Attorney for Parent 2 (if applicable):

Signature: [________________________________]
Attorney ID: [________________________________]
Date: [__/__/____]

11. Sources and References

• 23 Pa.C.S. S 4322 (Child Support Guideline)
• 23 Pa.C.S. S 4302 (Definitions -- Income)
• 23 Pa.C.S. S 4352 (Duration of Obligation)
• 23 Pa.C.S. S 4305 (Modification of Existing Orders)
• Pa.R.C.P. 1910.16-1 through 1910.16-7 (Support Guidelines and Worksheets)
• Pa.R.C.P. 1910.16-3 (Basic Child Support Schedule)
• Pa.R.C.P. 1910.16-6 (Additional Expenses)
• Pennsylvania Child Support Program: https://www.humanservices.state.pa.us/csws

Pennsylvania treats health insurance premiums as additional allocated expenses rather than deductions from income. Unreimbursed medical expenses are allocated only for amounts exceeding $250 per child per year, excluding chiropractic services. The guidelines include a Computed Allowance Minimum (CAM) to protect low-income obligors.