CHILD SUPPORT CALCULATION WORKSHEET

State of Tennessee

Court: [________________________________]
County: [________________________________]
Case No.: [________________________________]
Judge: [________________________________]
TCSES Case No.: [________________________________]

TABLE OF CONTENTS

1. Party and Children Identification
2. Calculation Model
3. Gross Income Determination
4. Adjustments to Income
5. Child Support Obligation Formula
6. Healthcare Expenses
7. Childcare Expenses
8. Extraordinary Expenses
9. Deviation Factors
10. Duration and Termination
11. State-Specific Notes

1. PARTY AND CHILDREN IDENTIFICATION

Mother:
- Full Name: [________________________________]
- Status: ☐ PRP ☐ ARP ☐ Split
- Employer: [________________________________]

Father:
- Full Name: [________________________________]
- Status: ☐ PRP ☐ ARP ☐ Split
- Employer: [________________________________]

Non-Parent Caretaker (if applicable): [________________________________]

Children Subject to This Order:

2. CALCULATION MODEL

Model: Income Shares per Tenn. Comp. R. & Regs. 1240-02-04
Number of Children: [____]
Total Parenting Days: PRP: [____] / ARP: [____] (must total 365)

3. GROSS INCOME DETERMINATION

Federal Benefits Paid to Child on Parent's Record:
- PRP: $[________] per month
- ARP: $[________] per month

4. ADJUSTMENTS TO INCOME

5. CHILD SUPPORT OBLIGATION FORMULA

Step 1: Combined AGI: $[________]

Step 2: Basic Child Support Obligation (BCSO) from TN Schedule (for [__] children): $[________]

Step 3: Percentage of Income (PI):
- PRP: $[________] / $[________] = [____]%
- ARP: $[________] / $[________] = [____]%

Step 4: Each Parent's Share of BCSO:
- PRP: $[________] x [____]% = $[________]
- ARP: $[________] x [____]% = $[________]

Step 5: Parenting Time Adjustment (PTA):
- ARP Days: [____]
- ☐ 0–68 days: PTA penalty (increase)
- ☐ 69–92 days: No PTA
- ☐ 93–182 days: PTA credit (decrease)
- ☐ 182.5 days each: Equal parenting calculation
- Adjusted BCSO for ARP: $[________]

6. HEALTHCARE EXPENSES

☐ Each parent pays their PI% of uninsured medical expenses
☐ PRP PI%: [____]% / ARP PI%: [____]%

7. CHILDCARE EXPENSES

• PRP's Share: [____]% = $[________]
• ARP's Share: [____]% = $[________]

8. EXTRAORDINARY EXPENSES

9. DEVIATION FACTORS

☐ No deviation requested
☐ Deviation requested based on:

☐ Extraordinary educational expenses
☐ Extraordinary medical expenses not covered by insurance
☐ Child in legal custody of another entity
☐ Extreme economic hardship
☐ High-income parents (combined monthly AGI >$28,250)
☐ Low-income obligor
☐ Best interest of the child
☐ Other: [________________________________]

Deviation Amount: $[________] per month
Written Justification: [________________________________]

10. DURATION AND TERMINATION

Child support continues until the earliest of:
- Child reaches age 18 and graduates from high school
- Child reaches age 19 (regardless of school status)
- Child marries or is emancipated
- Child enters military service
- Further order of the court

11. STATE-SPECIFIC NOTES

• High-Income Cap: For combined monthly AGI above $28,250, the BCSO from the schedule is used plus a percentage of income above $28,250 (6.81% for 1 child, 7.22% for 2, etc.).
• Low-Income Provision: When obligor's income falls in the shaded area of the schedule, a second calculation using only the obligor's income is performed; the lesser amount applies.
• Modification: Requires a significant variance of 15% or more (7.5% for orders initially set under Income Shares).
• Income Imputation: If a parent fails to provide income evidence, median income figures may be imputed.
• Parenting Plan Required: All custody orders require a parenting plan specifying days with each parent.

SUMMARY OF CHILD SUPPORT OBLIGATION

Final Child Support Order (FCSO): $[________] per month paid by [________] to [________]

Prepared By: [________________________________]
Date: [__/__/____]
BPR No.: [________]

Sources and References:
- TN Child Support Guidelines
- TN Child Support Calculator
- Tenn. Code Ann. § 36-5-101; Tenn. Comp. R. & Regs. 1240-02-04