Worksheet B - Child Support Obligation: Shared Physical Care Page 2
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1
2a. Work-related Child Care Costs - Actual costs minus Federal
$
$
Tax Credit pursuant to §14-10-115(9), C.R.S.
b. Education-related Child Care Costs pursuant to §14-10-
$
$
115(9), C.R.S.
c. Health Insurance premium costs - Children’s portion only
$
$
pursuant to §14-10-115(10), C.R.S
(See page 2 for
.
calculation worksheet)
d. Extraordinary Medical Expenses - Uninsured only pursuant to
$
$
§14-10-115(10), C.R.S.
e. Extraordinary Expenses - Agreed to by parents or by order of
$
$
the court pursuant to §14-10-115((11)(a), C.R.S.
f. Minus Extraordinary Adjustments pursuant to §14-10-115((11)
$
$
(b), C.R.S]
$
$
$
11. Total Adjustments
(For each column, add 10a, 10b, 10c,
10d and 10e. Subtract line 10f. Add two totals for Combined
column amount)
$
$
12. Each Parent’s Share of Adjustments
(Line 11
Combined column times line 3 for each parent)
13. Adjustments Paid in Excess of Fair Share
$
$
(Line
11 minus line 12. If negative number, enter zero)
14. Each Parent’s Adjusted Support Obligation
$
$
(Line 9 minus line 13)
$
$
15. Recommended Child Support Order**
(Subtract
lesser amount from greater amount in line 14 and enter result
under greater amount)
Comments:
*
This adjustment applies only to modification of child support orders entered between 7/1/91 and 7/1/97 that
provide for post-secondary education expenses pursuant to §14-10-115(15)(c), C.R.S.
**If either the paying parent’s monthly adjusted gross income or the combined monthly adjusted gross income
is less than $850.00, see §14-10-115(7)(a)(II)(B) and (C), C.R.S.
Prepared by:
Date:
Signature: ________________________________Print Name: ___________________________
The amount of child support ordered for shared physical care should not be more than
an order for sole physical care. Complete a Worksheet A for comparison.
Heath Insurance Premium Calculation
If the actual amount of the health insurance premium that is attributable to the child(ren) who are the subject of
this order is not available or cannot be verified, the total cost of the premium should be divided by the number of
persons covered by the policy to determine a per person cost. This amount is then multiplied by the number of
children who are the subject of this order and are covered by the policy. This amount is then entered on line 10c
on page 1 of this form.
$
÷
= $
X
=
Total
Number of
Per Person Cost
Number of
Children’s Portion of
Premium
Persons Covered
Children Who
Cost of Health
by the Policy
Are the Subject
Insurance Premium
of this Order
(Enter on line 10c)
JDF 1821M R1/08 WORKSHEET B – CHILD SUPPORT OBLIGATION: SHARED PHYSICAL CARE
Page 2 of 2
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