Form Ccsg-1 - Worksheet For The Connecticut Child Support And Arrearage Guidelines
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1
2STATE OF CONNECTICUT
CCSG-1 Rev. 7-15
C.G.S. §46b-215a
§46b - 215a - 6, Regulations of
COMMISSION FOR CHILD SUPPORT GUIDELINES
Connecticut State Agencies
WORKSHEET for the Connecticut Child Support and Arrearage Guidelines
PARENT A
PARENT B
CUSTODIAN
PARENT A
PARENT B
OTHER:
COURT
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)
$
$
PARENT A
PARENT B
Qualified Child Deduction Section:
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.)
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