In Re Proposed Amendments to Administrative Order No. 10

Cite as 2022 Ark. 92 SUPREME COURT OF ARKANSAS Opinion Delivered: April 14, 2022 IN RE AMENDMENTS TO ADMINISTRATIVE ORDER NO. 10 PER CURIAM The Supreme Court Committee on Child Support has proposed changes to Administrative Order No. 10 and the Affidavit of Financial Means. The Court extends its sincere gratitude to the members of the Child Support Committee for their work. These proposals are being published for comment, and the period shall end May 12, 2022. Comments should be submitted in writing to: Clerk of the Arkansas Supreme Court, Attention: Child Support Committee, Justice Building, 625 Marshall Street, Little Rock, Arkansas 72201. Administrative Order No. 10 – Child Support Guidelines Section I. Authority and Scope Pursuant to Act 948 of 1989, as amended, codified at Ark. Code Ann. § 9-12-312(a) and the Family Support Act of 1988, Pub. L. No. 100-485 (1988), the Court adopted and published Administrative Order Number 10, titled “Child Support Guidelines” (“Guidelines”). Pursuant to Act 907 of 2019, codified at Ark. Code Ann. § 9-12-312(a)(4), the attached revised monthly “Family Support Chart” (“Chart”) is based on an Income Shares Model. The attached Chart therefore, supersedes any prior payor-income-based family support chart. (Section II.1 discusses when this Administrative Order’s incorporation of the Income Shares Model affects existing child- support orders.) This Administrative Order includes and incorporates by reference the “Forms” Addendum: Sample Calculation, Sample Language for Child-Support Orders, Family Support Chart, Child Support Worksheet (“Worksheet”), and the revised Affidavit of Financial Means. These Guidelines are based on the Income Shares Model, developed by the Child Support Guidelines Project of the National Center for State Courts. The Income Shares Model is based on the concept that children should receive the same proportion of parental income that they would have received had the parents lived together and shared financial resources. The best available economic data on child-rearing expenditures was used to develop the model. A more detailed explanation of the Income Shares Model and the underlying economic evidence used to support it is contained in Development of Guidelines for Child Support Orders, Report to the Federal Office of Child Support Enforcement, September 1987 (National Center for State Courts, Denver, Colorado). The September 2019 Review of the Arkansas Child Support Guidelines, an Analysis of Economic Data, Development of Income Shares Charts, and Other Considerations, prepared by Jane Venohr, Ph.D., is available at www.arcourts.gov/forms-and-publications/arkansas-child- support-guidelines. Under the revised Family Support Chart, each parent’s share is that parent’s prorated share of the two parents’ combined income. The Chart reflects the average amount of money that families in the United States spend on their children. Differences between Arkansas prices and prices across the United States more generally have been accounted for using an index that the U.S. Bureau of Economic Analysis (BEA) developed. The Chart also considers and accounts for: • federal and state income taxes and FICA; • average child-rearing expenditures using current measurements developed by Professor David Betson using the Rothbarth methodology to separate the children’s share of expenditures from total expenditures; • out-of-pocket medical expenses of $250.00 per child per year. The Chart excludes parental expenditures for work-related childcare, the child’s share of health insurance premiums, and out-of-pocket medical expenses over $250.00 per child per year. These Guidelines and the accompanying Worksheet assume that the parent to whom support is owed (payee parent) is spending his or her calculated share directly on the child. For the parent with the obligation to pay support (payor parent), the pro-rata charted amount establishes the base level of child support to be given to the payee parent. The base amount may, however, be adjusted to account for work-related childcare expenditures, the child’s share of the health insurance premium, out-of-pocket medical expenses exceeding $250.00 per child per year, the self- support reserve, or other factors a court determines to be in the best interest of a child or children. Section II. Use of the Guidelines There is a rebuttable presumption that the amount of child support calculated pursuant to the most recent revision of the Family Support Chart and these Guidelines is the amount to be awarded in any judicial proceeding for divorce, separation, paternity, guardianship, or child support. 2 In addition to an initial award for child support or the modification of an existing obligation, these Guidelines should be used to assess the adequacy of agreements for child support and to encourage parties to settle support-related disputes in a comprehensive manner. These Guidelines provide calculated amounts of child support for a combined parental gross income of up to $30,000.00 per month, or $360,000.00 per year. The child-support obligation for incomes above $30,000.00 per month shall be determined by using the highest amount in these Guidelines. The court may then use its discretion in setting an amount above that to meet the needs of the child and the parent’s ability to provide support. These Guidelines assume that the payor parent has the minor child(ren) overnight in his or her residence less than 141 overnights per calendar year. 1 0F 1. Modification of Existing Child-Support Obligation: Pursuant to Act 904 of 2019, codified at Arkansas Code Annotated § 9-14-107(c)(2), “an inconsistency between the existing child-support award and the amount of child support that results from application of the Family Support Chart shall constitute a material change of circumstances sufficient to petition the court for modification of child support according to the Family Support Chart after appropriate deductions unless: a. The inconsistency does not meet a reasonable quantitative standard established by the State of Arkansas in accordance with subsection (a) of this section; b. The inconsistency is due to the fact that the amount of the current child support award resulted from a rebuttal of the guideline amount and there has not been a change of circumstances that resulted in the rebuttal of the guidelines amount; or c. The inconsistency is due solely to a promulgation to a revision of the Family Support Chart.” 2 1F 2. Deviation from the Chart: All orders granting or modifying child support shall contain the court’s determination of the payor’s income, payee’s income, recite the amount of support required under these Guidelines, and state whether the court deviated from the presumptive child-support calculation set by the Worksheet and these Guidelines. If an order deviates from the Guidelines amount, then the order must explain the reason(s) for the deviation. When deciding whether the Worksheet-based amount is unjust or inappropriate, the court must consider all the relevant factors, including what is in the child’s or children’s best interest. A deviation from these Guidelines should be the exception rather than the rule. If a court chooses to deviate from the Guidelines amount, th en it must make written findings and explain the deviation. It shall be sufficient in a particular case to rebut the presumption that the amount of child support calculated pursuant to the Worksheet is correct if the court provides in the order a specific written finding that the Worksheet-based amount is 1 This Administrative Order presumes that a traditional visitation schedule will be less than 141 nights while a liberal visitation schedule is usually more than 141 nights. 2 The Section titled “Modification of Existing Child-Support Order” recites verbatim Arkansas Code Annotated 9-14-107(c)(2). 3 unjust or inappropriate. When determining whether to deviate from the Guidelines’ amount, a court should consider the following: a. Educational expenses for the child(ren) (i.e., those incurred for private or parochial schools, or other schools where there are tuition or related costs) and/or the provision or payment of special education needs or expenses for the child(ren); b. The procurement and/or maintenance of life insurance, dental insurance, and/or other insurance for the children’s benefit (for health insurance premiums, see Section II.2 infra); c. Extraordinary travel expenses for court-ordered visitation; d. Significant available income of the child(ren); e. The creation or maintenance of a trust fund for the children; f. The support given by a parent for minor children in the absence of a court order; g. Extraordinary time spent with the payor parent; h. Additional e x p e n s e s i n c u r r e d b e c a u s e o f natural or adopted children living in the home, including stepchildren if the court finds there is a court-ordered responsibility to a stepchild; i. The provision for payment of work-related childcare, extraordinary medical expenses for the child in excess of $250.00 per year per child, and/or health insurance premiums. Ordinarily, these expenses will be divided pro rata between the parents and added to the base child support of the payor parent on the Worksheet. In that scenario, it shall not support a deviation. However, if the court chooses not to add them in the total child-support obligation, they could support a deviation; and j. Any other factors that warrant a deviation. 3. Self-Support Reserve, Minimum Order, and Deviation from the Minimum Order: In cases where the payor parent’s monthly gross income is less than $900.00, the Chart applies a self-support reserve (SSR). The SSR considers the basic subsistence needs of the payor parent and is based on the Federal Poverty Guidelines multiplied by Arkansas’s price parity. Arkansas’s price parity is the index used to adjust the Chart to reflect Arkansas prices. If the payor parent’s child-support amount pursuant to the chart is based solely on the payor parent’s gross income and corresponding number of children falls within the shaded area of the Chart, then the basic child-support obligation and the payor parent’s total child-support obligation are computed using only the payor parent’s income. In these cases, health insurance premiums, extraordinary medical expenses, and childcare expenses shall not be used to calculate the total child-support obligation. However, payment of these costs by either parent may be used as a reason to deviate from these Guidelines. When the payor parent’s monthly gross income is less than $900.00, a presumptive minimum award of $125.00 per month must issue unless a party can rebut the presumptive amount by a preponderance of the evidence. Some factors that a court may consider when deciding whether a party has rebutted the minimum order amount include but are not limited to the following: a. There is a large adjustment due to parenting time; b. The payor is incarcerated (see Section II.4 below); c. The payor is institutionalized due to a mental illness or other impairment; 4 d. The payor has a verified physical disability that precludes work; e. The payor’s only income is Supplemental Security Income (SSI); f. The payor’s ability or inability to work; or g. Any other deviation factor listed above in Subsection II.2 or any income imputation factor listed below in Section III.7. 4 . Inc a rc e ra te d Individua ls Pursuant to Act 904 of 2019, codified at Arkansas Code Annotated § 9-12-312(a), § 9-14- 106(a), and § 9-14-107(a), the incarceration of a parent shall be treated as involuntary unemployment for the purpose of establishing or modifying an award of child support. “Incarceration” means a conviction that results in a sentence of confinement to a local jail, state or federal correctional facility, or state psychiatric hospital for at least 180 days and excludes credit for time served before sentencing. Section III. Gross Income 1. Definitions: “Income” means the actual gross income of the parent, if employed to full capacity, or potential income if unemployed or underemployed as allowed under Section III.7. Gross income is used to avoid disputes over issues of deductibility that would arise if a net income was used. These Guidelines presume that the parent with the legal obligation to pay support will file federal taxes as a single individual and have only one state exemption. Adjustments have been made in the Chart for federal and state income taxes, FICA, and average child-rearing expenditures (for example, out-of-pocket medical expenses of $250.00 per child per year). The monthly child-support amount shall be converted to coincide with the payor’s receipt of salary, wages, or other income. For purposes of computing gross monthly income, a month is 4.334 weeks. Bi-weekly means a party is paid once every two weeks, or 26 times during a calendar year. Semi-monthly means a person is paid twice a month, or 24 times per calendar year. “Child Support Gross Income” means gross income—minus amounts for preexisting child- support obligations paid to another who is not a party to the proceedings and on behalf of a child who is not the subject of the action of the court. Child support arrearage payments shall not be considered in determining a payor’s gross income. “Combined Gross Income” means the combined gross income of both parties. 2. Gross Income Inclusions: “Income” is “intentionally broad and designed to encompass the widest range of sources consistent with the State’s policy to interpret ‘income’ broadly for the benefit of the child.” Evans v. Tillery, 361 Ark. 63, 204 S.W.3d 547 (2005); Ford v. Ford, 347 Ark. 485, 65 S.W.3d 432 (2002); McWhorter v. McWhorter, 346 Ark. 475, 58 S.W.3d 840 (2001); Davis v. Office of Child Support Enforcement, 341 Ark. 349, 20 S.W. 3d 273 (2000). Gross income includes, but is not limited to, the following: 5 i. Wages, overtime pay, commissions, regularly-received bonuses, or other monies from all employers or as a result of any employment (as usually reported in the Medicare, wages, and tips section of the parent’s W-2). ii. Earnings generated from a business, partnership, contract, self-employment or other similar arrangement, or from rentals. (a) Income (or losses) from a corporation should be carefully examined to determine the extent to which they were historically passed on to the parent or used merely as a tax strategy. iii. Distributed profits or payments from profit-sharing, a pension or retirement, an insurance contract, an annuity, trust fund, deferred compensation, retirement account, social security disability payments, social security retirement payments, unemployment compensation, supplemental unemployment benefits, disability insurance or benefits, or worker’s compensation. (a) Consider insurance or other similar payments received as compensation for lost earnings, but do not include payments that compensate for actual medical bills or for property loss or damage. (b) If a parent receives payments from an IRA, defined contribution, or deferred compensation plan, income does not include contributions to that account that were previously considered as the parent’s income used to calculate an earlier child-support obligation for a child in this case. To the extent that the funds received are equivalent to the amount of the funds contributed by the parent while paying child support, that amount should be excluded from the computation of gross income. (c)(1) When a monthly auxiliary Social Security payment is paid directly to a payee parent on behalf of a child(ren), that payment shall be treated as child support paid by the payor when: i) The monthly auxiliary benefit is paid from the payor’s social security account; and ii) The payor and the payee are parties to the same child support case and the monthly auxiliary payment will benefit those same child(ren). (2) If the monthly auxiliary benefit paid to the payee parent exceeds the amount of child support the court has ordered to be paid, then the excess benefit shall be treated as a gift that should not be credited against future child support or past due child support unless otherwise ordered by the court. If the monthly auxiliary payment does not satisfy the monthly child support for which the payor is responsible, then the payor is responsible for the difference unless the court finds that a deviation is warranted as set forth in Section II, Paragraph 2 herein. (3) In the event that the auxiliary benefit is paid directly to the payor parent, then the payor parent shall use those funds to pay his or her child support obligation to the payee parent. iv. Military specialty pay, allowance for quarters and rations, housing, veterans’ administration benefits, G.I. benefits (other than education allotment), or drill pay. (a) If the servicemember receives housing pay and supports another home (i.e. second residence), housing pay is not considered income to the individual. v. Tips, gratuities, royalties, interest, dividends, fees, or gambling or lottery winnings. vi. Capital gains to the extent that they result from recurring transactions. vii. The standard (basic needs) portion of adoption subsidies for children in the case under consideration (do not consider the medical needs and intensive rate portion of the subsidy, nor the family support subsidy as income). 6 viii. Any money or income due or owed by another individual, source of income, government, or other legal entity. ix. Income also includes the market value of perquisites (perks) received as goods, services, or other noncash benefit for which the parent did not pay, if they reduce personal expenses, and have significant value or are received regularly. (a) Common forms of perquisites (perks) or goods and services received in-kind include, but are not limited to, the following: housing, meals, or room and board, personal use of a company business vehicle or mileage reimbursement, including use between home and primary worksite, and other goods or services. (b) Perquisites (perks) do not include money paid by an employer for benefits like tuition reimbursement, educational cost reimbursement, uniforms, and health savings account (HSA) contributions. x. The court may consider assets available to generate income for child support. For example, the court may determine the reasonable earning potential of any asset at its market value and assess against it the current Treasury bill interest rate or some other similar appropriate method of computing income. To further this State’s policy of interpreting “income” broadly for the benefit of children, a support order may include as its basis a percentage of a bonus to be paid in the future. The child support attributable to a bonus amount (or another one-time source of money) shall be in addition to the periodic child-support obligation. This child-support obligation shall terminate when the underlying child-support obligation terminates. Variable income such as commissions, bonuses, overtime pay, military bonuses, and dividends shall be averaged by the court over a reasonable period of time consistent with the circumstances of the case and added to a parent's fixed salary or wages to determine gross income. When income is received on an irregular, nonrecurring, or one- time basis, the court may, but is not required to, average or prorate the income over a reasonable specified period of time or require the parent to pay as a one-time support amount a percentage of his or her nonrecurring income. One-time sources of money like an inheritance, gambling or lottery winning, or liquidating a Certificate of Deposit, for example, is income for these Guidelines purposes (as detailed in the previous paragraph). If the receipt of an asset is not sold or otherwise disposed of, however, then it has not “realized a gain” and therefore is not income under these Guidelines. 3. Income from Self-employment, Business Owners, Executives, and Others a. Difficulty in determining income for self-employed individuals, business owners, and others occurs for several reasons including: i. These individuals often have types of income and expenses not frequently encountered when determining income for most people. ii. Taxation rules, business records, and forms associated with business ownership and self-employment differ from those that apply to individuals employed by others. Common business documents reflect policies unrelated to an obligation to support one’s child. iii. Due to the control that business owners or executives exercise over the form and manner of their compensation, a parent, or a parent with the cooperation of a business owner or executive, may arrange compensation to reduce the amount visible to others looking for common forms of income. 7 b. To determine monies that a parent has available for support, it may be necessary to examine business tax returns, balance sheets, accounting or banking records, and other business documents to identify additional monies a parent has available for support that were not included as personal income. At a minimum, a self-employed parent shall provide their two most recent years of state and federal tax returns. The parent should provide three years of tax returns when there is a reduced, deferred, or elective income situation. Unless otherwise prohibited by law, the court may award expert witness fees when necessary to determine self-employed parent’s income. c. For income from self-employment, proprietorship of a business, or ownership or a partnership or closely held corporation, gross income is defined as gross receipts minus ordinary and necessary expenses required for self-employment or business operation, including an employer’s share of FICA. However, the court should exclude from those expenses amounts allowed by the Internal Revenue Service for accelerated depreciation of investment tax credits for purposes of these Guidelines and add those amounts back in to determine gross income. In general, the court should carefully review income and expenses from a parent’s self-employment or operation of a business to determine actual levels of gross income available to the parent. The court’s duty is to accurately determine a child-support obligation in every case. This amount may differ from the determination of business income for tax purposes. d. Whether organized informally, or as a corporation, a partnership, a sole proprietorship, or other arrangement or entity, these considerations apply to all forms of self- employment and business ownership, as well as to business executives and others who may receive similar forms of compensation. e. For purposes of this subsection, income includes amounts that were not otherwise included as income elsewhere in this chapter. Special attention shall be given to the following forms of compensation: i. Distributed profits, profit sharing, officers’ fees and other compensation, management or consulting fees, commissions, and bonuses. ii. In-kind income or perquisites (perks), gifts, free admission to entertainment, or personal use of business property. The value of these items must be based on a fair-market price, that is, the price a person not affiliated with the business would pay. In-kind payments received by a parent from self-employment or the operation of a business is income if the payments are significant and reduce personal living expenses. f. Redirected income, or amounts treated by the business or company as if the redirected amounts were something other than the parent’s income. Amounts include, but are not limited to, the following: i. Personal loans. Presume personal loans from a business are in fact redirected income, unless all the following are true: (1) the parent signed a contract or promissory note outlining the terms of the loan, (2) the business maintains records showing the loan owed as a receivable, (3) the parent makes installment payments and the present loan is paid current, and (4) the interest earned and repayment rate appear to be a reasonable business practice. Unless the presumption is overcome by a preponderance of the evidence, then a parent’s income includes the difference between the amount the parent repays and a repayment amount for a similar commercially available unsecured personal loan. ii. Payments made to friends or relatives of the parent. If the business cannot demonstrate that the payments are equivalent to a fair market value payment for the work or services the friend or relative performs, then include any amount that exceeds the fair-market value as the parent’s income. 8 g. Reduced or deferred income. Because a parent’s compensation can be rearranged to hide income, determine whether unnecessary reductions in salaries, fees, or distributed profits have occurred by comparing amounts and rates to historical patterns. i. Unless the business can demonstrate legitimate reasons for a substantial reduction in the percentage of distributed profits, use a three-year average to determine the amount to include as a parent’s income. ii. Unless a business can demonstrate legitimate reasons for reductions (as a percentage of gross business income) in salaries, bonuses, management fees, or other amounts paid to a parent, use a three-year average to determine the amount to include as a parent’s income. h. Business income subject to elective treatment. Income that is subject to elective status (for example, retained income) may be considered as income after the court considers the circumstances and history of the elective treatment, which includes but is not limited to the status prior to the implementation of the support order. If a change in the status was made after the original election, then a court can either choose to include the income in child-support calculations or not include it in the calculations. i. Deductions for Tax Purposes. For a variety of historical and policy reasons, the government allows considerable deductions for business-related expenses before taxes are calculated. Those same considerations are not always relevant to monies a parent should have available for child support. Therefore, some deductions should be added back into a parent’s income for purposes of determining child support. The deductions include, but are not limited to, the following: i. Rent paid by the business to the parent, if it is not counted as income on that parent’s personal tax return. ii. Real estate depreciation shall always be added back into a parent’s income when calculating support. iii. Depreciation figured at a straight-line (not accelerated) rate on a parent’s (not a corporation’s or partnership’s) tangible personal property, other than for personal vehicles or home offices, shall be deducted from income. Any parent who uses accelerated depreciation for tangible personal property may deduct the value of the straight-line depreciation amount for property other than personal vehicles or home offices, if the parent proves what the straight-line amounts would have been. iv. Home office expenses, including rent, hazard insurance, utilities, repairs, and maintenance. v. Entertainment expenses spent by the parent. Legitimate expenses for customers’ entertainment may be treated as deductions. vi. Travel expense reimbursements, except where such expenses are inherent in the nature of the business or occupation (for example, a traveling salesperson), and do not exceed the standard rates allowed by the State of Arkansas for employee travel. vii. Personal automobile repair and maintenance expenses. 4. Gross Income Exclusions: Gross income does not include benefits received from means-tested public assistance programs, such as Temporary Assistance to Needy Families (TANF), Supplemental Security Income (SSI) received for self or any child; Food Stamps and General Assistance; income derived by other household members; child support, adoption subsidy payments, and foster care board payments received for other children not involved in the case. 9 5. Spousal Support: If a parent paying spousal support also pays child support to the same person, then the amount of alimony a former payee spouse may be receiving shall be reduced from the payor’s gross income and added to the payee’s gross income for purposes of determining income under the child- support calculation. 6. Other Child Support Paid: Any previous or existing court orders requiring the payment of current child support shall receive priority over any subsequent child-support obligation. A subsequent support obligation shall not constitute the sole basis for a material change of circumstances sufficient to support a petition to the court for modification of a prior child-support order. Current child support paid for the benefit of children other than those considered in this computation, to the extent such payment or payments are required by a previous court order, shall be deducted from gross income. Child support arrearage payments shall not be considered in determining a payor’s gross income. 7. Income Verification: The Affidavit of Financial Means and Worksheet shall be used in all family-support matters. Each party shall exchange the Affidavit of Financial Means and Worksheet at least three days before a hearing to establish or modify a support order. The Worksheet shall be filed in the court file and attached to the order that includes the child-support award. The Affidavit of Financial Means shall not be filed in the court file. A court may rely on suitable documentation of current earnings, preferably for at least one month. Suitable documentation includes, but is not limited to, pay stubs, employer statements or verifications, and receipts and expenses if the parent is self-employed. Verification of current earnings, whether they are reflected on the Affidavit of Financial Means or not, can be supported with copies of the most recent federal and state tax returns that a parent has filed. Income can also be verified through the Department of Workforce Services or through the Department of Finance and Administration. 8. Income Imputation Considerations: If imputation of income is ordered, the court must take into consideration the specific circumstances of both parents, to the extent known, including such factors as the parents’ assets, residence, employment and earnings history, job skills, educational attainment, literacy, age, health, criminal record and other employment barriers, and record of seeking work, as well as the local job market, the availability of employers willing to hire the parent, prevailing earnings level in the local community, and other relevant background factors in the case. 10 There is a rebuttable presumption that the payor and the payee can work full-time or earn full-time income, and the court may calculate child support based on a determination of potential income that would otherwise ordinarily be available to the parties. The court may consider a disability or the presence of young children or disabled children who must be cared for by the parent as being a reason why a parent is unable to work. Although Temporary Assistance to Needy Families (TANF) and other means-tested public assistance benefits are not included in gross income, income may be imputed to these recipients. In addition to determining potential earnings, the court may impute income to any non- income producing assets of either parent, if significant, other than a primary residence or personal property. Examples of such assets are vacation homes (if not maintained as rental property) and idle land. The current rate determined by the court is the rate at which income may be imputed to such nonperforming assets. Section IV. Health Insurance, Extraordinary Medical Expenses, and Childcare Costs Three additional child-rearing expenses—health insurance premiums, extraordinary medical expenses, and childcare expenses—shall be added to the Worksheet and must be considered by the court when determining the total child-support obligation. If either or both parents carry health insurance for the child(ren), incur extraordinary medical expenses for the child(ren), or pay for childcare expenses for one or more children who receive support, the cost of these expenses shall be added to the Worksheet. The court may in turn add one or more of these expenses to the basic child-support obligation as detailed below. 1. Health insurance: The court shall consider provisions for the children’s health care needs through health insurance coverage. Health insurance coverage is considered reasonable if the cost of dependent coverage does not exceed 5% of the gross income of the parent who is to provide coverage. The court may require coverage by one or both parents who can obtain the most comprehensive coverage through an employer or otherwise, and at the most reasonable cost. If the employer provides some coverage, then only the amount the employee pays shall be used in the calculation of support. This amount may be determined by the difference between self- only coverage and family coverage, or the cost of medical insurance for the child. If the amounts for self-only and family coverage cannot be verified, then the total cost of the premium may be divided by the total number of persons covered by the policy and then multiplied by the number of children in the support order. If the party providing coverage does not incur an additional cost to add the child(ren), then no amount shall be added to the child-support obligation for insurance. 2. Extraordinary Medical Expenses: Extraordinary medical expenses may be added to the basic child-support obligation and may include uninsured expenses for a single illness or condition. It may include but is not limited to reasonable and necessary costs for orthodontia, dental treatment, asthma treatment, physical therapy, uninsured chronic health problems, and professional counseling or psychiatric therapy for diagnosed 11 mental disorders (including any reasonable treatment or diagnostic testing needed to diagnose whether there is a recognized mental disorder or disability in the first place). 3. Childcare Costs: The childcare costs that a parent incurs due to employment or the search for employment is the third add-on to the Worksheet, and they may be considered in the total child-support obligation. Childcare costs must be reasonable, not to exceed the level required to provide quality care for child(ren) from a licensed provider. Section V. Computation of Child Support 1. Calculation and Use of Worksheet: Except as provided in Section II, paragraph 3, Self-Support Reserve, the gross income of both parents shall first be determined and combined. Each parent’s share of the combined total gross income is then determined based on their percentage of the combined income. Next, the basic child-support obligation is determined by looking at the Chart for the parties’ combined income and the number of children they have. A presumptive child-support obligation is then determined by adding the allowed additional monthly child-rearing expenses (including health insurance premiums, extraordinary medical expenses, and childcare expenses). Each parent’s share of additional child-rearing expenses is determined by multiplying the percentage of income they have available for support, which was determined in step 1. The total child-support obligation for each parent is determined by adding each parent’s share of the child-support obligation with their share of allowed additional child- rearing expenses. Lastly, the payor receives a credit for the additional child-rearing expenses that the payor is paying out of pocket, resulting in their presumed child-support order. See the “Forms” Addendum for a sample child-support calculation. The payor parent shall owe his or her presumed child-support obligation as a money judgment of child support to payee parent. All orders granting or modifying child support shall contain the court’s determination of both parents’ gross income and shall specify who is the payor parent and who is the payee parent. Any order shall also state the amount of health insurance premiums, extraordinary medical expenses, and childcare expenses allowed in determining the total child-support obligation. See the “Forms” Addendum for sample language that may be used. 2. Shared Custody Adjustment: In cases where the parties share approximately an equal amount of time, the parties shall complete the Worksheet and Affidavit of Financial Means. The court shall then set the child support obligation by offsetting the smaller obligation against the larger obligation on the Worksheet. The parent with the larger obligation shall pay to the other parent the difference between the two obligations. If the court determines that the Worksheet-based offset amount is inappropriate, the court may deviate after having considered the deviation factors set forth in Section II, Paragraph 2 above, including what is in the child’s or children’s best interest. In cases where the parties share less than an equal amount of time but each parent has both parents have responsibility of the child(ren) for at least 141 overnights per calendar year, 12 the parties shall complete the Worksheet and Affidavit of Financial Means. The court may then consider the time spent by the child(ren) with the payor parent as a basis for adjusting the child-support amount from the amount determined on the Worksheet. 3 In 2F particular, in deciding whether to apply an additional credit, the court should consider the presence and amount of disparity between the income of the parties, giving more weight to those disparities in the parties’ income of less than 20% and considering which parent is responsible for the majority of the non-duplicated fixed expenditures, such as routine clothing costs, costs for extracurricular activities, school supplies, and any other similar non-duplicated fixed expenditures. This discretionary adjustment is based on the number of overnights, or overnight equivalents, that a parent spends with a child pursuant to a court order. For purposes of this section, overnight equivalents are calculated using a method other than overnights if the parent has significant tim e periods on separate days when the child is in the parent’s physical custody, under the direct care of the parent, but does not stay overnight. 3. Split Custody: When each of the parents have sole custody of one or more of the children, a theoretical support obligation for each parent shall be determined based on the number of children in the other household and offsetting the smaller obligation against the larger one obligation. The parent with the larger obligation pays the difference shall pay to the other parent the difference between the two obligations. To accomplish this calculation, a Worksheet must be completed for each custody arrangement. There must be separate worksheets for the child(ren) who do not live primarily with the other(s). 4. Third-party Custody: When one or more children are not in the care of either biological parent, a child- support order can issue against each parent. The support amount is calculated by using the Worksheet and computing the obligation of each parent by multiplying each parent’s share of income by the total child-support obligation. Both parties shall owe his or her total child- support obligation as a money judgment of child support to the third-party caretaker or guardian. If only one parent is available, that parent’s sole income shall be used to determine the total gross income and one hundred percent of the basic child-support obligation shall be given to that parent. If the third-party caretaker or guardian incurs costs for health insurance premiums, extraordinary medical expenses, and childcare expenses, those expenses may be apportioned pro rata between the parents, or apportioned by the court if only one parent is available, as a deviation from these Guidelines. SECTION VI. Miscellaneous Provisions 1. Allocation of Dependents for Tax Purposes: 3 The Guidelines intend for the court to deviate (in an amount to be determined) on a case-by- case basis when the payor parent has more than 141 overnights with a child(ren). This discretionary deviation shall also apply when the parents each have the child(ren) for approximately 50% of the time. 13 Allocation of dependents for tax purposes belongs to the payee parent pursuant to the Internal Revenue Code. However, if allowed by state or federal law, the court shall have the discretion to grant dependency allocation, or any part of it, to the payor parent if the benefit of the allocation to the payor parent substantially outweighs the benefit to the payee parent. 2. Administrative Costs: The amount paid to the Clerk of the Court or to the Arkansas Clearinghouse for administrative costs pursuant to Ark. Code Ann. § 9-12-312(e)(1)(A), § 9-10-109(b)(1)(A) and § 9-14-804(b) shall not be included as support. 3. Provisions for payment All child-support orders shall fix the beginning date of the child-support obligation and the interval (weekly, bi-weekly, semimonthly, or monthly) on which payments shall be made. Child-support obligations shall be rounded down to the nearest whole dollar. All other computations relating to the determination of a payor’s child-support obligation shall use mathematical rules for rounding. If the number you are rounding is followed by 5, 6, 7, 8, or 9, round the number up. For example: 37.5 will be rounded to 38. If the number you are rounding is followed by 0, 1, 2, 3, or 4, round the number down. For example, 37.4 will be rounded to 37. Each parent’s share of the basic child-support obligation on Line 5 of the Worksheet should be rounded to two decimal places. All child-support orders shall include a provision for immediate implementation of income withholding or withholding from a financial institution, absent a finding of good cause not to require immediate income withholding or withholding from a financial institution. All withholding forms shall be filed in the court file and have a security level where it can only be viewed by the parties and attorneys of record. Circuit clerks shall only release the withholding order to parties, their employers, and attorneys of record. Payment shall be made through the Arkansas Clearinghouse pursuant to Ark. Code Ann. § 9-14-805. 4. Sharing of income information Parents shall provide proof of income for a previous calendar year whenever requested in writing by certified mail by the other parent, but not more than one (1) time a year. 14 FORMS ADDENDUM Sample Calculation Step 1: The gross income of both parents is determined and combined. Payor parent earns $2,000 and (payee parent earns $1,000, for a $3,000 combined gross income. Each parents’ share of income is then determined based on their percentage of the combined income. Payor earns 66.66% of the income, and payee earns 33.33% of the income. Step 2: The basic child-support obligation is determined by looking at the Chart for the $3,000 combined income and is $469 for the parties’ one child. Each parent’s share of the basic child-support obligation is then determined: 66.66% of $469 is $312.67 (payor parent), and 33.33% of $469 is $156.33 (payee parent). Step 3: A presumptive child-support obligation is then determined by adding the allowed additional monthly child-rearing expenses including health insurance premiums, extraordinary medical expenses, and childcare expenses. In this case, the court allows $100 that payor parent is paying for the child’s health insurance premium and $200 that payee parent is paying for childcare expenses, for a total of $300 for additional child-rearing expenses. Each parent’s share of additional child-rearing expenses is determining by multiplying the percentage of income they have available for support (see step 1) by the total expenses: 66.66% of $300 is $200 (payor parent), and 33.33% of $300 is $100 (payee parent). Step 4: The total child-support obligation for each parent is determined by adding each parent’s share of the child-support obligation with their share of allowed additional child- rearing expenses. Payor parent ($312.67 plus $200) has a total child-support obligation of $512.67, and payee parent ($156.33 plus $100) has a total child-support obligation of $256.33. Step 5: The payor receives a credit for the additional child-rearing expenses that he is paying out of pocket. In this example, payor is paying $100 for the child’s health insurance premium, so we deduct $100 from payor’s total child-support obligation of $512.67. Payor has a presumed child-support order of $412.67, which shall be rounded down to $412. Sample language for a court order based on the calculation provided above: The court has determined that Plaintiff (payor) earns a gross income of $2,000 per month and Defendant (payee) earns a gross income of $1,000 per month. Therefore, the parents’ combined gross income is $3,000 with a basic child-support obligation of $469 for their one child per the Chart. The court also finds that Plaintiff (payor) is paying for the child’s health insurance premium in the amount of $100 per month and that Defendant (payee) is paying $200 for childcare expenses, for a total of $300 for additional child-rearing expenses. Plaintiff (payor) is responsible for 66% of the total obligation ($312.67 share of basic obligation plus $200 for expenses) and has a total child-support obligation of $512.67. Defendant (payee) is responsible for 33% of the total obligation ($156.33 share of basic obligation plus $100 for expenses) and has a total child-support obligation of $256.33. Plaintiff, as the payor, shall receive a $100 credit for the additional child-rearing expenses that he is paying out of pocket. Plaintiff shall pay $412 per month to Defendant beginning on March 1, 2020, and he shall continue to cover the child’s health insurance premium. 15 Child Support Worksheet Number of children for whom support is sought__ Plaintiff is payee/payor (circle one) and Defendant is payee/payor (circle one) Payee Payor Combined PART I: Monthly Income Line 1: Child support guidelines income Line 1a: Permissible deduction from income Line 1b: Another Permissible deduction from income Line 2: Income available for support (Line 1 minus Line 1a minus Line 1b) Line 3: Each parent’s share of income available for support (Each parent’s line 2 divided by combined line 2) PART II: Basic Obligation Line 4: Basic child-support obligation from monthly chart. Line 5: Each parent’s share of the basic child-support obligation (each parent’s line 3 multiplied by combined Line 4) PART III: Additional Monthly Child-Rearing Expenses Line 6: Cost of the child’s health insurance Line 7: Cost of the child’s extraordinary medical expenses Line 8: Cost of work-related child care expenses Line 9: Total additional child-rearing expenses (sum of line 6, 7 & 8) Line 10: Each parent’s share of additional child-rearing expenses (each parent’s line 3 multiplied by combined Line 9) PART IV: Monthly Child-Support Order Line 11: Total child-support obligation (each parent’s line 5 plus line 10) Line 12: Credit for additional child-rearing expenses (obligor’s line 9 only) Line 13: Presumed child-support order (Line 11 minus line 12 for obligor only) 16 Family Support Chart of Basic Child Support Obligations (Self-Support Reserve = $900/month, Minimum Order = $125 per month) Combined Gross Monthly One Two Three Four Five Six 4 Income 3F Child Children Children Children Children Children 1-1050 125 125 125 125 125 125 1100 140 142 144 146 148 150 1150 175 178 180 183 185 188 1200 203 213 216 219 222 225 1250 211 249 252 256 259 263 1300 218 284 288 292 296 300 1350 226 320 324 329 333 338 1400 234 343 360 365 370 375 1450 241 354 396 402 407 413 1500 249 365 432 438 444 450 1550 256 376 454 475 481 488 1600 264 387 468 511 518 525 1650 271 398 481 537 555 563 1700 279 409 494 552 592 600 1750 286 420 507 567 623 638 1800 293 431 520 581 639 675 1850 301 442 534 596 656 713 1900 308 453 547 611 672 730 1950 316 463 560 626 688 748 2000 323 474 573 640 704 765 2050 330 485 586 654 720 783 2100 338 496 599 669 736 800 2150 345 506 612 683 752 817 2200 352 517 625 698 768 834 2250 360 528 638 712 784 852 2300 367 538 651 727 799 869 2350 374 549 664 741 815 886 2400 381 560 677 756 831 904 2450 389 571 689 770 847 921 2500 396 581 702 785 863 938 2550 403 592 715 799 879 955 2600 411 603 728 814 895 973 2650 418 613 741 828 911 990 4The Combined Gross Monthly Income does not apply in cases where the child support amount is in the blue shaded area. 17 2700 425 624 754 842 927 1007 2750 433 635 767 857 943 1025 2800 440 646 780 871 958 1042 2850 447 656 793 886 974 1059 2900 454 667 806 900 990 1076 2950 462 678 819 915 1006 1094 3000 469 688 832 929 1022 1111 3050 476 699 845 944 1038 1128 3100 484 710 858 958 1054 1146 3150 491 720 871 972 1070 1163 3200 498 731 883 987 1085 1180 3250 505 742 896 1001 1101 1197 3300 512 752 909 1015 1117 1214 3350 520 763 922 1029 1132 1231 3400 527 773 934 1044 1148 1248 3450 534 784 947 1058 1164 1265 3500 541 794 960 1072 1180 1282 3550 548 805 973 1087 1195 1299 3600 556 816 986 1101 1211 1316 3650 563 826 998 1115 1227 1333 3700 570 837 1011 1129 1242 1350 3750 577 847 1024 1144 1258 1367 3800 584 858 1037 1158 1274 1385 3850 592 868 1049 1172 1289 1402 3900 599 879 1062 1186 1305 1419 3950 606 890 1075 1201 1321 1436 4000 612 899 1086 1213 1335 1451 4050 619 908 1097 1226 1348 1465 4100 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19650 1622 2178 2607 2912 3204 3482 19700 1624 2181 2610 2916 3207 3486 19750 1627 2184 2614 2919 3211 3491 19800 1629 2186 2617 2923 3215 3495 19850 1632 2189 2620 2926 3219 3499 19900 1634 2192 2623 2930 3223 3503 19950 1637 2195 2626 2933 3226 3507 20000 1639 2197 2629 2937 3230 3511 20050 1642 2200 2632 2940 3234 3515 20100 1644 2203 2635 2944 3238 3520 20150 1647 2206 2638 2947 3242 3524 20200 1649 2208 2641 2950 3245 3528 20250 1652 2211 2644 2954 3249 3532 20300 1654 2214 2648 2957 3253 3536 20350 1657 2216 2651 2961 3257 3540 20400 1659 2219 2654 2964 3261 3544 20450 1662 2222 2657 2968 3264 3548 20500 1664 2225 2660 2971 3268 3553 20550 1667 2227 2663 2975 3272 3557 20600 1669 2230 2666 2978 3276 3561 20650 1672 2233 2669 2982 3280 3565 25 20700 1674 2235 2672 2985 3284 3569 20750 1677 2238 2675 2988 3287 3573 20800 1679 2241 2679 2992 3291 3577 20850 1681 2243 2681 2995 3295 3581 20900 1683 2246 2684 2998 3298 3585 20950 1684 2248 2687 3001 3301 3588 21000 1686 2251 2689 3004 3304 3592 21050 1687 2253 2692 3007 3308 3595 21100 1689 2255 2695 3010 3311 3599 21150 1691 2258 2697 3013 3314 3602 21200 1692 2260 2700 3016 3317 3606 21250 1694 2262 2702 3019 3321 3609 21300 1695 2265 2705 3022 3324 3613 21350 1697 2267 2708 3025 3327 3616 21400 1698 2269 2710 3027 3330 3620 21450 1700 2272 2713 3030 3333 3623 21500 1701 2274 2716 3033 3337 3627 21550 1703 2277 2718 3036 3340 3630 21600 1704 2279 2721 3039 3343 3634 21650 1706 2281 2723 3042 3346 3637 21700 1707 2284 2726 3045 3350 3641 21750 1709 2286 2729 3048 3353 3644 21800 1710 2288 2731 3051 3356 3648 21850 1712 2291 2734 3054 3359 3652 21900 1713 2293 2737 3057 3362 3655 21950 1715 2295 2739 3060 3366 3659 22000 1716 2298 2742 3063 3369 3662 22050 1718 2300 2744 3066 3372 3666 22100 1719 2303 2747 3069 3375 3669 22150 1721 2305 2750 3071 3379 3673 22200 1722 2307 2752 3074 3382 3676 22250 1724 2310 2755 3077 3385 3680 22300 1726 2312 2758 3080 3388 3683 22350 1727 2314 2760 3083 3392 3687 22400 1729 2317 2763 3086 3395 3690 22450 1730 2319 2766 3089 3398 3694 22500 1732 2321 2768 3092 3401 3697 22550 1733 2324 2771 3095 3404 3701 22600 1735 2326 2773 3098 3408 3704 22650 1736 2328 2776 3101 3411 3708 22700 1738 2331 2779 3104 3414 3711 22750 1739 2333 2781 3107 3417 3715 22800 1741 2336 2784 3110 3421 3718 22850 1742 2338 2787 3113 3424 3722 22900 1744 2340 2789 3115 3427 3725 26 22950 1745 2343 2792 3118 3430 3729 23000 1747 2345 2794 3121 3433 3732 23050 1748 2347 2797 3124 3437 3736 23100 1750 2350 2800 3127 3440 3739 23150 1751 2352 2802 3130 3443 3743 23200 1753 2354 2805 3133 3446 3746 23250 1754 2357 2808 3136 3450 3750 23300 1756 2359 2810 3139 3453 3753 23350 1758 2362 2813 3142 3456 3757 23400 1759 2364 2815 3145 3459 3760 23450 1761 2366 2818 3148 3462 3764 23500 1762 2369 2821 3151 3466 3767 23550 1764 2371 2823 3154 3469 3771 23600 1765 2373 2826 3157 3472 3774 23650 1767 2376 2829 3159 3475 3778 23700 1768 2378 2831 3162 3479 3781 23750 1770 2380 2834 3165 3482 3785 23800 1771 2383 2836 3168 3485 3788 23850 1773 2385 2839 3171 3488 3792 23900 1774 2388 2842 3174 3492 3795 23950 1776 2390 2844 3177 3495 3799 24000 1777 2392 2847 3180 3498 3802 24050 1779 2395 2850 3183 3501 3806 24100 1780 2397 2852 3186 3504 3809 24150 1782 2399 2855 3189 3508 3813 24200 1783 2402 2857 3192 3511 3816 24250 1785 2404 2860 3195 3514 3820 24300 1786 2406 2863 3198 3517 3823 24350 1788 2409 2865 3201 3521 3827 24400 1789 2411 2868 3203 3524 3830 24450 1791 2414 2871 3206 3527 3834 24500 1793 2416 2873 3209 3530 3837 24550 1794 2418 2876 3212 3533 3841 24600 1796 2421 2878 3215 3537 3844 24650 1797 2423 2881 3218 3540 3848 24700 1799 2425 2884 3221 3543 3851 24750 1800 2428 2886 3224 3546 3855 24800 1802 2430 2889 3227 3550 3858 24850 1803 2432 2892 3230 3553 3862 24900 1805 2435 2894 3233 3556 3865 24950 1806 2437 2897 3236 3559 3869 25000 1808 2440 2899 3239 3563 3872 25050 1809 2442 2902 3242 3566 3876 25100 1811 2444 2905 3245 3569 3879 25150 1812 2447 2907 3247 3572 3883 27 25200 1814 2449 2910 3250 3575 3886 25250 1815 2451 2913 3253 3579 3890 25300 1817 2454 2915 3256 3582 3893 25350 1818 2456 2918 3259 3585 3897 25400 1820 2458 2920 3262 3588 3901 25450 1821 2461 2923 3265 3592 3904 25500 1823 2463 2926 3268 3595 3908 25550 1825 2466 2928 3271 3598 3911 25600 1826 2468 2931 3274 3601 3915 25650 1828 2470 2934 3277 3604 3918 25700 1829 2473 2936 3280 3608 3922 25750 1831 2475 2939 3283 3611 3925 25800 1832 2477 2941 3286 3614 3929 25850 1834 2480 2944 3289 3617 3932 25900 1835 2482 2947 3291 3621 3936 25950 1837 2484 2949 3294 3624 3939 26000 1838 2487 2952 3297 3627 3943 26050 1840 2489 2955 3300 3630 3946 26100 1841 2492 2957 3303 3633 3950 26150 1843 2494 2960 3306 3637 3953 26200 1844 2496 2962 3309 3640 3957 26250 1846 2499 2965 3312 3643 3960 26300 1847 2501 2968 3315 3646 3964 26350 1849 2503 2970 3318 3650 3967 26400 1850 2506 2973 3321 3653 3971 26450 1852 2508 2976 3324 3656 3974 26500 1853 2510 2978 3327 3659 3978 26550 1855 2513 2981 3330 3663 3981 26600 1856 2515 2983 3333 3666 3985 26650 1858 2518 2986 3335 3669 3988 26700 1860 2520 2989 3338 3672 3992 26750 1861 2522 2991 3341 3675 3995 26800 1863 2525 2994 3344 3679 3999 26850 1864 2527 2997 3347 3682 4002 26900 1866 2529 2999 3350 3685 4006 26950 1867 2532 3002 3353 3688 4009 27000 1869 2534 3004 3356 3692 4013 27050 1870 2536 3007 3359 3695 4016 27100 1872 2539 3010 3362 3698 4020 27150 1873 2541 3012 3365 3701 4023 27200 1875 2544 3015 3368 3704 4027 27250 1876 2546 3018 3371 3708 4030 27300 1878 2548 3020 3374 3711 4034 27350 1879 2551 3023 3377 3714 4037 27400 1881 2553 3025 3379 3717 4041 28 27450 1882 2555 3028 3382 3721 4044 27500 1884 2558 3031 3385 3724 4048 27550 1885 2560 3033 3388 3727 4051 27600 1887 2562 3036 3391 3730 4055 27650 1888 2565 3039 3394 3734 4058 27700 1890 2567 3041 3397 3737 4062 27750 1892 2570 3044 3400 3740 4065 27800 1893 2572 3046 3403 3743 4069 27850 1895 2574 3049 3406 3746 4072 27900 1896 2577 3052 3409 3750 4076 27950 1898 2579 3054 3412 3753 4079 28000 1899 2581 3057 3415 3756 4083 28050 1901 2584 3060 3418 3759 4086 28100 1902 2586 3062 3420 3763 4090 28150 1904 2588 3065 3423 3766 4093 28200 1905 2591 3067 3426 3769 4097 28250 1907 2593 3070 3429 3772 4100 28300 1908 2596 3073 3432 3775 4104 28350 1910 2598 3075 3435 3779 4107 28400 1911 2600 3078 3438 3782 4111 28450 1913 2603 3081 3441 3785 4114 28500 1914 2605 3083 3444 3788 4118 28550 1916 2607 3086 3447 3792 4121 28600 1917 2610 3088 3450 3795 4125 28650 1919 2612 3091 3453 3798 4128 28700 1920 2614 3094 3456 3801 4132 28750 1922 2617 3096 3459 3804 4135 28800 1924 2619 3099 3462 3808 4139 28850 1925 2622 3102 3464 3811 4142 28900 1927 2624 3104 3467 3814 4146 28950 1928 2626 3107 3470 3817 4150 29000 1930 2629 3109 3473 3821 4153 29050 1931 2631 3112 3476 3824 4157 29100 1933 2633 3115 3479 3827 4160 29150 1934 2636 3117 3482 3830 4164 29200 1936 2638 3120 3485 3834 4167 29250 1937 2640 3123 3488 3837 4171 29300 1939 2643 3125 3491 3840 4174 29350 1940 2644 3127 3493 3842 4177 29400 1941 2646 3129 3495 3844 4179 29450 1942 2647 3130 3496 3846 4181 29500 1943 2648 3131 3498 3848 4183 29550 1943 2649 3133 3499 3850 4185 29600 1944 2650 3134 3501 3851 4186 29650 1945 2652 3135 3502 3853 4188 29 29700 1946 2653 3137 3504 3855 4190 29750 1947 2654 3138 3505 3857 4192 29800 1948 2655 3140 3507 3859 4194 29850 1949 2656 3141 3508 3860 4196 29900 1950 2658 3142 3510 3862 4198 29950 1951 2659 3144 3512 3864 4200 30000 1952 2660 3145 3513 3866 4202 30 IN THE CIRCUIT COURT OF COUNTY, ARKANSAS (Domestic Relations Division) _____Division Plaintiff v. Case No. _____DR__________________ Defendant AFFIDAVIT OF FINANCIAL MEANS Name:_________________________, being duly sworn, says under penalty of perjury, that he/she has prepared or approved this financial statement, and that the following information and attachments (including income verification as required by page 6) are complete, true, and correct. __________________ _____________________________ Date Signature Subscribed and sworn to before me on this day of 20 . Notary Public My commission expires: MY INCOME 1. How often are you paid? ____ weekly ____ bi-weekly (every two weeks—26 times a year) ____ monthly ____ bi-monthly (twice a month–24 times a year) ____ other –Explain (attach an exhibit if necessary): 2. Gross Pay: $__________________________ Page 1 of 6 ______ ______ Initials Initials 31 INCOME Income: Amount: Source Frequency 3 Gross wages from employment, 3.1 contract labor, etc. 3.2 Bonuses or incentive pay not reflected on page 2: 3.3 Other court-ordered income such as alimony/child support paid to you: 3.4 Payments from a settlement or annuity: 3.5 Regular gifts from relatives or friends: 3.6 Investment income such as rent payments to you: 3.7 Stock dividends or bond payments: 3.8 Regular payments to you or on your behalf from a Trust: 3.9 Other: 3.10 TOTAL MONTHLY INCOME: $ OTHER AVAILABLE FUNDS 4 ASSET AMOUNT SOURCE Cash on hand, and in bank 4.1 accounts: 4.2 Trust fund assets held on your behalf: 4.3 Stocks, bonds, mutual funds: 4.4 Other (i.e., 401-K, retirement, etc): 4.5 TOTAL: $ Page 2 of 6 ______ ______ Initials Initials 32 MY CURRENT MONTHLY EXPENSES * 5. Expense: Amount: Expense: Amount: Health Insurance- for Health Insurance- a. child only $ n. excludes amount in $ “a” Extraordinary medical Non-covered medical b. expenses for child in this $ o. for self or child not $ case involved in this case Childcare for child in Childcare for child not c. this case $ p. involved in this case $ Rent/house payment Car payment d. $ q. $ Media Services, e.g. Car Insurance e. Cable/Satellite, Internet $ r. $ Telephone Car fuel and f. $ s. maintenance $ Gas, water, trash, & Lawn care g. electricity $ t. $ h. Union dues $ u. Charitable giving $ i. Pension plan $ v. Household Expenses $ j. 401(k) payments $ w. Dry cleaning $ k. Garnishments $ x. Life Insurance: $ l. Alcohol and Tobacco $ y. Other: $ Products Cigarettes m. Food Alcohol $ z. TOTAL $ * Place a check mark by all expenses which you are not currently paying. Page 3 of 6 ______ ______ Initials Initials 33 MINOR CHILDREN 6. Number of children: a. Number of minor children I have with opposing party: # b. Number of other minor children I have: # c. Names of minor children involved in this case: AGE 1. 2. 3. 4. CREDITORS & DEBTS 7. Debts in the names of BOTH PARTIES are: Creditor: Total amount owed: Monthly payment: a. $ $ b. $ $ c. $ $ d. $ $ e. $ $ f. $ $ Totals: $ $ Page 4 of 6 _______ ______ Initials Initials 34 8. Debts only in my name: Creditor: Total amount owed: Monthly payment: a. $ $ b. $ $ c. $ $ d. $ $ e. $ $ Totals: $ $ 9. Debts only in the name of the other party: Creditor: Total amount owed: Monthly payment: a. $ $ b. $ $ c. $ $ d. $ $ e. $ $ Totals: $ $ 10. SUMMARY OF ABOVE DEBT TABLES: Summary of Debts: Total Owed: Total Monthly Payments: Joint Debts: a. $ $ My Debts: b. $ $ Other Party’s Debts: c. $ $ Page 5 of 6 _______ ______ Initials Initials 35 ACKNOWLEDGEMENT OF RESPONSIBILITIES AND CONSEQUENCES I, _________________________, understand that I must comply with the following. I acknowledge and agree to each provision by initialing each paragraph below. _____Both parties must complete and exchange this six-page affidavit at least three days before a court hearing where financial matters are at issue. The affidavit must be provided to opposing counsel, if a party is represented, or directly to a self-represented litigant. _____Both parties must supply the original notarized affidavit to the court. _____ If I am employed, I must attach copies of my last three paystubs to this affidavit. _____ If I am self-employed, I must attach copies of my last two federal and state tax returns, including all schedules, to this affidavit. _____ Before each court hearing where financial matters are at issue, I will review this document and provide updated information to the other party and to the court. _____ I understand that the cost of dependent health insurance coverage is the difference between self-only and self with dependents or family coverage or the cost of adding the child(ren) to existing coverage. _____ I understand that failing to comply with these provisions, or deliberately attempting to mislead the court or the opposing party, may result in my being held in contempt of court, being fined, being ordered to pay attorney’s fees, and/or being sentenced up to 6 months in jail, and that serious violations can result in prosecution for felony perjury—punishable by 3 to 10 years in prison. ______________________ ________________________________ Date Signature I certify that I have reviewed this affidavit with my client and advised him or her of the importance of providing true, correct, complete answers and the required exhibits. _______________________ ________________________________ Date Attorney Page 6 of 6 ______ ______ Initials Initials Revised 12/2021 36