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Child Support Worksheets and Order

Instructions and Forms
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Table of Contents
Part 1. Important Info ...............................................................................................1
A. Should I use this? ...........................................................................................1
B. Try Using Washington Forms Online ..............................................................1
C. What if I have questions that this packet does not answer? ...........................2
Part 2. Court forms in this packet ...........................................................................3
Part 3. Other court forms and documents you may need to get ..........................4
Part 4. General instructions for filling out forms ...................................................6
Part 5. How to fill out each form ............................................................................10
A. Washington State Child Support Worksheets ...............................................10
B. Financial Declaration of: – FL All Family 131 ................................................13
C. Sealed Financial Source Documents (Cover Sheet) – FL All Family 011 .....15
D. Child Support Order – FL All Family 130 ......................................................15
Part 6. Blank Forms ................................................................................................22

This publication provides general information concerning your rights and responsibilities. It is not intended
as a substitute for specific legal advice.
© 2020 Northwest Justice Project — 1-888-201-1014.
(Permission for copying and distribution granted to the Alliance for Equal Justice and to individuals for non-
commercial use only.)

Table of Contents – Page 1

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Part 1. Important Info

A. Should I use this?

Use this only if you are

 Petitioner (starting the court case) or Respondent (responding to the petition) in a

family law case where someone is asking for child support. Examples of such
cases: Petition for Divorce, Petition to End Domestic Partnership, Petition to
Establish Parentage.

 Either parent in a Petition to Change Parenting Plan.

This packet should help you fill out the forms and papers for child support orders. Do not use
it alone. Use it with the other packet(s) you need, for example Make a Parenting Plan, and/or
File for Divorce.

Before using this, read How is Child Support Set. If you or the other party is in the military,
read Military Service and Petitions to Change Parenting Plans: Your Rights in Washington
State. Get the other do-it-yourself family law packets you need. These are all available at
WashingtonLawHelp.org.

In this packet, “the other parent” means the other party or person involved in your court case.
This e could be someone other than a parent (example: a grandparent or other party
petitioning for custody). Where your case involves parties other than the parents, anything
required for “the other parent” is also required for every other party.

This has no forms or instructions for filing and serving the papers or for preparing for or
going to hearings. Visit WashingtonLawHelp.org for more on those issues.

B. Try Using Washington Forms Online

The Northwest Justice Project has a new program called Washington

Forms Online. It helps people fill out family law forms on a computer.
Answer interview questions on LawHelp Interactive to create completed
forms and instructions that are ready for your use. The forms included in this packet and
many others are available now at WashingtonLawHelp.org.

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C. What if I have questions that this packet does not answer?

Talk to a lawyer familiar with family law before filing anything with the court. Many
counties have family law facilitators who can help you out forms or free legal clinics where
you can get legal advice.

 Do you live in King County? Call 211 weekdays, 8:00 a.m. - 6:00 p.m. From a pay or
public phone, call 1-800-621-4636. They will refer you to a legal aid provider.
 Apply online with CLEAR*Online - nwjustice.org/get-legal-help
 Call the CLEAR Legal Hotline at 1-888-201-1014.

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Part 2. Court forms in this packet

You can also download these court forms in Microsoft Word or PDF format at
www.courts.wa.gov/forms.

Court Form Title Court Form Number

Washington State Child Support Schedule & CS Schedule; CS

Worksheets Worksheet
or use Child Support Ord

Financial Declaration of: FL All Family 131

Sealed Financial Source Documents (Cover FL All Family 011

Sheet)

Child Support Order FL All Family 130

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Part 3. Other court forms and documents you may

need to get

You may need other forms or papers that are not in any of our packets.

Our packets provide only the forms you need at the stage you need them. You will need
more than one packet to file and finalize your case. Read the info below carefully. Check the
boxes by the other packets you need.

If you have a very low income, you can get packets by mail by calling CLEAR at 1-888-201-
1014.

 File for Divorce

 File a Petition to Decide Parentage – if you were never married to the child’s other
parent.

 File a Petition to Change Your Parenting Plan, Residential Schedule, or Custody Order –
if the court already entered a final parenting plan, and you want to change it.

 Make a Parenting Plan – to ask for court orders about custody and/or visitation.
 Respond to Divorce Petition or Respond to Petition to End Domestic Partnership – if
you have been served with one of these petitions

 Respond to Petition to Decide Parentage – if you have been served with this Petition
 Respond to Petition to Change Parenting Plan, Residential Schedule, or Custody Order
–if you have been served with this petition.

 Finalize a Divorce (with children) by Agreement or Finalize a Divorce by Default– if

you have already filed or responded to a divorce and need to finalize.

 Finalize a Petition to a Change Parenting Plan – if you have already filed or been
served with this type of petition and need to finalize.

 Ask for Temporary Family Law Orders: Divorce Cases and Petition to Change
Parenting Plan Cases or Ask for Immediate Restraining Orders: Divorce Cases and
Petition to Change Parenting Plan Cases - for an order covering the period between
the time your case is filed and the entry of final orders, or to ask for a Guardian ad
Litem. These packets have the Sealed Personal Health Care Records Cover Sheet and

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the Sealed Confidential Reports Cover Sheet.

 Respond to Motions for Temporary Family Law Orders or Immediate Restraining

Orders: Divorce Cases - if the other party has served you with one of these motions.

 Ask for Temporary Family Law Orders: Parentage Cases; Ask for Temporary Family
Law Order: Petition to Change Parenting Plan Cases or Ask for Immediate
Restraining Orders: Parentage Cases – for an order covering the period between the
filing of your case and the entry of final orders or if you want to appoint a Guardian
Ad Litem (GAL). (The main packet you are using and Guardians Ad Litem in Family
Law Cases have more about GALs. These packets have the Sealed Personal Health
Care Records Cover Sheet and the Sealed Confidential Reports Cover Sheet you need
if filing this confidential info.)

 Respond to Motions for Temporary Family Law Orders or Immediate Restraining

Orders: Parentage Cases - if the other party has served you with one of these type of
motions.

 Declaration about Public Assistance (FL All Family 132): We do not include this
form in our packets. It is optional. We tell you to serve the State in any case where
TANF, Medicaid, or foster care is involved. We tell you to get the state’s signature on
all default and agreed orders where the state might have an interest in the child
support obligation in your case. You may need the form if your county requires it, or
to verify that no public assistance has been paid or that the children are not in foster
care or out-of-home placement. Get it at www.courts.wa.gov/forms.

 Serving Papers on the State – Get this if child support is an issue, and any child has
gotten public assistance (TANF) or medical coupons or Medicaid, or is in foster care
or out-of-home placement. You must include the state as a party and serve them
with papers you file.

 Notice of Address Change (FL All Family 120): If you move during or after your
case, fill this out, file it with the court, and get all other parties a copy. Get it at
www.courts.wa.gov/forms.

 Other: Local Do-it-Yourself packets: Some counties may require other forms or
packets. Ask the court clerk or family law facilitator (if there is one) if your county
needs more info.

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Part 4. General instructions for filling out forms

The General Instructions provide important info that applies to all forms, including how to
fill out the caption. Follow those general instructions for all the forms you use before
going on to the instructions for each form.

THE CAPTION. The caption is the name of your case. It is a section appearing at the top of
the first page of every form. See the sample below:
Put the county where you
are filing this form.
This case type is
for a divorce.

Superior Court of Washington, County of __________________ Put the case number.

The court clerk assigns
In re the marriage of: this number when the
Petitioner files the case.
Petitioner (person who started this case): No.
Jane Brown Notice of Hearing This is the
(NTHG) form’s title.
And Respondent (other spouse):

John Brown  Clerk’s action required: 1

Case number. When petitioner files the papers to start the case and pays the filing fee (or
has it waived), the court clerk assigns a case number. You must put that number on every
paper you file with the court and serve on the other parties during the case. Put it near the
top on the right-hand section of the first page of every form after "No." (abbreviation for
“number”)

When petitioner first files the case, petitioner may be able to use a special stamp at the
court clerk’s counter to stamp the case number on each paper. You may print or stamp the
case number. If you are filing a modification or adjustment case in the same court that
entered the order you want to change, use the case number on that order.

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 If you do not put the case number on the first page of every copy of everything
you file with the court and copies for other parties, your papers may be lost, or
the clerk may return them to you. Some courts will fine you for filing incorrect
forms.

Title. Each form has a title on the right-hand side of the form under the case number. You
may have to add to it. Example: on a declaration, you put the name of the person filling out
the declaration.

 Format: Pleadings (legal forms) you file with the court and attachments to
pleadings must follow court rules about size and margins (GR 14(a)). You must
use regular size (8 ½ x 11”) white paper. You may write on only one side. The
first page of each paper you file must have three inches of space (a three-inch
margin) at the top. The other margins (left, right and bottom, and the top from
the second page on) must be at least one inch wide. Use black or dark blue ink. If
your forms do not follow these rules, the clerk may refuse to file them or make
you pay a fine.

The contents. Fill out each form according to its instructions. Usually you may print or
type. It must be readable. You must use black or dark blue ink.. After filling out each
form, re-read it. Make sure you have correctly filled in all blanks needed. Any corrections
must be neat and readable.

Do not write in the margins. The clerk may reject your form.

Dates. The last page of most forms (not orders) has a space for the person filling it out to
put the date they signed it. The judge puts dates in orders when she signs it.

Signatures.

 Your Signature: After filling out a form, look for the place(s) to sign your name:
o Some forms have one signature line for “petitioner” or “respondent.” After
filling out a form such as the petition, sign at the place that applies to you.
Look carefully. You may have to sign in more than one place. You may have
to put the date and place (city, state) you signed it.
o When you prepare and file motions, you are the moving party. On the last
page of your motion, you must fill out and sign the section Person making
this motion or requesting this order fills out below. When you prepare an
order and plan to present it to the judge to sign, look for the place at the end
for your signature. Check is presented by me.

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 Judge’s Signature: Leave the judge’s signature line and the date blank.
 Other party’s signature: Some forms have a place for other parties to sign. You
cannot force another party to sign a court paper. The other party can choose (not) to
sign. If you have prepared an order after a hearing, the other party may be willing to
sign it if they agree it accurately states the judge’s decisions (or the judge may
require the other party to sign), even if the party is not happy with the decision
itself.
o Agreed orders. If the other party agrees with the orders you have written,
they should sign in the right place on each court order they agree to.
o May be signed by the court without notice to me. If you are the respondent or
nonmoving party, or you did not prepare the order, the other party may ask
you to check this box and sign. If you do, you are agreeing the judge should
sign the order as written AND the other party can give the order to the judge
to sign without letting you know when they are doing it.
 Other signatures: If someone else (a witness or the person serving papers) must
sign a form, they must fill out all info correctly and sign in the right space.
Place signed. Motions, Declarations, and Proofs of Service must include the date and place
you signed them.

Identifying Information. Court rules try to protect privacy but also allow for public access
to some info in court files. The next three boxes discuss these rules:

Box #1- Things to not write in most court papers:

Court General Rules 22 & 31 try to protect privacy in family law cases. Almost all pleadings,
orders and other papers filed with the court are available to the public. They may also be
available to the public online.
Except where instructions about a specific form tell you otherwise (example: the forms in
Box #3), use these rules for papers you file with the court.
Address (Where you Live) and Phone Number: You must put an address where you can
get mail from the court. It does not have to be your home address. You should also give the
court a phone number where they can reach you.
Social Security/Driver’s License, ID Numbers of Adults and Children: Put only the last
four digits.
Bank Account, Credit Card Numbers: Put the bank name, type of account (savings,
checking, and so on), and last four digits of the account number.

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Box #2 - Private information you should file with sealed cover sheets:
If you use a sealed cover sheet, this info is usually available to the other party and the court.
It is not available to the public.
Financial Information: You must attach any paystubs, checks, loan applications, tax
returns, credit card statements, check registers, W-2 forms, bank statements, or retirement
plan orders you file to a Sealed Financial Source Documents form. Then the public cannot
access them.
Medical or Mental Health Records or Information: You must attach anything you file
with info about someone’s past, present, or future physical or mental health, including
insurance or payment records to a Sealed Personal Health Care Records form. Then the
public cannot access them.
Confidential Reports: Reports intended for court use must have public and private
sections. You attach the private to a Sealed Confidential Reports Cover Sheet.
Retirement Plan Orders: Certain retirement info belongs in the public file. “Retirement
Plan Orders” do not. Use the Sealed Financial Source Documents Cover Sheet for the
Retirement Plan Order. See GR 22, or see a lawyer if this affects your case.
Other Kinds of Confidential or Embarrassing Information Not Mentioned Above. If the
paper you want kept confidential is not in this list, you may need to file a motion asking to
have that paper, or part of it, sealed under General Rule (GR) 15. Talk to a lawyer.

Box #3 - When to put private information in court forms:

These forms are not in the public file. Info in them is usually not available to the other
party.
You must fill in your personal info completely (including your home address, social security
number, and so on):
Confidential Information Form
Vital Statistics Form
Domestic Violence Information Form
Law Enforcement Information Sheet.

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Part 5. How to fill out each form

A. Washington State Child Support Worksheets

Each party must fill out a set of child support worksheets, using the instructions and
schedule that come with them. You may have to file and serve worksheets more than once
during the course of your case:

 With the Petition and Response

 When there are motions and hearings involving child support, to update info in your
first set of worksheets

The judge will sign a set of worksheets he approves when entering a child support order.
The judge may sign worksheets you prepared. Or the judge may ask you to prepare a new
set of worksheets with the specific income, expense, and child support amounts the judge
announced at hearing or trial.

 The instructions here only cover a few special issues.

The instructions and worksheets in this packet are current as of January 2019. Use them
along with the Washington State Child Support Schedule. Also, read How is Child Support is
Set.

 These instructions are for filling out worksheets based on the income, child
support amounts, and expense figures you propose at the start of the case
and/or before a hearing or trial.

 If the parties all agree on the income, child support amounts, and expense
figures, you must fill out the worksheets using the figures you agree to. You may
still need to show the judge that those amounts are correct.

 If you are filling these worksheets out after the judge has announced a decision,
you must use the income, child support amounts, expenses, and other info the
judge announced, even if you disagree with them and/or they are different from
what you proposed.

Use the Division of Child Support’s (DCS) online Child Support Estimator,
https://fortress.wa.gov/dshs/dcs/SSGen/Home/QuickEstimator for help

 estimating the amount of support the judge might order

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 preparing proposed child support worksheets

 filling out your Worksheets online

 The Estimator may not work if you are asking for a “deviation” from the
standard child support calculation. Examples of when you might do this: the
parents have the children a lot; there are children from other relationships; each
parent has custody of a child.

To fill out the worksheets, follow the instructions in the Washington State Child Support
Schedule (WSCSS). They explain:

 the meaning of gross and net income

 how to list your income

 how and when to impute income to the other party

 how to fill out the rest of the financial info

These instructions address gaps in the WSCSS instructions:

1. Above the caption, check the box showing if these worksheets are proposed or an
order signed by the judge. If they are proposed, check the box showing who is
proposing them and put your name.
2. Caption your worksheets: At the top of worksheet page 1, put your county, the
case number, the parents’ and children’s names, and children’s ages where it says.
Each parent will get a column where their info will go.
3. List your info on the Worksheet in Column 1. The other parent’s info goes in
Column 2.
4. Put info for the other parent only if you know or can estimate their income
and expenses. If you have used estimates, put that. If you have any income info
for the other parent, even an estimate, use that info. Explain in Other Factors for
Consideration at Line 26 any income info or estimates you listed which you did
not base on wage stubs or tax returns. The other parent will have a chance to
correct any incorrect info.
5. If any party gets SSI, TANF, or Food Stamps, list that income on line 22(f), Income
from Assistance Programs, and not line 1, Gross Monthly Income. You should
list income from other common programs such as social security, worker’s

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compensation, unemployment benefits, and pension or retirement benefits on line

1(e), “Other Income.”
6. If you cannot get accurate income info about the other parent or estimate
their income based on what you know, or you believe they are voluntarily
unemployed or underemployed, follow the instructions for imputing income to
that parent. See the WSCSS Definitions and Standards, INCOME STANDARD #6, on
page 2.
7. Health Care Expenses (Part III): Just include expenses you pay regularly
(example: monthly health insurance premium). Do not include doctor bills that
may change over time. If you are listing health care expenses on lines 10a and
10b, you should also list monthly payments you actually made for those expenses
on line 16a, Monthly Health Care Expenses Credit.
8. Daycare, Education & Travel Expenses: In section 11, you can put your
daycare, tuition or other special childcare expense, and have that amount included
in the transfer payment. Then mark the first box in section 21 of the Child Support
Order under Other shared expenses: “Does not apply. The monthly amount
covers all expenses, except health care expenses.” If you are listing day care or
other special expenses in part III of the Worksheets, you must also list monthly
payments that parent actually made for those expenses on line 16b, Day Care and
Special Expenses Credit.
In most cases, you should not list daycare, education and travel expenses here.
Instead, you should list them in section 21 of the Child Support Order under Other
shared expenses, after checking the parents will share the cost for the
expenses listed below. This allows for future changes in these expenses. Then
you may not need to change your support order later. The downside of putting
these expenses in the Order instead of the Worksheets is that it may be harder to
collect payment from the other parent for these expenses. DCS will help compute
and collect day care and other special expenses.
9. In the “Other Factors for Consideration” part of the Worksheet, explain how
you calculated income and expenses, and show factors that may allow “deviation”
from the “standard calculation.” If there are special circumstances, list this info on
the worksheet. See the “Limitation Standards” and the "Deviation Standards" on
pages 3 - 4 of the Child Support Schedule to decide what to put.
You can also explain how you calculated the support amount. State how you
calculated each parent’s income. If the income you put for someone is imputed or
estimated, put how you figured it out. If you believe support should be less than
the standard calculation, state how much it should be and why.

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If a parent gets disability benefits like Social Security and the child is eligible for
them on the parent’s account, you must report both parent’s and child’s shares
under “net income.” You should then explain in Other factors for Consideration
the child’s share of the benefit, who is currently getting the child’s benefit, and that
the parent should get credit against their support obligation as long as the child’s
benefit continues.

 Fill out the Worksheet Completely. It takes time and patience. The judge
decides child support based on the worksheets.

10. Signature. Sign where it says on the last page. Put the date and place (city) you
signed.

B. Financial Declaration of: – FL All Family 131

Caption. Fill out the caption, including your name in the title.

1. Your personal information. Give the info requested. Check yes if you are working and
put your hire date. Check no if you are not currently working and give the info requested.

2. Summary of your financial information. Skip this section. Come back to it after filling
out the rest of the form.

3. Income.

 If you do not know how much the other parent’s income is, give your best
estimate, or use the support schedule’s instructions for imputing income.

Use the You column for your info. Use the Other Party column for the other parent. Put the
income info and income deduction info requested. Make sure you use the correct column
for each party.

Income from Benefits: If a parent gets Social Security Disability (SSDI) or workers’
compensation (L&I, or other disability benefits from an employer), put that amount in
Other Income.

Work-Related Disability Benefits: If a parent gets SSDI, L&I and some employer-paid
disability benefits or Social Security retirement, and the child gets dependent benefits as a
result, the payments the child gets directly counts as income to that parent even if it goes to
the other parent or custodian. You should add those amounts under 3A to income of the
parent getting benefits. Those benefits should also be credited as child support paid by

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the parent. The paying parent’s support should go down dollar for dollar by the amount of
dependent benefits their child gets directly for current child support. See RCW 26.18.190.

Deductions from Income: If you include any deductions from income other than income
tax, FICA, and L&I payments, you must provide proof of each deduction. RCW
26.19.071(5). Paystubs may show union and pension plan deductions. You must have extra
proof (such as pages from a collective bargaining agreement or employee handbook, or a
letter from the employer) that these deductions are required. If pension deductions are
voluntary, show documents proving you have had them taken for at least two years.
Otherwise, the court may not allow it. If the other parent disputes your claims, you must
have business records and receipts proving any business expenses you are claiming. Follow
the instructions at the end of the Financial Declaration Form. You should attach private
financial info to the Financial Source Documents Cover Sheet.

4. Other Income and Household Income.

A. Other income. Put the name and amount of any other income (including TANF,
SSI, and/or food stamps) a parent gets regularly.

B. Household Income. List the gross monthly income of other adults in the
household. That income is not included in calculating the basic child support
obligation. The court might consider it if someone asks for a deviation from the
standard child support amount.

5. Disputed income. If you think anyone will dispute a parent’s income, state what you
believe is the correct amount of that parent’s income. Explain why you believe that is the
amount.

6. Available Assets. List your assets - cash, and things you own that could easily be sold for
cash. (Examples: stocks, bonds, and so on.)

7. Monthly Expenses after Separation. Put your monthly household expenses. Put your
best estimate of each. Many expenses are not monthly. For those, take the actual amount
you pay. Calculate the monthly average. Example: If you pay your car insurance every six
months, take the amount you pay, divide it by 6, and put that amount in the blank under 7F.

Your total monthly expenses may end up being more than your net monthly household
income. This is especially common for people who have a low income. You may put off
paying a bill or make other cutbacks in your expenses. If your expenses are far more than
your income, the court might ask how you are meeting. Be ready to show how you are
doing it.

8. & 9. Section 8 is for giving more details about expenses you listed in 7.

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11. Attorney Fees. If you hire a lawyer for this case, put those expenses here.

Signed at: Put the city or town and state where you are signing this form, and the date. Sign
and print where it says to.

C. Sealed Financial Source Documents (Cover Sheet) – FL All

Family 011

Use this when filing private financial documents with the court. Keep a blank copy of this
form in case you file more financial documents later. You can attach one form to a stack of
documents.

Caption. Fill out the caption.

Check the boxes next to each type of paper you are filing. If you are submitting child
support worksheets, the instructions to the child support worksheets say which documents
you must file.

 If you are afraid for your or the children’s safety, you can block out info
identifying your location on the copies you file with the court and give the other
parties.

Submitted by: Check the box showing which party you are. Sign and print your name.

D. Child Support Order – FL All Family 130

Our instructions for the Child Support Order cover several different types of family law
cases:

 If this is a proposed order, it must show what you want the judge to order.

 If you have reached agreement, it must show your agreement.

 If you are filling it out after the judge has announced a decision, it must show what
the judge decided, even if you disagree.

After the judge signs your Child Support Order, get a conformed copy from the court clerk.
The main packets you are using have more info about orders the judge has signed.

Caption. Fill out the caption. Check if this order is temporary (entered before your case is
over) or final (entered with other final orders at the end of the case).

Check the first box and skip to 2 if you do not want a judgment for back support, or the
judge did not award a judgment for back support or attorney fees after hearing.

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Check the second box and come back to fill in the table after filling out section 22 if one of
these is true:

 This is a final order

 One or both parents owes child support or attorney fees (for temporary or final
orders)

Findings and Order

2. Check the appropriate box.

3. Do not change this section.

4. Parents’ contact and employment information. Read this.

5. Parents’ Income. Put all the info you can. Each parent gets their own column. Use the
same numbers as the Child Support Worksheets.

 If a parent has no income, or you do not know it, you must impute income to
them (make a reasonable guess), unless there is reason not to. Examples: do
not impute income to a parent who is in prison or long-term drug treatment.
Check “imputed to this parent” and skip to 6 if you impute income.

 If this order is based on the judge’s decision at your trial or hearing: put the
income info the judge announced for each parent. Check the box showing if the
judge found this amount was the parent’s imputed or actual income.

6. Imputed Income. Check the first box for a parent and skip to 7 if you are NOT imputing
income.

Check This parent’s monthly net income is imputed because and then the boxes below
showing why you are imputing income. Pages 2 and 6 of the Child Support Schedule
Definitions and Standards have more about imputing income.

7. Limits affecting the monthly child support amount.

Check the first box and skip to 8 if any of these is true:

 The paying parent’s monthly income is more than 125% of the federal poverty
guidelines.

 The child support amount will be 45% of the paying parent’s income or less.

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 The parents’ combined monthly net income is less than $12,000.

Check the second box and then:

 low-income limits if in anywhere in line 8 of the worksheets, you put that a parent
will pay $50 monthly.

 the 45% net income limit if the child support amount is more than 45% of the
paying parent’s net income.

 Combined Monthly Net Income over $12,000 if that is true. Check the box
immediately under if the paying parent will pay the advisory amount. Fill in the
blank if it is more than the amount the economic table advises.

 We do not explain here setting support when the parents’ combined monthly
net income is over $12,000. The Child Support Schedule at page 3 has more.

8. Standard Calculation. List each party’s name on the left-hand side of the first table. Put
the amount listed on line 17 of the Worksheets for each party. Put the amounts from the
Worksheets for both parents.

Check Residential Split only if you want or are agreeing to this, or the judge ordered it. Put
which child is living with which parent. Put the amount a parent is paying support in this
situation. Give the other info requested.

9. Deviation from standard calculation. Check No if you do not want a deviation or the
judge denied a request for one. Check underneath why there will be no deviation. Fill in any
blanks needed. If you check there is no good reason to approve, you must check the
appropriate indented boxes underneath.

Check Yes if you agree to a deviation. Check underneath all your reasons. If you check A
parent or parents in this case has or The children in this case, you must check the
appropriate indented boxes underneath.

 You might check other reasons in the case of, for example, a parent's temporary
unemployment to get schooling or training.

10. Monthly child support amount (transfer payment). Most people will check the first
box, put the paying person’s name in the first blank, and the other’s in the second. You then
list the children’s names and ages. If you can calculate the amount of support for each
child, list those amounts and the total at the bottom. Otherwise, just put the Total Monthly
Transfer Amount on the last line.

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 3213EN | March 2020

 If support will be the standard calculation child support amount (not a

deviation), the total support amount will be the amount listed at line 17 of the
child support worksheets for the party this order covers.

 If there are no special expenses or credits in lines 10-16 of the Worksheets, you
can figure out the support for each child. Multiply the basic support obligation
for each child (in the left-hand box at line 5 on the worksheets) by the paying
person’s share of income (line 6 of the Worksheets). The amounts for each child
must add up to the Total Monthly Transfer Amount on the last line.

 If there are special expenses or credits in lines 10-16 of the Worksheets, you may
not be able to figure out the amount per child.

 If you are agreeing to a deviation or the judge ordered one after hearing, put
the amount a parent will pay, after applying the deviation.

Check Residential Split and fill this part out only if you want or are agreeing to this, or the
judge ordered it.

11. Starting date and payment schedule. In the blank, put when support under this
order will start. (Usually, the earliest a new Support Order can become effective is the date
the petition was filed and served.) Check the box showing the schedule. Fill in blanks where
needed.

12. Step Increase. Most people will check Does not apply. Check Approved and fill in the
blanks if all these are true:

 This changes an earlier support order.

 The support payment will go up by more than 30%.

 You agree payments should go up gradually

Check Denied if you do not agree to a gradual increase.

13. Periodic Adjustment. Most people will check the first box. Then you can adjust or
change this order according to Washington law.

Check the second box if you agree to have the support amount adjusted periodically, such
as every year due to small changes in income. Then check the boxes underneath showing
when adjustments should take place. You must still go back to court for the adjustment.
It does not automatically happen.

14. Payment Method. Check the first box if one of these is true:

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 3213EN | March 2020

 the child has ever gotten public assistance

 you want DCS to help collect support

Having DCS collect can be good. DCS must help you if the parent paying support pays late or
stops paying. DCS will have documented proof of all payment dates and amounts.

 For more about the differences between enforcement and payment processing
services, contact your local DCS office.

DCS Enforcement. Check the boxes that apply.

Direct Pay. Check this if you want this or the judge ordered this after hearing. Check the
first box if you want payment by mail. Put the address where the paying parent should mail
payments. Check the second box if you do not want payment by mail. Put how you want
payments made.

 If you are concerned about your home address being in a public record, put an
address where you can get your legal mail regularly even after the case is final.
If you change your address for legal mail, give DCS, the other party and the
court your new address as soon as possible by filing a Notice of Address Change
(available at www.courts.wa.gov/forms). If you do not, orders could be entered
without notice to you.

15. Enforcement through income withholding (garnishment). Usually, support is

deducted from the paying parent’s wages and sent to the registry. Most people check the
first box.

Check the second box and the boxes after it that apply if you want or agree to a special
exception, or the judge ordered this after hearing. The judge must find good cause not to
order wage withholding.

 You should not be fired because your paycheck is being garnished for child
support. If your employer threatens to fire you if you are garnished, contact DCS,
a lawyer, your local legal services office, or CLEAR at 1-888-201-1014.

16. End date for support. Check the first box if this is a temporary order.

If this is a final order: Most people will check the second box if the child is not yet in high
school and does not have a disability, unless the judge has ordered otherwise.

Check the third box if you checked Reserved or Granted in 17, or the judge ordered one of
those after hearing.

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 3213EN | March 2020

Check the fourth box if a child has a disability and will need support even after age 18. In
the blank, put the child’s name. Check the box immediately underneath showing when
support should end. Fill in the blanks as appropriate.

 Child support usually ends when the child turns 18 years old or completes high
school, whichever happens later. Check other if you want child support to end
at some other time, or the judge ordered this. Put when support will end.

17. Post-secondary educational support (for college or vocational school).

Check Reserved if you want the court to decide later, but before the support obligation
ends, if a parent should pay post-secondary support, or the judge reserved this decision
after hearing. You might want to do this if, for example, the child is too young for you to
know what her needs after high school will be, or the child’s plans are not yet certain.

Check Granted if you want a parent to pay post-secondary support, or the judge ordered
this. Check the first box immediately underneath if you agree the court should decide the
amount later, or the judge decided to do this later. Example: You want the court to order
both parents to pay for college but the child is not going soon.

Check the second box immediately underneath if you want the judge to decide the amount
now. In the blank, put how much you want or what the judge ordered.

Check Denied if someone asked for post-secondary support but you do not want the court
to order it, OR the court denied the request.

Check Other to describe any agreement you and the other parent have made about post-
secondary support, or to add specifics from the judge’s ruling.

18. Claiming children as dependents on tax forms.

Most people agree the custodian should get the tax exemption for the children. If true in
your case, check the second box and the first box immediately underneath. In the first
blank, put the custodian’s name. In the second, put the children’s names.

If you agree a noncustodial parent should claim the exemptions part of the time, you
should still check the second box. Then check the boxes showing what your arrangement
will be. Check other. In the blank, put “a parent may claim an exemption at the times stated
above only if that parent has fully paid all child support, daycare, and uninsured medical
expenses owed as of December 31 of the relevant tax year.” Then a parent who does not
pay support on time cannot take the exemption.

Child Support Worksheets and Order | Page - 20

 3213EN | March 2020

 If you do not have custody, you must sign an IRS form 8332 saying who gets the
tax exemptions.

19. Medical Support. Check the first box and skip to 20 if true in your case.

Otherwise, check either Private health insurance ordered and all the boxes underneath it
that apply, or Public health care coverage and all the applicable boxes underneath it,
depending on what you want or can afford, or what the judge ordered. Public health
coverage means Medicaid programs, such as Apple Health.

20. Health insurance if circumstances change or court has not ordered. Do not make
any changes to this section.

21. Children’s expenses not included in the monthly child support payment

Uninsured medical expenses: In each blank at the top of the chart, put a parent’s name.
Then check proportional share and put that parent’s share of uninsured expenses from
the worksheets at line 6 in the blank, unless the court orders a different amount. If that
happens, check the box under proportional share and put what the judge ordered.

Other shared expenses: Check does not apply if that is what you want or what the judge
ordered. Otherwise, check the second box. In the chart, check the children’s expenses for
whatever you want the order to cover or whatever the judge ordered. Then follow the
instructions in uninsured medical expenses above for filling out the chart.

22. Past due child support, medical support and other expenses. Check the first box
and skip to 23 if you do not want the judge to decide about past support or interest or the
judge did not do so.

Check the second box if you want an order stating neither parent owes back amounts, or
the judge ordered this. Put the date the judge will sign this order. Check all boxes that
apply.

 Check the second box only if you know a paying parent owes no back child
support, or the judge ordered this. If you check the first box, a paying parent
could be excused from paying back support owed.

Check money judgments if you want the judge to award back support OR the judge did
this after hearing. Then fill out the chart with the info requested.

 In from and to, put the dates the support is owed for.

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 3213EN | March 2020

23. Overpayment caused by change. Check does not apply and skip to 24 if true in your
case, or the judge ordered this.

Check the second box if you are asking for an order that would cause someone to have
overpaid support, or the judge made an order that did this. Give the info requested.

24. Other Orders. The judge may use this.

Ordered: LEAVE THIS FOR THE JUDGE.

Petitioner and Respondent or their lawyers fill out below: Check presented by me in
the column for you (Petitioner or Respondent). Sign and print your name and the date
where it says.

If any parent or child received government assistance: An assistant prosecutor who

handles support cases in this county fills out and signs this section.1

Parent or Non-Parent Custodian applies for DCS enforcement services: Check this, and
sign and print your name and put the date if you want this. Having DCS collect can be good.
DCS must help you if the parent paying support pays late or stops paying. DCS will have
documented proof of the dates and amounts of all payments.

 For more about the differences between enforcement and payment processing
services, contact your local DCS office.

Part 6. Blank Forms

This packet has blank forms for your use. Make a copy of each form so you have an extra in
case your first draft needs lots of changes. You may need forms from other packets. You
may not need all the forms in this packet. Or fill out the forms online using the Washington
Forms Online program at WashingtonLawhelp.org. It helps people fill out family law forms
on a computer.

1If the child has ever gotten public assistance (TANF) or Medicaid, or is in foster care or out-of-home placement,
and the lawyer for DCS will not sign the child support order, you must schedule a court hearing to present the
order to the judge for signature and give the other parties advance notice of the hearing. This packet does not
explain how to do that.

Child Support Worksheets and Order | Page - 22

 WASHINGTON STATE
CHILD SUPPORT SCHEDULE
Including:

 Definitions and Standards

 Instructions
 Economic Table
 Worksheets

Effective Dates:

Definitions & Standards January 1, 2019

Instructions - only January 1, 2019
Economic Table January 1, 2019
Worksheets January 1, 2019

Order forms--voice mail telephone number (360) 705-5328

Internet--download forms: http://www.courts.wa.gov/
Questions about the Instructions or Worksheets? Contact: Merrie Gough
Tel. (360) 357-2128 E-mail merrie.gough@courts.wa.gov or
webmaster@courts.wa.gov

Child Support Hotline, State DSHS, 1 (800) 442-KIDS

 WASHINGTON STATE CHILD SUPPORT SCHEDULE
DEFINITIONS AND STANDARDS
Definitions determined for minors, to adult children who are
dependent on their parents and for whom support is
Unless the context clearly requires otherwise, these definitions apply to ordered pursuant to RCW 26.09.100.
the standards following this section. RCW 26.19.011.
The provisions of RCW 26.19 for determining child support and
Basic child support obligation: means the monthly child support reasons for deviation from the standard calculation shall be
obligation determined from the economic table based on the parties’ applied in the same manner by the court, presiding officers and
combined monthly net income and the number of children for whom reviewing officers. RCW 26.19.035(1).
support is owed.
2. Written findings of fact supported by the evidence: An order for
Child support schedule: means the standards, economic table, child support shall be supported by written findings of fact upon
worksheets and instructions, as defined in chapter 26.19 RCW. which the support determination is based and shall include
reasons for any deviation from the standard calculation and
Court: means a superior court judge, court commissioner, and presiding reasons for denial of a party’s request for deviation from the
and reviewing officers who administratively determine or enforce child standard calculation. RCW 26.19.035(2).
support orders.
3. Completion of worksheets: Worksheets in the form developed
Deviation: means a child support amount that differs from the standard by the Administrative Office of the Courts shall be completed
calculation. under penalty of perjury and filed in every proceeding in which
child support is determined. The court shall not accept
Economic table: means the child support table for the basic support incomplete worksheets or worksheets that vary from the
obligation provided in RCW 26.19.020. worksheets developed by the Administrative Office of the
Courts. RCW 26.19.035(3).
Instructions: means the instructions developed by the Administrative
Office of the Courts pursuant to RCW 26.19.050 for use in completing 4. Court review of the worksheets and order: The court shall
the worksheets. review the worksheets and the order setting child support for the
adequacy of the reasons set forth for any deviation or denial of
Standards: means the standards for determination of child support as any request for deviation and for the adequacy of the amount of
provided in chapter 26.19 RCW. support ordered. Each order shall state the amount of child
support calculated using the standard calculation and the amount
Standard calculation: means the presumptive amount of child support of child support actually ordered. Worksheets shall be attached
owed as determined from the child support schedule before the court to the decree or order or if filed separately, shall be initialed or
considers any reasons for deviation. signed by the judge and filed with the order. RCW 26.19.035(4).

Support transfer payment: means the amount of money the court orders Income Standards
one parent to pay to another parent or custodian for child support after
determination of the standard calculation and deviations. If certain 1. Consideration of all income: All income and resources of each
expenses or credits are expected to fluctuate and the order states a parent’s household shall be disclosed and considered by the court
formula or percentage to determine the additional amount or credit on an when the court determines the child support obligation of each
ongoing basis, the term “support transfer payment” does not mean the parent. Only the income of the parents of the children whose
additional amount or credit. support is at issue shall be calculated for purposes of calculating
the basic support obligation. Income and resources of any other
Worksheets: means the forms developed by the Administrative Office of person shall not be included in calculating the basic support
the Courts pursuant to RCW 26.19.050 for use in determining the obligation. RCW 26.19.071(1).
amount of child support. 2. Verification of income: Tax returns for the preceding two years
and current paystubs shall be provided to verify income and
Application Standards deductions. Other sufficient verification shall be required for
income and deductions which do not appear on tax returns or
1. Application of the support schedule: The child support schedule paystubs. RCW 26.19.071(2).
shall be applied: 3. Income sources included in gross monthly income: Monthly
a. in each county of the state; gross income shall include income from any source, including:
b. in judicial and administrative proceedings under titles 13, salaries; wages; commissions; deferred compensation; overtime,
26 and 74 RCW; except as excluded from income in RCW 26.19.071(4)(h);
c. in all proceedings in which child support is determined or contract-related benefits; income from second jobs except as
modified; excluded from income in RCW 26.19.071(4)(h); dividends;
d. in setting temporary and permanent support; interest; trust income; severance pay; annuities; capital gains;
e. in automatic modification provisions or decrees entered pension retirement benefits; workers’ compensation;
pursuant to RCW 26.09.100; and unemployment benefits; maintenance actually received; bonuses;
f. in addition to proceedings in which child support is social security benefits; disability insurance benefits;

WSCSS-Schedule 01/2019 Page 1

 and income from self-employment, rent, royalties, contracts, which there is a disagreement. Items deducted from gross
proprietorship of a business, or joint ownership of a partnership income shall not be a reason to deviate from the standard
or closely held corporation. RCW 26.19.071(3). calculation. RCW 26.19.071(5).

Veterans’ disability pensions: Veterans’ disability pensions or Allocation of tax exemptions: The parties may agree which
regular compensation for disability incurred in or aggravated by parent is entitled to claim the child or children as dependents for
service in the United States armed forces paid by the Veterans’ federal income tax exemptions. The court may award the
Administration shall be disclosed to the court. The court may exemption or exemptions and order a party to sign the federal
consider either type of compensation as disposable income for income tax dependency exemption waiver. The court may divide
purposes of calculating the child support obligation. See RCW the exemptions between the parties, alternate the exemptions
26.19.045. between the parties or both. RCW 26.19.100.

4. Income sources excluded from gross monthly income: The 6. Imputation of income: The court shall impute income to a parent
following income and resources shall be disclosed but shall not when the parent is voluntarily unemployed or voluntarily
be included in gross income: income of a new spouse or underemployed. The court shall determine whether the parent is
domestic partner or income of other adults in the household; voluntarily underemployed or voluntarily unemployed based
child support received from other relationships; gifts and prizes; upon that parent’s work history, education, health and age or any
temporary assistance for needy families; Supplemental Security other relevant factors. A court shall not impute income to a
Income; general assistance; food stamps; and overtime or income parent who is gainfully employed on a full-time basis, unless the
from second jobs beyond forty hours per week averaged over a court finds that the parent is voluntarily underemployed and finds
twelve-month period worked to provide for a current family’s that the parent is purposely underemployed to reduce the parent’s
needs, to retire past relationship debts, or to retire child support child support obligation. Income shall not be imputed for an
debt, when the court finds the income will cease when the party unemployable parent. Income shall not be imputed to a parent to
has paid off his or her debts. Receipt of income and resources the extent the parent is unemployed or significantly
from temporary assistance for needy families, Supplemental underemployed due to the parent’s efforts to comply with court-
Security Income, general assistance and food stamps shall not be ordered reunification efforts under chapter 13.34 RCW or under
a reason to deviate from the standard calculation. RCW a voluntary placement agreement with an agency supervising the
26.19.071(4). child. In the absence of records of a parent’s actual earnings, the
court shall impute a parent’s income in the following order of
VA aid and attendant care: Aid and attendant care payments to priority:
prevent hospitalization paid by the Veterans Administration (a) Full-time earnings at the current rate of pay;
solely to provide physical home care for a disabled veteran, and (b) Full-time earnings at the historical rate of pay based on
special compensation paid under 38 U.S.C. Sec. 314(k) through reliable information, such as employment security
(r) to provide either special care or special aids, or both to assist department data;
with routine daily functions shall be disclosed. The court may (c) Full-time earnings at a past rate of pay where information is
not include either aid or attendant care or special medical incomplete or sporadic;
compensation payments in gross income for purposes of (d) Full-time earnings at minimum wage in the jurisdiction
calculating the child support obligation or for purposes of where the parent resides if the parent has a recent history of
deviating from the standard calculation. See RCW 26.19.045. minimum wage earnings, is recently coming off public
assistance, general assistance-unemployable, supplemental
Other aid and attendant care: Payments from any source, other security income, or disability, has recently been released
than veterans’ aid and attendance allowance or special medical from incarceration, or is a high school student;
compensation paid under 38 U.S.C. Sec. 314(k) through (r) for (e) Median net monthly income of year-round full-time workers
services provided by an attendant in case of a disability when the as derived from the United States bureau of census, current
disability necessitates the hiring of the services or an attendant population reports, or such replacement report as published
shall be disclosed but shall not be included in gross income and by the bureau of census. (See “Approximate Median Net
shall not be a reason to deviate from the standard calculation. Monthly Income” table on page 7.)
RCW 26.19.055. RCW 26.19.071(6).

5. Determination of net income: The following expenses shall be Allocation Standards

disclosed and deducted from gross monthly income to calculate
net monthly income: federal and state income taxes (see the 1. Basic child support: The basic child support obligation derived
following paragraph); federal insurance contributions act from the economic table shall be allocated between the parents
deductions (FICA); mandatory pension plan payments; based on each parent’s share of the combined monthly net
mandatory union or professional dues; state industrial insurance income. RCW 26.19.080(1).
premiums; court-ordered maintenance to the extent actually paid;
up to five thousand dollars per year in voluntary retirement 2. Health care expenses: Health care costs are not included in the
contributions actually made if the contributions show a pattern of economic table. Monthly health care costs shall be shared by the
contributions during the one-year period preceding the action parents in the same proportion as the basic support obligation.
establishing the child support order unless there is a Health care costs shall include, but not be limited to, medical,
determination that the contributions were made for the purpose dental, orthodontia, vision, chiropractic, mental health treatment,
of reducing child support; and normal business expenses and prescription medications, and other similar costs for care and
self-employment taxes for self-employed persons. Justification treatment. RCW 26.19.080(2).
shall be required for any business expense deduction about

WSCSS-Schedule 01/2019 Page 2

3. Day care and special child rearing expenses: Day care and construed to require monthly substantiation of income. (See the
special child rearing expenses, such as tuition and long distance Self-Support Reserve memorandum on the courts’ website
transportation costs to and from the parents for visitation www.courts.wa.gov/forms and at
purposes, are not included in the economic table. These www.WashingtonLawHelp.org.) RCW 26.19.065(2)(b).
expenses shall be shared by the parents in the same proportion as
the basic child support obligation. RCW 26.19.080(3). 4. Income above twelve thousand dollars: The economic table is
presumptive for combined monthly net incomes up to and
4. The court may exercise its discretion to determine the necessity including twelve thousand dollars. When combined monthly net
for and the reasonableness of all amounts ordered in excess of income exceeds twelve thousand dollars, the court may exceed
the basic child support obligation. RCW 26.19.080(4). the maximum presumptive amount of support upon written
findings of fact. RCW 26.19.065(3).
Limitations Standards
Deviation Standards
1. Limit at 45 percent of a parent’s net income:
Neither parent’s child support obligation owed for all his or her 1. Reasons for deviation from the standard calculation include but
biological or legal children may exceed 45 percent of net income are not limited to the following:
except for good cause shown.
a. Each child is entitled to a pro rata share of the income a. Sources of income and tax planning: The court may deviate
available for support, but the court only applies the pro rata from the standard calculation after consideration of the
share to the children in the case before the court. following:
b. Before determining whether to apply the 45 percent i. Income of a new spouse or new domestic partner if the
limitation, the court must consider the best interests of the parent who is married to the new spouse or the parent
child(ren) and the circumstances of each parent. Such who is in a domestic partnership with the new
circumstances include, but are not limited to, leaving domestic partner is asking for a deviation based on any
insufficient funds in the custodial parent’s household to other reason. Income of a new spouse or domestic
meet the basic needs of the child(ren), comparative hardship partner is not, by itself, a sufficient reason for
to the affected households, assets or liabilities, and any deviation;
involuntary limits on either parent’s earning capacity ii. Income of other adults in the household if the parent
including incarceration, disabilities, or incapacity. who is living with the other adult is asking for a
c. Good cause includes, but is not limited to, possession of deviation based on any other reason. Income of the
substantial wealth, child(ren) with day care expenses, other adults in the household is not, by itself, a
special medical need, educational need, psychological need, sufficient reason for deviation;
and larger families. RCW 26.19.065(1). iii. Child support actually received from other
relationships;
2. Presumptive minimum support obligation: When a parent’s iv. Gifts;
monthly net income is below 125% of the federal poverty v. Prizes;
guideline for a one-person family, a support order of not less vi. Possession of wealth, including but not limited to
than fifty dollars per child per month shall be entered unless the savings, investments, real estate holdings and business
obligor parent establishes that it would be unjust to do so in that interests, vehicles, boats, pensions, bank accounts,
particular case. The decision whether there is a sufficient basis insurance plans or other assets;
to go below the presumptive minimum payment must take into vii. Extraordinary income of a child; or
consideration the best interests of the child(ren) and viii. Tax planning considerations. A deviation for tax
circumstances of each parent. Such circumstances can include planning may be granted only if child(ren) would not
leaving insufficient funds in the custodial parent’s household to receive a lesser economic benefit due to the tax
meet the basic needs of the child(ren), comparative hardship to planning;
the affected households, assets or liabilities, and earning ix. Income that has been excluded under RCW
capacity. RCW 26.19.065(2)(a). 26.19.071(4)(h) if the person earning that income asks
for a deviation for any other reason.
3. Self-support reserve: The basic support obligation of the parent RCW 26.19.075(1)(a)
making the transfer payment, excluding health care, day care,
and special child-rearing expenses, shall not reduce his or her net b. Nonrecurring income: The court may deviate from the
income below the self-support reserve of 125% of the federal standard calculation based on a finding that a particular
poverty level for a one-person family, except for the presumptive source of income included in the calculation of the basic
minimum payment of fifty dollars per child per month or when it support obligation is not a recurring source of income.
would be unjust to apply the self-support reserve limitation after Depending on the circumstances, nonrecurring income may
considering the best interests of the child(ren) and the include overtime, contract-related benefits, bonuses or
circumstances of each parent. Such circumstances include, but income from second jobs. Deviations for nonrecurring
are not limited to, leaving insufficient funds in the custodial income shall be based on a review of the nonrecurring
parent’s household to meet the basic needs of the child(ren), income received in the previous two calendar years.
comparative hardship to the affected households, assets or RCW 26.19.075(1)(b).
liabilities, and earning capacity. This section shall not be

WSCSS-Schedule 01/2019 Page 3

 c. Debt and high expenses: The court may deviate from the 3. The court shall enter findings that specify reasons for any deviation
standard calculation after consideration of the following or any denial of a party’s request for any deviation from the standard
expenses: calculation made by the court. The court shall not consider reasons
i. Extraordinary debt not voluntarily incurred; for deviation until the court determines the standard calculation for
ii. A significant disparity in the living costs of the parents each parent. RCW 26.19.075(3).
due to conditions beyond their control;
iii. Special needs of disabled child(ren); or 4. When reasons exist for deviation, the court shall exercise discretion
iv. Special medical, educational or psychological needs of in considering the extent to which the factors would affect the
the child(ren). support obligation. RCW 26.19.075(4).
v. Costs anticipated to be incurred by the parents in
compliance with court-ordered reunification efforts 5. Agreement of the parties is not by itself adequate reason for any
under chapter 13.34 RCW or under a voluntary deviations from the standard calculations. RCW 26.19.075(5).
placement agreement with an agency supervising the
child. RCW 26.19.075(1)(c). Benefits paid that apply toward a person’s
d. Residential schedule: The court may deviate from the child support obligation
standard calculation if the child(ren) spend(s) a significant
amount of time with the parent who is obligated to make a If an injured worker, person with disabilities, deceased person, retired
support transfer payment. The court may not deviate on person, or veteran who owes a child support obligation receives one of these
that basis if the deviation will result in insufficient funds in benefits:
the household receiving the support to meet the basic needs
of the child or if the child is receiving temporary assistance  Department of Labor and Industries payments
for needy families. When determining the amount of the  Self-Insurer’s payment
deviation, the court shall consider evidence concerning the  Social Security Administration:
increased expenses to a parent making support transfer o Social Security disability dependency benefits
payments resulting from the significant amount of time o Retirement benefits
spent with that parent and shall consider the decreased o Survivors insurance benefits
expenses, if any, to the party receiving the support resulting  Veteran’s Administration benefits
from the significant amount of time the child spends with
the parent making the support transfer payment. and shows that the child or the child’s household receives a payment from
RCW 26.19.075(1)(d). those benefits, then, the amount of the payment made on behalf of the child
or on account of the child applies toward the person’s child support
e. Children from other relationships: The court may deviate obligation for the same period covered by the benefit.
from the standard calculation when either or both of the
parents before the court have children from other
relationships to whom the parent owes a duty of support. Post-Secondary Education Standards
i. The child support schedule shall be applied to the
parents and children of the family before the court to 1. The child support schedule shall be advisory and not mandatory for
determine the presumptive amount of support. post-secondary educational support. RCW 26.19.090(1)
ii. Children from other relationships shall not be counted 2. When considering whether to order support for post-secondary
in the number of children for purposes of determining educational expenses, the court shall determine whether the child is
the basic support obligation and the standard in fact dependent and is relying upon the parents for the reasonable
calculation. necessities of life. The court shall exercise its discretion when
iii. When considering a deviation from the standard determining whether and for how long to award post-secondary
calculation for children from other relationships, the educational support based upon consideration of factors that include
court may consider only other children to whom the but are not limited to the following: age of the child; the child’s
parent owes a duty of support. The court may needs; the expectations of the parties for their child(ren) when the
consider court-ordered payments of child support for parents were together; the child(ren)’s prospects, desires, aptitudes,
children from other relationships only to the extent abilities or disabilities; the nature of the post-secondary education
that the support is actually paid. sought and the parent’s level of education, standard of living and
iv. When the court has determined that either or both current and future resources. Also to be considered are the amount
parents have children from other relationships, and type of support that the child would have been afforded if the
deviations under this section shall be based on parents had stayed together. RCW 26.19.090(2).
consideration of the total circumstances of both 3. The child must enroll in an accredited academic or vocational school,
households. All child support obligations paid, must be actively pursuing a course of study commensurate with the
received, and owed for all children shall be disclosed child’s vocational goals and must be in good academic standing as
and considered. RCW 26.19.075(1)(e). defined by the institution. The court-ordered post-secondary
2. All income and resources of the parties before the court, new educational support shall be automatically suspended during the
spouses or domestic partners, and other adults in the household period or periods the child fails to comply with these conditions.
shall be disclosed and considered as provided. The presumptive RCW 26.19.090(3).
amount of support shall be determined according to the child 4. The child shall also make available all academic records and grades
support schedule. Unless specific reasons for deviation are set to both parents as a condition of receiving post-secondary
forth in the written findings of fact and are supported by the educational support. Each parent shall have full and equal access to
evidence, the court shall order each parent to pay the amount of the post-secondary education records as provided by statute (RCW
support determined by using the standard calculation. 26.09.225). RCW 26.19.090(4).
RCW 26.19.075(2).

WSCSS-Schedule 01/2019 Page 4

5. The court shall not order the payment of post-secondary
educational expenses beyond the child’s twenty-third birthday,
except for exceptional circumstances, such as mental, physical or
emotional disabilities. RCW 26.19.090(5).

6. The court shall direct that either or both parents’ payments for
post-secondary educational expenses are made directly to the
educational institution if feasible. If direct payments are not
feasible, then the court in its discretion may order that either or
both parents’ payments are made directly to the child if the child
does not reside with either parent. If the child resides with one
of the parents, the court may direct that the parent making the
support transfer payments make the payments to the child or to
the parent who has been receiving the support transfer payments.
RCW 26.19.090(6).

WSCSS-Schedule 01/2019 Page 5

 WASHINGTON STATE CHILD SUPPORT SCHEDULE
INSTRUCTIONS FOR WORKSHEETS
Worksheets: LINE 1b, Interest and Dividend Income: Enter the average
monthly total of dividends and interest income.
Immediately below the form title, check the box showing if the
worksheets are proposed or an order signed by the judge. If LINE 1c, Business Income: Enter the average monthly
they are proposed, check the box showing who proposed them income from self-employment, rent, royalties, contracts,
and put your name. proprietorship of a business, or joint ownership of a
partnership or closely held corporation.
Fill in your county, the case number, and the names and ages of
only those children whose support is at issue. LINE 1d, Maintenance Received: Enter the monthly amount
of maintenance actually received.
Write your name above “(Column 1)” and write the other
parent’s name above “(Column 2).” In the rest of the LINE 1e, Other Income: Enter the average monthly total of
worksheet, list your information under “Column 1” and list the other income. (Other income includes, but is not limited to:
other parent’s information under “Column 2.” income tax refunds, trust income, severance pay, annuities,
capital gains, pension retirement benefits, workers compensation,
Part I: Income unemployment benefits, social security benefits and disability
insurance benefits.)
Pursuant to INCOME STANDARD #1: Consideration of all
income, “only the income of the parents of the child(ren) whose LINE 1f, Imputed Income: Enter the imputed gross monthly
support is at issue shall be calculated for purposes of calculating income for a parent who is voluntarily unemployed,
the basic support obligation.” (See page 1.) underemployed or if you do not have records of a parent’s
actual earnings. Refer to “INCOME STANDARD #6:
Pursuant to INCOME STANDARD #2: Verification of income, Imputation of income.” (See page 2.) Impute income using the
“tax returns for the preceding two years and current paystubs are first method possible based on the information you have in the
required for income verification purposes. Other sufficient following order:
verification shall be required for income and deductions which
do not appear on tax returns or paystubs.” (See page 1.) Calculate full-time earnings using either:

Gross Monthly Income 1. Current rate of pay;

2. Historical rate of pay based on reliable information;
Gross monthly income is defined under INCOME STANDARD 3. Past rate of pay, if current information is incomplete or
#3: Income sources included in gross monthly income. (See sporadic; or
page 1.) 4. Minimum wage where the parent lives when the parent has a
history of minimum wage or government assistance is
Income exclusions are defined under INCOME STANDARD recently released from incarceration or is a high school
#4: Income sources excluded from gross monthly income. (See student.
page 2.) Excluded income must be disclosed and listed in Part
VIII of the worksheets. Historical rate of pay information may be available from the
Division of Child Support. Use form 18-701: “Request for
Monthly Average of Income: Income Information for Purposes of Entering a Child Support
 If income varies during the year, divide the annual total of Order”, available online at:
the income by 12. http://www.dshs.wa.gov/dcs/Resources/Forms.asp
 If paid weekly, multiply the weekly income by 52 and
divide by 12. If you impute income using one of the four methods, above, enter
 If paid every other week, multiply the two-week income by the amount in line 1f. Also, in line 26 of the Worksheets, explain
26 and divide by 12. which method you used to impute income and how you
 If paid twice a month (bi-monthly), multiply the bi-monthly calculated the amount of imputed income.
income by 24 and divide by 12.
If you cannot use any of the above methods, impute the parent’s
LINE 1a, Wages and Salaries: Enter the average monthly net monthly income using the table below, and enter the
total of all salaries, wages, contract-related benefits, appropriate amount for the parent’s age and gender on line 1f
bonuses, and income from overtime and second jobs that is and on line 3. The table, below, shows net income, after
not excluded from income by RCW 26.19.071(4)(i). deductions. So if you impute using this table, you will not enter
any deductions on the worksheet under line 2. Leave lines 2a
through 2i blank. For this parent, go to line 4.

WSCSS-Instructions 01/2019 Page 6

Also, in line 26 of the Worksheets, explain that net income LINE 2e, Mandatory Pension Plan Payments: Enter the
was imputed using the Approximate Median Net Monthly monthly cost of mandatory pension plan payments amount.
Income Table
LINE2f, Voluntary Retirement Contributions: Enter the
Approximate Median Net Monthly Income monthly cost of voluntary Retirement Contributions. Divide
the amount of the voluntary retirement contribution, up to $5,000
MALE age FEMALE per year, by 12 to calculate the monthly cost. (For more
$2,088 15-24 $1,934 information regarding limitations on the allowable deduction of
$3,243 25-34 $2,816 voluntary retirement contributions, refer to INCOME STANDARD
#5: Determination of net income. See page 2.)
$4,098 35-44 $3,321
$4,232 45-54 $3,365 LINE 2g, Maintenance Paid: Enter the monthly amount of
$4,318 55-64 $3,288 maintenance actually paid pursuant to a court order.
$4,972 65 + $3,858 LINE 2h, Normal Business Expenses: If self-employed, enter
the amount of normal business expenses. (Pursuant to INCOME
U.S. Census Bureau, Current Population Survey, 2018 Annual
STANDARD #5: Determination of net income,
Social and Economic Supplement, Table PINC-01. Selected
“justification shall be required for any business expense deduction
Characteristics of People 15 Years Old and Over by Total
about which there is a disagreement.” See page 2.)
Money Income in 2017, Work Experience in 2017, Race,
Hispanic Origin, and Sex, Worked Full Time, Year Round. LINE 2i, Total Deductions From Gross Income: Add the
monthly deductions for each parent (lines 2a through 2h) and
[Net income has been determined by subtracting FICA (7.65 enter the totals on line 2i.
percent) and the tax liability for a single person (one
withholding allowance).] LINE 3, Monthly Net Income: For each parent, subtract total
deductions (line 2i) from total gross monthly income (line 1g)
LINE 1g, Total Gross Monthly Income: Add the monthly and enter these amounts on line 3.
income amounts for each parent (lines 1a through 1f) and
enter the totals on line 1g. LINE 4, Combined Monthly Net Income: Add the parents’
monthly net incomes (line 3) and enter the total on line 4.
Monthly Deductions from Gross Income
LINE 5, Basic Child Support Obligation: In the work area
Allowable monthly deductions from gross income are defined provided on line 5, enter the basic support obligation amount
under INCOME STANDARD #5: Determination of net determined for each child. Add these amounts together and
income. (See page 2.) enter the total in the box on line 5. (To determine a per child
basic support obligation, see the following economic table
Monthly Average of Deductions: If a deduction is annual or instructions.)
varies during the year, divide the annual total of the deduction
by 12 to determine a monthly amount. Economic Table Instructions
LINE 2a, Income Taxes: Enter the net monthly amount To use the Economic Table to determine an individual support
actually owed for state and federal income taxes. (The amount for each child:
amount of income tax withheld on a paycheck may not be the
actual amount of income tax owed due to tax refunds,  Locate in the left-hand column the combined monthly net
deductions, etc. It is appropriate to consider tax returns from income amount closest to the amount entered on line 4 of
prior years as indicating the actual amount of income tax Worksheet (round up when the combined monthly net income
owed if income has not changed.) falls halfway between the two amounts in the left-hand
column);
LINE 2b, FICA/Self Employment Taxes: Enter the total
monthly amount of FICA, Social Security, Medicare and  Locate on the top row the family size for the number of
Self-employment taxes owed. children for whom child support is being determined (when
determining family size for the required worksheets, do not
LINE 2c, State Industrial Insurance Deductions: Enter include child(ren) from other relationships) and circle the
the monthly amount of state industrial insurance number in the column below the family size that is across
deductions such as Medical Aid Fund Tax, Accident Fund from the net income. The amount circled is the basic support
Tax, and Supplement Pension Fund Tax. Self-insured amount for each child.
employers may use different terms for the deductions.

LINE 2d, Mandatory Union/Professional Dues: Enter the

monthly cost of mandatory union or professional dues.

WSCSS-Instructions 01/2019 Page 7

 Part III: Health Care, Day Care, and Special
LINE 6, Proportional Share of Income: Divide the Child Rearing Expenses
monthly net income for each parent (line 3) by the
combined monthly net income (line 4) and enter these Pursuant to ALLOCATION STANDARD #4: “the court may
amounts on line 6. (The entries on line 6 when added exercise its discretion to determine the necessity for and the
together should equal 1.00.) reasonableness of all amounts ordered in excess of the basic child
support obligation.” (See page 2.)
Part II: Basic Child Support Obligation
Pursuant to ALLOCATION STANDARD #2: Health care expenses
LINE 7, Each Parent’s Basic Child Support Obligation and #3: Day care and special child rearing expenses, health care,
without consideration of low income limitations: Multiply day care, and special child rearing expenses shall be shared by the
the total basic child support obligation (amount in box on parents in the same proportion as the basic support obligation. (See
line 5) by the income share proportion for each parent page 2.) NOTE: The court order should reflect that health care,
(line 6) and enter these amounts on line 7. (The amounts day care and special child rearing expenses not listed should be
entered on line 7 added together should equal the amount apportioned by the same percentage as the basic child support
entered on line 5.) obligation.

LINE 8, Calculating low income limitations: Fill in only Monthly Average of Expenses: If a health care, day care, or special
those that apply: child rearing expense is annual or varies during the year, divide the
annual total of the expense by 12 to determine a monthly amount.
To calculate the low-income limitation standards in lines 8b
and 8c, you will need to know the self-support reserve Health Care Expenses
amount, which is 125% of the current federal poverty LINE 10a, Monthly Health Insurance Premiums Paid For
guideline for a one-person family. As of January 1, 2019, the Child(ren): List the monthly amount paid by each parent for
self-support reserve is $1,265. The guideline and self-support health care insurance for the child(ren) of the relationship.
reserve change roughly annually. To check the current self- (When determining an insurance premium amount, do not include
support reserve amount go to the courts’ web site at: the portion of the premium paid by an employer or other third party
www.courts.wa.gov, or go to www.WashingtonLawHelp.org. and/or the portion of the premium that covers the parent or other
Enter the self-support reserve amount in the space provided in household members.)
line 8. (For more information, see Limitation Standard #2 on
page 3 of the Definitions and Standards.) LINE 10b, Uninsured Monthly Health Care Expenses Paid For
Child(ren): List the monthly amount paid by each parent for
8a. Is combined net income less than $1,000? If the child(ren)’s health care expenses not reimbursed by
combined net monthly income on line 4 is less than insurance.
$1,000, enter each parent’s presumptive support
obligation of $50 per child. Do not enter an LINE 10c, Total Monthly Health Care Expenses: For each
amount on line 8a if combined income on line 4 is parent add the health insurance premium payments (line 10a)
more than $1,000. to the uninsured health care payments (line 10b) and enter
these amounts on line 10c.
8b. Is monthly net income less than self-support
reserve? For each parent whose monthly net income LINE 10d, Combined Monthly Health Care Expenses: Add the
on line 3 is less than the self-support reserve, enter parents’ total health care payments (line 10c) and enter this
the parent’s presumptive support obligation of $50 amount on line 10d.
per child. Do not use this box for a parent whose
net income on line 3 is greater than the self- Day Care and Special Expenses
support reserve.
LINE 11a, Day Care Expenses: Enter average monthly day
8c. Is monthly net income equal to or more than self- care costs.
support reserve? Subtract the self-support reserve LINE 11b, Education Expenses: Enter the average monthly
from line 3 and enter this amount or enter $50 per costs of tuition and other related educational expenses.
child whichever is greater. Do not use this box if
the amount is greater than the amount in line 7. LINE 11c, Long Distance Transportation Expenses: Enter the
average monthly costs of long distance travel incurred
LINE 9, Each parent’s basic child support obligation after pursuant to the residential or visitation schedule.
calculating applicable limitations: For each parent, enter
the lowest amount from line 7, 8a – 8c, but not less than the
presumptive $50 per child.

WSCSS-Instructions 01/2019 Page 8

 Part VI: Standard Calculation/Presumptive
LINE 11d, Other Special Expenses: Identify any other Transfer Payment
special expenses and enter the average monthly cost of
each. LINE 17, For Each Parent: subtract the total support credits
(line 16d) from the gross child support obligation (line 15) and
LINE 11e, Total Day Care and Special Expenses: Add the enter the resulting amounts on line 17. If the amount is less
monthly expenses for each parent (lines 11a through 11d) than $50 per child for either parent, then enter the presumptive
and enter these totals on line 11e. minimum support obligation of $50 per child, instead of the
LINE 12, Combined Monthly Total of Day Care and lower amount.
Special Expenses: Add the parents’ total expenses (line
11e) and enter this total on line 12. Part VII: Additional Informational Calculations

LINE 13, Total Health Care, Day Care and Special LINE 18, 45% of Each Parent’s Net Income From Line 3: For
Expenses: Add the health care expenses (line 10d) to the each parent, multiply line 3 by .45. Refer to LIMITATIONS
combined monthly total of day care and special expenses Standards #1: Limit at 45% of a parent’s net income.
(line 12) and enter this amount on line 13. LINE 19, 25% of Each Parent’s Basic Support Obligation from
LINE 14, Each Parent’s Obligation For Health Care, Day Line 9: For each parent, multiply line 9 by .25.
Care And Special Expenses: Multiply the total health
care, day care, and special expense amount (line 13) by the
Part VIII: Additional Factors for Consideration
income proportion for each parent (line 6) and enter these Pursuant to INCOME STANDARD #1: Consideration of all
amounts on line 14. income: “all income and resources of each parent’s household shall
LINE 15, Gross Child Support Obligation: For each be disclosed and considered by the court when the court determines
parent, add the basic child support obligation (line 9) to the child support obligation of each parent.” (See page 1.)
the obligation for extraordinary health care, day care and LINE 20 a-h, Household Assets: Enter the estimated present
special expenses (line 14). Enter these amounts on line 15. value of assets of the household.
Part V: Child Support Credits LINE 21, Household Debt: Describe and enter the amount of
liens against assets owned by the household and/or any
Child support credits are provided in cases where parents extraordinary debt.
make direct payments to third parties for the cost of goods
and services which are included in the standard calculation Other Household Income
support obligation (e.g., payments to an insurance company or
a day care provider). LINE 22a, Income of Current Spouse or Domestic Partner: If a
parent is currently married to or in a domestic partnership
LINE 16a, Monthly Health Care Expenses Credit: Enter with someone other than the parent of the child(ren) for whom
the total monthly health care expenses amounts from line support is being determined, list the name and enter the income
10c for each parent. of the present spouse or domestic partner.
LINE 16b, Day Care And Special Expenses Credit: Enter LINE 22b, Income of Other Adults In The Household: List the
the total day care and special expenses amounts from line names and enter the incomes of other adults residing in the
11e for each parent. household.
LINE 16c, Other Ordinary Expense Credit: If approval of LINE 22c, Gross income from overtime or from second jobs the
another ordinary expense credit is being requested, in the party is asking the court to exclude per INCOME STANDARD
space provided, specify the expense and enter the average #4, Income sources excluded from gross monthly income (see
monthly cost in the column of the parent to receive the page 2).
credit. (It is generally assumed that ordinary expenses are
paid in accordance with the child(ren)’s residence. If payment LINE 22d, Income of Children: If the amount is considered to
of a specific ordinary expense does not follow this be extraordinary, list the name and enter the income of
assumption, the parent paying for this expense may request children residing in the home.
approval of an ordinary expense credit. This credit is
discretionary with the court.)

LINE 16d, Total Support Credits: For each parent, add

the entries on lines 16 a through c and enter the totals on
line 16d.

WSCSS-Instructions 01/2019 Page 9

LINE 22e, Income from Child Support: List the name of
the child(ren) for whom support is received and enter the
amount of the support income. Do not include the
child(ren) for whom support is being determined.

LINE 22f, Income from Assistance Programs: List the

program and enter the amount of any income received
from assistance programs. (Assistance programs include,
but are not limited to: temporary assistance for needy
families, SSI, general assistance, food stamps and aid and
attendance allowances.)

LINE 22g, Other Income: Describe and enter the amount

of any other income of the household. (Include income
from gifts and prizes on this line.)

LINE 23, Nonrecurring Income: Describe and enter the

amount of any income included in the calculation of gross
income (LINE 1g) which is nonrecurring. (Pursuant to
DEVIATION STANDARD #1b: Nonrecurring income,
“depending on the circumstances, nonrecurring income may
include overtime, contract-related benefits, bonuses or income
from second jobs.” See page 3.)

LINE 24, Monthly Child Support Ordered for Other

Children. List the names and ages and enter the amount
of child support owed for other children, (not the children
for whom support is being determined). Is the support
paid? Check [ ] Yes or [ ] No.

LINE 25, Other Child(ren) Living in Each Household:

List the names and ages of children, other than those for
whom support is being determined, who are living in each
household.

LINE 26, Other Factors For Consideration: In the space

provided list any other factors that should be considered
in determining the child support obligation. (For
information regarding other factors for consideration, refer to
DEVIATION STANDARDS. See page 3.) Also use this
space to explain how you calculated the income and
deductions in lines 1 and 2.

Nonparental Custody Cases: When the children do not reside

with either parent, the household income and resources of the
children’s custodian(s) should be listed on line 26.

WSCSS-Instructions 01/2019 Page 10

 Washington State Child Support Schedule
Economic Table
Monthly Basic Support Obligation
Per Child
Repeat column heading
Combined One Two Three Four Five
Monthly Net Child Children Children Children Children
Income Family Family Family Family Family
For income less than $1,000, the obligation is based upon the resources and living expenses of each household. Minimum
support shall not be less than $50 per child per month except when allowed by RCW 26.19.065(2).
1000 216 167 136 114 100
1100 238 184 150 125 110
1200 260 200 163 137 120
1300 281 217 177 148 130
1400 303 234 191 160 141
1500 325 251 204 171 151
1600 346 267 218 182 161
1700 368 284 231 194 171
1800 390 301 245 205 180
1900 412 317 258 216 190
2000 433 334 271 227 200
2100 455 350 285 239 210
2200 477 367 298 250 220
2300 499 384 311 261 230
2400 521 400 325 272 239
2500 543 417 338 283 249
2600 565 433 351 294 259
2700 587 450 365 305 269
2800 609 467 378 317 279
2900 630 483 391 328 288
3000 652 500 405 339 298
3100 674 516 418 350 308
3200 696 533 431 361 318
3300 718 550 444 372 328
3400 740 566 458 384 337
3500 762 583 471 395 347
3600 784 599 484 406 357
3700 803 614 496 416 366
3800 816 624 503 422 371
3900 830 634 511 428 377
4000 843 643 518 434 382
4100 857 653 526 440 388
4200 867 660 531 445 392
4300 877 668 537 450 396
4400 887 675 543 455 400
4500 896 682 548 459 404
4600 906 689 554 464 408
4700 916 697 559 469 412
4800 927 705 566 474 417
4900 939 714 573 480 422
5000 951 723 580 486 428

WSCSS-Economic Table 01/2019

 5100 963 732 587 492 433
5200 975 741 594 498 438
5300 987 750 602 504 443
5400 999 759 609 510 449
5500 1011 768 616 516 454
5600 1023 777 623 522 459
5700 1030 782 627 525 462
5800 1036 786 630 528 465
5900 1042 791 634 531 467
6000 1048 795 637 534 470
6100 1054 800 641 537 472
6200 1061 804 644 540 475
6300 1067 809 648 543 477
6400 1073 813 651 545 480
6500 1081 819 656 549 483
6600 1096 830 665 557 490
6700 1111 842 674 564 497
6800 1126 853 683 572 503
6900 1141 864 692 579 510
7000 1156 875 701 587 516
7100 1170 886 710 594 523
7200 1185 898 719 602 530
7300 1200 909 727 609 536
7400 1212 918 734 615 541
7500 1222 925 740 620 545
7600 1231 932 745 624 549
7700 1241 939 751 629 554
7800 1251 946 756 634 558
7900 1261 953 762 638 562
8000 1270 960 767 643 566
8100 1280 968 773 647 570
8200 1290 975 778 652 574
8300 1299 981 783 656 577
8400 1308 987 788 660 581
8500 1316 994 793 664 584
8600 1325 1000 797 668 588
8700 1334 1007 802 672 591
8800 1343 1013 807 676 595
8900 1352 1019 812 680 599
9000 1361 1026 817 684 602
9100 1370 1032 822 689 606
9200 1379 1040 828 694 611
9300 1387 1047 835 699 616
9400 1396 1055 841 705 620
9500 1405 1062 848 710 625
9600 1414 1069 854 716 630
9700 1423 1077 861 721 635
9800 1432 1084 867 727 639
9900 1441 1092 874 732 644
10000 1451 1099 879 737 648

WSCSS-Economic Table 01/2019

 10100 1462 1107 885 741 652
10200 1473 1114 890 745 656
10300 1484 1122 895 750 660
10400 1495 1129 900 754 664
10500 1507 1136 906 759 668
10600 1518 1144 911 763 672
10700 1529 1151 916 767 675
10800 1539 1159 921 772 679
10900 1542 1161 924 774 681
11000 1545 1164 926 776 683
11100 1548 1166 928 778 684
11200 1551 1169 931 780 686
11300 1554 1172 933 782 688
11400 1556 1174 936 784 690
11500 1559 1177 938 786 692
11600 1562 1179 940 788 693
11700 1565 1182 943 790 695
11800 1568 1184 945 792 697
11900 1571 1187 948 794 699
12000 1573 1190 950 796 700
The economic table is presumptive for combined monthly net incomes up to and including twelve
thousand dollars. When combined monthly net income exceeds twelve thousand dollars, the court may
exceed the maximum presumptive amount of support upon written findings of fact.

WSCSS-Economic Table 01/2019

 Washington State Child Support Schedule Worksheets
Proposed by (name) State of WA (CSWP)
Or, Signed by the Judicial/Reviewing Officer. (CSW)
County Case No.
Child/ren and Age/s:
Parents’ names:
(Column 1) (Column 2)

Column 1 Column 2
Part I: Income (see Instructions, page 6)
1. Gross Monthly Income
a. Wages and Salaries $ $
b. Interest and Dividend Income $ $
c. Business Income $ $
d. Maintenance Received $ $
e. Other Income $ $
f. Imputed Income $ $
g. Total Gross Monthly Income (add lines 1a through 1f) $ $
2. Monthly Deductions from Gross Income
a. Income Taxes (Federal and State) $ $
b. FICA (Soc. Sec.+ Medicare)/Self-Employment Taxes $ $
c. State Industrial Insurance Deductions $ $
d. Mandatory Union/Professional Dues $ $
e. Mandatory Pension Plan Payments $ $
f. Voluntary Retirement Contributions $ $
g. Maintenance Paid $ $
h. Normal Business Expenses $ $
i. Total Deductions from Gross Income (add lines 2a through 2h) $ $
3. Monthly Net Income (line 1g minus 2i) $ $
4. Combined Monthly Net Income
(add both parents’ monthly net incomes from line 3) $
5. Basic Child Support Obligation
Number of children: ______ x $__________ per child
(enter total amount in box ) $

WSCSS-Worksheets - Mandatory (CSW/CSWP) 01/2019 Page 1 of 5

 Column 1 Column 2
6. Proportional Share of Income (divide line 3 by line 4 for each parent)
. .

Part II: Basic Child Support Obligation (see Instructions, page 7)

7. Each Parent’s Basic Child Support Obligation without consideration
of low income limitations. (Multiply each number on line 6 by line 5.) $ $
8. Calculating low income limitations: Fill in only those that apply.
Self-Support Reserve: (125% of the federal poverty guideline for a $
one-person family.)
a. Is Combined Net Income Less Than $1,000? If yes, for each
parent enter the presumptive $50 per child. $ $
b. Is Monthly Net Income Less Than Self-Support Reserve? If yes,
for that parent enter the presumptive $50 per child. $ $
c. Is Monthly Net Income equal to or more than Self-Support
Reserve? If yes, for each parent subtract the self-support reserve
from line 3. If that amount is less than line 7, enter that amount or
the presumptive $50 per child, whichever is greater. $ $
9. Each parent’s basic child support obligation after calculating
applicable limitations. For each parent, enter the lowest amount from
line 7, 8a - 8c, but not less than the presumptive $50 per child. $ $
Part III: Health Care, Day Care, and Special Child Rearing Expenses (see Instructions, page 8)
10. Health Care Expenses
a. Monthly Health Insurance Premiums Paid for Child(ren) $ $
b. Uninsured Monthly Health Care Expenses Paid for Child(ren) $ $
c. Total Monthly Health Care Expenses (line 10a plus line 10b) $ $
d. Combined Monthly Health Care Expenses
$
(add both parents’ totals from line 10c)
11. Day Care and Special Expenses
a. Day Care Expenses $ $
b. Education Expenses $ $
c. Long Distance Transportation Expenses $ $
d. Other Special Expenses (describe) $ $
$ $
$ $
$ $

e. Total Day Care and Special Expenses

(add lines 11a through 11d) $ $
12. Combined Monthly Total Day Care and Special Expenses (add both
parents’ day care and special expenses from line 11e) $

WSCSS-Worksheets - Mandatory (CSW/CSWP) 01/2019 Page 2 of 5

 Column 1 Column 2
13. Total Health Care, Day Care, and Special Expenses (line 10d plus
line 12) $

14. Each Parent’s Obligation for Health Care, Day Care, and Special
Expenses (multiply each number on line 6 by line 13) $ $

Part IV: Gross Child Support Obligation

15. Gross Child Support Obligation (line 9 plus line 14) $ $
Part V: Child Support Credits (see Instructions, page 9)
16. Child Support Credits
a. Monthly Health Care Expenses Credit $ $
b. Day Care and Special Expenses Credit $ $
c. Other Ordinary Expenses Credit (describe)

$ $

d. Total Support Credits (add lines 16a through 16c) $ $

Part VI: Standard Calculation/Presumptive Transfer Payment (see Instructions, page 9)
17. Standard Calculation (line 15 minus line 16d or $50 per child
whichever is greater) $ $
Part VII: Additional Informational Calculations
18. 45% of each parent’s net income from line 3 (.45 x amount from line
3 for each parent) $ $
19. 25% of each parent’s basic support obligation from line 9 (.25 x
amount from line 9 for each parent) $ $
Part VIII: Additional Factors for Consideration (see Instructions, page 9)
20. Household Assets
(List the estimated present value of all major household assets.)
a. Real Estate $ $
b. Investments $ $
c. Vehicles and Boats $ $
d. Bank Accounts and Cash $ $
e. Retirement Accounts $ $
f. Other (describe) $ $
$ $
21. Household Debt
(List liens against household assets, extraordinary debt.)
$ $
$ $
$ $
$ $
$ $
22. Other Household Income

WSCSS-Worksheets - Mandatory (CSW/CSWP) 01/2019 Page 3 of 5

 Column 1 Column 2
a. Income Of Current Spouse or Domestic Partner
(if not the other parent of this action)
Name __________________________________________ $ $
Name __________________________________________ $ $
b. Income Of Other Adults In Household
Name __________________________________________ $ $
Name __________________________________________ $ $
c. Gross income from overtime or from second jobs the party is
asking the court to exclude per Instructions, page 8
_________________________________________________ $ $

d. Income Of Child(ren) (if considered extraordinary)

Name __________________________________________ $ $
Name __________________________________________ $ $
e. Income From Child Support
Name __________________________________________ $ $
Name __________________________________________ $ $

f. Income From Assistance Programs

Program ________________________________________ $ $
Program ________________________________________ $ $
g. Other Income (describe)
________________________________________________ $ $
________________________________________________ $ $
23. Non-Recurring Income (describe)
_________________________________________________ $ $
_________________________________________________ $ $
24. Monthly Child Support Ordered for Other Children

Name/age: _____________________________ Paid [ ] Yes [ ] No $ $

Name/age: _____________________________ Paid [ ] Yes [ ] No $ $

Name/age: _____________________________ Paid [ ] Yes [ ] No $ $
25. Other Child(ren) Living In Each Household
(First name(s) and age(s))

26. Other Factors For Consideration

WSCSS-Worksheets - Mandatory (CSW/CSWP) 01/2019 Page 4 of 5

 Other Factors for Consideration (continued) (attach additional pages as necessary)

Signature and Dates

I declare, under penalty of perjury under the laws of the State of Washington, the information contained
in these Worksheets is complete, true, and correct.

Parent’s Signature (Column 1) Parent’s Signature (Column 2)

Date City Date City

________________________________________ _______________________________________
Judicial/Reviewing Officer Date

This worksheet has been certified by the State of Washington Administrative Office of the Courts.
Photocopying of the worksheet is permitted.

WSCSS-Worksheets - Mandatory (CSW/CSWP) 01/2019 Page 5 of 5

 Superior Court of Washington, County of
In re:
Petitioner/s (person/s who started this case): No.

Financial Declaration of
(name):
And Respondent/s (other party/parties): (FNDCLR)

Financial Declaration
1. Your personal information
Name:
Highest year of education you completed: Your job/profession is:
Are you working now?
Yes. List the date you were hired (month / year):
No. List the last date you worked (month / year):
What was your monthly pay before taxes: $
Why are you not working now?

2. Summary of your financial information

(Complete this section after filling out the rest of this form.)

1. Total Monthly Net Income (copy from section 3, line C. 3.) $

2. Total Monthly Expenses After Separation (copy from section 7, line I.) $
3. Total Monthly Payments for Other Debts (copy from section 9) $
4. Total Monthly Expenses + Payments for Other Debts (add line 2 and line 3) $

Gross Monthly Income of Other Party (copy from section 3. A.) $

RCW 26.18.220(1) Financial Declaration

Mandatory Form (09/2016)
FL All Family 131 p. 1 of 6
3. Income
List monthly income and deductions below for you and the other person in your case. If
your case involves child support, this same information is required on your Child Support
Worksheets. If you do not know the other person’s financial information, give an estimate.
Tip: If you do not get paid once a month, calculate your monthly income like this:
Monthly income = Weekly x 4.3 or 2-week x 2.15 or Twice a month x 2
A. Gross Monthly Income (before taxes, deductions, or retirement contributions)
You Other Party
Monthly wage / salary
Income from interest / dividends
Income from business
Spousal support / maintenance received
(Paid by: )
Other income

Total Gross Monthly Income (add all lines above)

Total gross income for this year before deductions
(starting January 1 of this year until now)

B. Monthly Deductions
You Other Party
Income taxes (federal and state)
FICA (Soc.Sec. + Medicare) or self-employment taxes
State Industrial Insurance (Workers’ Comp.)
Mandatory union or professional dues
Mandatory pension plan payments
Voluntary retirement contributions (up to the limit in RCW
26.19.071(5)(g))
Spousal support / maintenance paid
Normal business expenses

Total Monthly Deductions (add all lines above)

C. Net Monthly Income

You Other Party
1. Total Gross Monthly Income (from A above)
2. Total Monthly Deductions (from B above)

3. Net Monthly Income (Line 1 minus Line 2)

RCW 26.18.220(1) Financial Declaration
Mandatory Form (09/2016)
FL All Family 131 p. 2 of 6
4. Other Income and Household Income
Tip: If this income is not once a month, calculate the monthly amount like this:
Monthly income = Weekly x 4.3 or 2-week x 2.15 or Twice a month x 2
A. Other Income (Do not repeat income you already listed on page 2.)
You Other Party
Child support received from other relationships
Other income (From: )
Other income (From: )

Total Other Income (add all lines above)

B. Household Income (Monthly income of other adults living in the home)

Your Home Other Party’s
Home
Other adult’s gross income
(Name: )
Other adult’s gross income
(Name: )
Total Household Income of other adults in the home
(add all lines above)

5. Disputed Income – If you disagree with the other party’s statements about anyone’s
income, explain why the other party’s statements are not correct, and your statements are
correct:

6. Available Assets
List your liquid assets, like cash, stocks, bonds, that can be easily cashed.
Cash on hand and money in all checking & savings accounts $
Stocks, bonds, CDs and other liquid financial accounts $
Cash value of life insurance $
Other liquid assets $
Total Available Assets (add all lines above)

RCW 26.18.220(1) Financial Declaration

Mandatory Form (09/2016)
FL All Family 131 p. 3 of 6
7. Monthly Expenses After Separation
Tell the court what your monthly expenses are (or will be) after separation. If you have
dependent children, your expenses must be based on the parenting plan or schedule you
expect to have for the children.
A. Housing Expenses F. Transportation Expenses
Rent / Mortgage Payment Automobile payment (loan or lease)
Property Tax (if not in monthly payment) Auto insurance, license, registration
Homeowner’s or Rental Insurance Gas and auto maintenance
Other mortgage, contract, or debt Parking, tolls, public transportation
payments based on equity in your home
Homeowner’s Association dues or fees Other transportation expenses
Total Housing Expenses Total Transportation Expenses

B. Utilities Expenses G. Personal Expenses (not children’s)

Electricity and heating (gas and oil) Clothes
Water, sewer, garbage Hair care, personal care
Telephone(s) Recreation, clubs, gifts
Cable, Internet Education, books, magazines
Other (specify): Other Personal Expenses
Total Utilities Expenses Total Personal Expenses
C. Food and Household Expenses H. Other Expenses
Groceries for (number of people): _____ Life insurance (not deducted from pay)
Household supplies (cleaning, paper, pets) Other (specify):
Eating out Other (specify):
Other (specify): Other (specify):
Total Food and Household Expenses Total Other Expenses

D. Children’s Expenses List all Total Expenses from above:

Childcare, babysitting A. Total Housing Expenses
Clothes, diapers B. Total Utilities Expenses
Tuition, after-school programs, lessons C. Total Food and Household Expenses
Other expenses for children D. Total Children’s Expenses
Total Children’s Expenses E. Total Health Care Expenses
F. Total Transportation Expenses
E. Health Care Expenses G. Total Personal Expenses
Insurance premium (health, vision, dental) H. Total Other Expenses
Health, vision, dental, orthodontia, mental
I. All Total Expenses (add A - H above)
health expenses not covered by insurance
Other health expenses not covered by
insurance Use section 10 below to explain any unusual
expenses, or attach additional pages.
Total Health Care Expenses

RCW 26.18.220(1) Financial Declaration

Mandatory Form (09/2016)
FL All Family 131 p. 4 of 6
8. Debts included in Monthly Expenses listed in section 7 above
Debt for what expense Who do you owe Amount you owe this Last Monthly
(mortgage, car loan, etc.) (Name of creditor) creditor now Payment made
$ Date:
$ Date:
$ Date:
$ Date:

9. Monthly payments for other debts (not included in expenses listed in section 7)
Describe Debt Who do you owe Amount you owe Last Monthly Payment
(credit card, loan, etc.) (Name of creditor) this creditor now (Date and Amount)
$ Date: $
$ Date: $
$ Date: $
$ Date: $
$ Date: $
$ Date: $

Total Monthly Payments for Debts

10. Explanation of expenses or debts (if any needed):

11. Lawyer Fees

List your total lawyer fees and costs for this case as of today.
Source of the money you used to pay these fees and costs:
Amount paid $

Describe your agreement with your lawyer to pay your fees and
Amount still owed $
costs:

Total Fees/Costs $

I declare under penalty of perjury under the laws of the state of Washington that the facts I have
provided on this form are true.

Signed at (city and state): Date:

Sign here Print name

RCW 26.18.220(1) Financial Declaration

Mandatory Form (09/2016)
FL All Family 131 p. 5 of 6
Financial Records – You must provide financial records as required by statute and state and
local court rules. These records may include:
 Personal Income Tax Returns  Partnership or Corporate Income Tax Returns

 Pay stubs  Other financial records

Important! Do not attach financial records to this form. Financial records should be served on the other party and
filed with the court separately using the Sealed Financial Source Documents cover sheet (FL All Family 011). If
filed separately using the cover sheet, the records will be sealed to protect your privacy (although they will be
available to all parties and lawyers in this case, court personnel and certain state agencies and boards.) See GR
22(c)(2).

RCW 26.18.220(1) Financial Declaration

Mandatory Form (09/2016)
FL All Family 131 p. 6 of 6
 Superior Court of Washington, County of
In re:
Petitioner/s (person/s who started this case): No.

Sealed Financial Source Documents

(Cover Sheet)
And Respondent/s (other party/parties): (SEALFN)
 Clerk’s action required.
For use in Family Law and Guardianship cases.

Sealed Financial Source Documents

(Cover Sheet)
Use this form as a cover sheet to keep your financial documents private from the public. On the first page of each
document, write the word “SEALED” 1 inch from the top of the page.

Check the documents you are attaching to this cover sheet to be sealed:
Income tax records Pay stubs or other proof of earnings
Credit card statements Bank statements
Checks or the equivalent Loan application documents
Check registers Retirement plan orders
Other financial information sealed by court order (specify):

Submitted by: Petitioner or his/her lawyer Respondent or his/her lawyer

Sign here Print name (if lawyer, also provide WSBA #)

Important! The other person and the lawyers in your case can see your sealed documents. If you need to keep
your address information private for safety reasons, you may cross out or delete your address information.

GR 22(b)(8), (g) Sealed Financial Source Documents

Mandatory Form (05/2016)
FL All Family 011 p. 1 of 1
 Superior Court of Washington, County of
In re:
No.
Petitioner/s (person/s who started this case):
Child Support Order
[ ] Temporary (TMORS)
And Respondent/s (other party/parties): [ ] Final (ORS)
[x] Clerk’s action required: WSSR

Child Support Order

1. Money Judgment Summary
[ ] No money judgment is ordered.
[ ] Summarize any money judgments from section 22 in the table below.
Judgment for Debtor’s name Creditor’s name Amount Interest
(person who must (person who must
pay money) be paid)
Past due child support $ $
from to

Past due medical support $ $

from to
Past due children’s exp. $ $
from to
Other amounts (describe): $ $

Yearly Interest Rate for child support, medical support, and children’s expenses: 12%.
For other judgments: ______% (12% unless otherwise listed)
Lawyer (name): Represents (name):
Lawyer (name): Represents (name):

 Findings and Orders

2. The court orders child support as part of this family law case. This is a (check one):
RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order
Mandatory Form (07/2019)
FL All Family 130 p. 1 of 15
 [ ] temporary order. [ ] final order.
3. The Child Support Schedule Worksheets attached or filed separately are approved by the
court and made part of this Order.
4. Parents’ contact and employment information
Each parent must fill out and file with the court a Confidential Information form (FL All Family
001) including personal identifying information, mailing address, home address, and
employer contact information.
Important! If you move or get a new job any time while support is still owed, you must:
 Notify the Support Registry, and
 Fill out and file an updated Confidential Information form with the court.
Warning! Any notice of a child support action delivered to the last address you provided on
the Confidential Information form will be considered adequate notice, if the party trying to
serve you has shown diligent efforts to locate you.
5. Parents’ Income
Parent (name): Parent (name):
Net monthly income $ . Net monthly income $ .
(line 3 of the Worksheets) (line 3 of the Worksheets)
This income is (check one): This income is (check one):
[ ] imputed to this parent. (Skip to 6.) [ ] imputed to this parent. (Skip to 6.)
[ ] this parent’s actual income (after any exclusions [ ] this parent’s actual income (after any exclusions
approved below). approved below).
Does this parent have income from overtime or a Does this parent have income from overtime or a
2nd job? 2nd job?
[ ] No. (Skip to 6.) [ ] No. (Skip to 6.)
[ ] Yes. (Fill out below.) [ ] Yes. (Fill out below.)
Should this income be excluded? (check one): Should this income be excluded? (check one):
[ ] No. The court has included this income in this [ ] No. The court has included this income in this
parent’s gross monthly income on line 1 of the parent’s gross monthly income on line 1 of the
Worksheets. Worksheets.
[ ] Yes. This income should be excluded because: [ ] Yes. This income should be excluded because:
 This parent worked over 40 hours per week  This parent worked over 40 hours per week
averaged over 12 months, and averaged over 12 months, and
 That income was earned to pay for  That income was earned to pay for
[ ] current family needs [ ] debts from a past [ ] current family needs [ ] debts from a past
relationship [ ] child support debt, and relationship [ ] child support debt, and
 This parent will stop earning this extra  This parent will stop earning this extra
income after paying these debts. income after paying these debts.
The court has excluded $ The court has excluded $
from this parent’s gross monthly income on line from this parent’s gross monthly income on line
1 of the Worksheets. 1 of the Worksheets.
[ ] Other Findings: [ ] Other Findings:

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order

Mandatory Form (07/2019)
FL All Family 130 p. 2 of 15
 Parent (name): Parent (name):

6. Imputed Income
To calculate child support, the court may impute income to a parent:
 whose income is unknown, or
 who the court finds is unemployed or under-employed by choice.
Imputed income is not actual income. It is an assigned amount the court finds a parent
could or should be earning. (RCW 26.19.071(6))

Parent (name): Parent (name):

[ ] Does not apply. This parent’s actual income is [ ] Does not apply. This parent’s actual income is
used. (Skip to 7.) used. (Skip to 7.)
[ ] This parent’s monthly net income is imputed [ ] This parent’s monthly net income is imputed
because (check one): because (check one):
[ ] this parent’s income is unknown. [ ] this parent’s income is unknown.
[ ] this parent is voluntarily unemployed. [ ] this parent is voluntarily unemployed.
[ ] this parent is voluntarily under-employed. [ ] this parent is voluntarily under-employed.
[ ] this parent works full-time but is purposely [ ] this parent works full-time but is purposely
under-employed to reduce child support. under-employed to reduce child support.
The imputed amount is based on the information The imputed amount is based on the information
below: (Options are listed in order of required below: (Options are listed in order of required
priority. The Court used the first option possible priority. The Court used the first option possible
based on the information it had.) based on the information it had.)
[ ] Full-time pay at current pay rate. [ ] Full-time pay at current pay rate.
[ ] Full-time pay based on reliable information [ ] Full-time pay based on reliable information
about past earnings. about past earnings.
[ ] Full-time pay based on incomplete or [ ] Full-time pay based on incomplete or
irregular information about past earnings. irregular information about past earnings.
[ ] Full-time pay at minimum wage in the area [ ] Full-time pay at minimum wage in the area
where the parent lives because this parent where the parent lives because this parent
(check all that apply): (check all that apply):
[ ] is a high school student. [ ] is a high school student.
[ ] recently worked at minimum wage jobs. [ ] recently worked at minimum wage jobs.
[ ] recently stopped receiving public [ ] recently stopped receiving public
assistance, supplemental security assistance, supplemental security
income (SSI), or disability. income (SSI), or disability.
[ ] was recently incarcerated. [ ] was recently incarcerated.
[ ] Table of Median Net Monthly Income. [ ] Table of Median Net Monthly Income.
[ ] Other (specify): [ ] Other (specify):

7. Limits affecting the monthly child support amount

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order
Mandatory Form (07/2019)
FL All Family 130 p. 3 of 15
 [ ] Does not apply. The monthly amount was not affected by the upper or lower limits in
RCW 26.19.065.
[ ] The monthly amount has been affected by (check all that apply):
[ ] low-income limits. The self-support reserve and presumptive minimum payment
have been calculated in the Worksheets, lines 8.a. - c.
[ ] the 45% net income limit. The court finds that the paying parent’s child support
obligations for his/her biological and legal children are more than 45% of his/her
net income (Worksheets, line 18). Based on the children’s best interests and the
parents’ circumstances, it is (check one): [ ] fair. [ ] not fair to apply the 45%
limit. (Describe both parents’ situations):

[ ] Combined Monthly Net Income over $12,000. Together, the parents earn more
than $12,000 per month (Worksheets line 4). The child support amount (check one):
[ ] is the presumptive amount from the economic table.
[ ] is more than the presumptive amount from the economic table because (specify):

8. Standard Calculation

Parent Name Standard calculation

Worksheets line 17

[ ] Check here if there is a Residential Split – (each parent has at least one of the
children from this relationship living with him/her most of the time.)
These children (names and ages): These children (names and ages):

Live with (parent’s name): Live with (parent’s name):

The standard calculation for the parent paying support is $ . This is from
(check one):
[ ] The Attachment for Residential Split Adjustment (Arvey calculation), line G (form
WSCSS–Attachment for RSA). This Attachment to the Child Support Schedule
Worksheets is approved by the court and made part of this order.

[ ] Other calculation (specify method and attach Worksheet/s):

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order
Mandatory Form (07/2019)
FL All Family 130 p. 4 of 15
9. Deviation from standard calculation
Should the monthly child support amount be different from the standard calculation?
[ ] No – The monthly child support amount ordered in section 10 is the same as the
standard calculation listed in section 8 because (check one):
[ ] No one asked for a deviation from the standard calculation. (Skip to 10.)
[ ] There is no good reason to approve the deviation requested by (name/s):
The facts supporting this decision are (check all that apply):
[ ] detailed in the Worksheets, Part VIII, lines 20 through 26.
[ ] the parent asking for a deviation:
[ ] has a new spouse or domestic partner with income of $ .
[ ] lives in a household where other adults have income of $ .
[ ] has income from overtime or a 2nd job that was excluded in section 5
above.
[ ] other (specify):
[ ] Yes – The monthly child support amount ordered in section 10 is different from the
standard calculation listed in section 8 because (check all that apply):
[ ] A parent or parents in this case has:
[ ] children from other relationships.
[ ] paid or received child support for children from other relationships.
[ ] gifts, prizes, or other assets.
[ ] income that is not regular (non-recurring income) such as bonuses, overtime,
etc.
[ ] unusual unplanned debt (extraordinary debt not voluntarily incurred).
[ ] tax planning considerations that will not reduce the economic benefit to the
children.
[ ] very different living costs, which are beyond their control.
[ ] The children in this case:
[ ] spend significant time with the parent who owes support. The non-standard
amount still gives the other parent’s household enough money for the children’s
basic needs. The children do not get public assistance (TANF).
[ ] have extraordinary income.
[ ] have special needs because of a disability.
[ ] have special medical, educational, or psychological needs.
[ ] There are (or will be) costs for court-ordered reunification or a voluntary placement
agreement.
[ ] The parent who owes support has shown it is not fair to have to pay the $50 per
child presumptive minimum payment.
[ ] The parent who is owed support has shown it is not fair to apply the self-support
reserve (calculated on lines 8.a. – c. of the Worksheets).
[ ] Other reasons:

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order

Mandatory Form (07/2019)
FL All Family 130 p. 5 of 15
 The facts that support the reasons checked above are (check all that apply):
[ ] detailed in the Worksheets, Part VIII, lines 20 through 26.
[ ] the parent asking for a deviation:
[ ] has a new spouse or domestic partner with income of $ .
[ ] lives in a household where other adults have income of $ .
[ ] has income from overtime or a 2nd job that was excluded in section 5 above.
[ ] as follows:

10. Monthly child support amount (transfer payment)

After considering the standard calculation in section 8, and whether or not to apply a
deviation in section 9, the court orders the following monthly child support amount
(transfer payment).
[ ] (Name): must pay child
support to (name): each month as follows for the children
listed below (add lines for additional children if needed):
Child’s Name Age Amount
1. $
2. $
3. $
4. $
5. $
Total monthly child support amount: $

[ ] Residential Split – Each parent has at least one of the children from this relationship
living with him/her most of the time. (Name): must pay
child support to (name): each month as follows:

Total monthly child support amount: $

11. Starting date and payment schedule

The monthly child support amount must be paid starting (month, year):
on the following payment schedule:
[ ] in one payment each month by the day of the month.
[ ] in two payments each month: ½ by the and ½ by the day of the month.
[ ] other (specify):

12. Step Increase (for modifications or adjustments only)

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order
Mandatory Form (07/2019)
FL All Family 130 p. 6 of 15
 [ ] Does not apply.
[ ] Approved – The court is changing a final child support order. The monthly child
support amount is increasing by more than 30% from the last final child support order.
This causes significant financial hardship to the parent who owes support, so the
increase will be applied in two equal steps:
 For six months from the Starting Date in section 11 above, the monthly child
support amount will be the old monthly amount plus ½ of the increase, for a total of
$ each month.
 On (date): , six months after the Starting Date in section 11,
the monthly child support amount will be the full amount listed in section 10.
[ ] Denied – The court is changing a final child support order (check one):
[ ] but the monthly payment increased by less than 30%.
[ ] and the monthly payment increased by more than 30%, but this does not cause a
significant hardship to the parent who owes support.
13. Periodic Adjustment
[ ] Child support may be changed according to state law. The Court is not ordering a
specific periodic adjustment schedule below.
[ ] Any party may ask the court to adjust child support periodically on the following
schedule without showing a substantial change of circumstances:
The Motion to Adjust Child Support Order may be filed:
[ ] every months.
[ ] on (date/s):
[ ] other (describe condition or event):

Important! A party must file a Motion to Adjust Child Support Order (form FL Modify 521), and the
court must approve a new Child Support Order for any adjustment to take effect.
[ ] Deadlines, if any (for example, deadline to exchange financial information, deadline to
file the motion):

14. Payment Method (check either Registry or Direct Pay)

[ ] Registry – Send payment to the Washington State Support Registry. The Division of
Child Support (DCS) will forward the payments to the person owed support and keep
records of all payments.
Address for payment: Washington State Support Registry
PO Box 45868, Olympia, WA 98504
Phone number/s: 1 (800) 922-4306 or 1 (800) 442-5437

Important! If you are ordered to send your support payments to the Washington State Support
Registry, and you pay some other person or organization, you will not get credit for your payment.

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order

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FL All Family 130 p. 7 of 15
 DCS Enforcement (if Registry is checked above):
[ ] DCS will enforce this order because (check all that apply):
[ ] this is a public assistance case.
[ ] one of the parties has already asked DCS for services.
[ ] one of the parties has asked for DCS services by signing the application
statement at the end of this order (above the Warnings).
[ ] DCS will not enforce this order unless one of the parties applies for DCS services
or the children go on public assistance.
[ ] Direct Pay – Send payment to the other parent or non-parent custodian by:
[ ] mail to:

street address or PO box city state zip

or any new address the person owed support provides to the parent who owes
support. (This does not have to be his/her home address.)
[ ] other method:

15. Enforcement through income withholding (garnishment)

DCS or the person owed support can collect the support owed from the wages, earnings,
assets, or benefits of the parent who owes support, and can enforce liens against real or
personal property as allowed by any state’s child support laws without notice to the parent
who owes the support.
If this order is not being enforced by DCS and the person owed support wants to have
support paid directly from the employer, the person owed support must ask the court to
sign a separate wage assignment order requiring the employer to withhold wages and
make payments. (Chapter 26.18 RCW.)
Income withholding may be delayed until a payment becomes past due if the court finds
good reason to delay.
[ ] Does not apply. There is no good reason to delay income withholding.
[ ] Income withholding will be delayed until a payment becomes past due because
(check one):
[ ] the child support payments are enforced by DCS and there are good reasons in the
children’s best interest not to withhold income at this time. If this is a case about
changing child support, previously ordered child support has been paid on time.
List the good reasons here:

[ ] the child support payments are not enforced by DCS and there are good reasons
not to withhold income at this time.
List the good reasons here:

[ ] the court has approved the parents’ written agreement for a different payment
arrangement.
RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order
Mandatory Form (07/2019)
FL All Family 130 p. 8 of 15
16. End date for support
Support must be paid for each child until (check one):
[ ] the court signs a different order, if this is a temporary order.
[ ] the child turns 18 or is no longer enrolled in high school, whichever happens last,
unless the court makes a different order in section 17.
[ ] the child turns 18 or is otherwise emancipated, unless the court makes a different
order in section 17.
[ ] after (child’s name): turns 18. Based on
information available to the court, it is expected that this child will be unable to support
him/herself and will remain dependent past the age of 18. Support must be paid until
(check one):
[ ] this child is able to support him/herself and is no longer dependent on the parents.
[ ] other:
[ ] other (specify):
17. Post-secondary educational support (for college or vocational school)
[ ] Reserved – A parent or non-parent custodian may ask the court for post-secondary
educational support at a later date without showing a substantial change of
circumstances by filing a Petition to Modify Child Support Order (form FL Modify 501).
The Petition must be filed before child support ends as listed in section 16.
[ ] Granted – The parents must pay for the children’s post-secondary educational
support. Post-secondary educational support may include support for the period after
high school and before college or vocational school begins. The amount or
percentage each person must pay (check one):
[ ] will be decided later. The parties may make a written agreement or ask the
court to set the amount or percentage by filing a Petition to Modify Child
Support Order (form FL Modify 501).
[ ] is as follows (specify):

[ ] Denied – The request for post-secondary educational support is denied.

[ ] Other (specify):
18. Tax Issues
Important! Although the personal tax exemptions are currently suspended under federal law through tax
year 2025, other tax benefits may flow from claiming a child as dependent.

[ ] Does not apply.

[ ] The parties have the right to claim the children as their dependents for purposes of
personal tax exemptions and associated tax credits on their tax forms as follows
(check one):
[ ] Every year – (name):
has the right to claim (children’s names): ;
and (name):
has the right to claim (children’s names): .
RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order
Mandatory Form (07/2019)
FL All Family 130 p. 9 of 15
 [ ] Alternating – (name):
has the right to claim the children for (check one): [ ] even [ ] odd years. The
other parent has the right to claim the children for the opposite years.
[ ] Other (specify):

For tax years when a non-custodial parent has the right to claim the children, the
parents must cooperate to fill out and submit IRS Form 8332 in a timely manner.
19. Medical Support
Important! Read the Medical Support Warnings at the end of this order. Medical Support
includes health insurance (both public and private) and cash payments towards premiums
and uninsured medical expenses.
[ ] The court is not ordering how health care coverage must be provided for the children
because the court does not have enough information to determine the availability of
accessible health care coverage for the children (coverage that could be used for the
children’s primary care). The law requires every parent to provide or pay for medical
support. The Division of Child Support (DCS) or any parent can enforce this
requirement. (Skip to 20.)
[ ] Private health insurance ordered. (Name): must pay
the premium to provide health insurance coverage for the children. The court has
considered the needs of the children, the cost and extent of coverage, and the
accessibility of coverage.
[ ] The other parent must pay his/her proportional share* of the premium paid. Health
insurance premiums (check one):
[ ] are included on the Worksheets (line 14). No separate payment is needed.
[ ] are not included on the Worksheets. Separate payment is needed. A parent
or non-parent custodian may ask DCS or the court to enforce payment for the
proportional share.
* Proportional share is each parent’s percentage share of the combined net
income from line 6 of the Child Support Schedule Worksheets.
[ ] The other parent is not ordered to pay for any part of the children’s insurance
because (explain):

A parent cannot be excused from providing health insurance coverage through an employer or
union solely because the child receives public health care coverage.
[ ] A parent has been ordered to pay an amount that is more than 25% of his/her
basic support obligation (Worksheets, line 19). The court finds this is in the
children’s best interest because:

A parent cannot be ordered to pay an amount towards health care coverage premiums that is more
than 25% of his/her basic support obligation (Worksheets, line 19) unless the court finds it is in the
best interest of the children.

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order

Mandatory Form (07/2019)
FL All Family 130 p. 10 of 15
 [ ] Public health care coverage. (Name): has enrolled the
child in public health care coverage, and does not have available at no cost accessible
health insurance coverage through an employer or union.
[ ] The other parent must enroll the child in accessible health insurance coverage
through their employer or union up to 25% of their basic support obligation.
[ ] The other parent must pay his/her proportional share* of the premium for public
health care coverage for the child. Public health care premiums (check one):
[ ] are included on the Worksheets (line 14). No separate payment is needed.
[ ] are not included on the Worksheets. Separate payment is needed. A parent
or non-parent custodian may ask DCS or the court to enforce payment for the
proportional share.
* Proportional share is each parent’s percentage share of the combined net
income from line 6 of the Child Support Schedule Worksheets.
[ ] The other parent is not ordered to pay for any part of the children’s health care
coverage because (explain):

A parent cannot be excused from providing health insurance coverage through an employer or
union solely because the child receives public health care coverage.
[ ] A parent has been ordered to pay an amount that is more than 25% of his/her basic
support obligation (Worksheets, line 19). The court finds this is in the children’s best
interest because:
[ ] Other (specify):

20. Health care coverage if circumstances change or court has not ordered
If the parties’ circumstances change, or if the court is not ordering how health care coverage
must be provided for the children in section 19:
 A parent, non-parent custodian, or DCS can enforce the medical support requirement.
 If a parent does not provide proof of accessible health care coverage (coverage that
can be used for the children’s primary care), that parent must:
 Get (or keep) insurance through his/her work or union, unless the insurance costs
more than 25% of his/her basic support obligation (line 19 of the Worksheets),
 Pay his/her share of the other parent’s monthly premium up to 25% of his/her basic
support obligation (line 19 of the Worksheets), or
 Pay his/her share of the monthly cost of any public health care coverage, such as
Apple Health or Medicaid, which is assigned to the state.
21. Children’s expenses not included in the monthly child support amount
Uninsured medical expenses – Each parent is responsible for a share of uninsured
medical expenses as ordered below. Uninsured medical expenses include premiums, co-
pays, deductibles, and other health care costs not paid by health care coverage.

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order

Mandatory Form (07/2019)
FL All Family 130 p. 11 of 15
 Make payments to:
Parent (name): Parent (name):
Person who
Service
Children’s pays the
pays monthly pays monthly Provider
Expenses for: expense
Uninsured medical [ ] Proportional Share* [ ] Proportional Share*
[ ] [ ]
expenses [ ] %** [ ] %**
* Proportional Share is each parent’s percentage share of the combined net income from line 6 of the
Child Support Schedule Worksheets.
** If the percentages ordered are different from the Proportional Share, explain why:

Other shared expenses (check one):

[ ] Does not apply. The monthly amount covers all expenses, except health care expenses.
[ ] The parents will share the cost for the expenses listed below (check all that apply):
Make payments to:
Parent (name): Parent (name):
Person who
Service
Children’s pays the
pays monthly pays monthly Provider
Expenses for: expense
[ ] Day care: [ ] Proportional Share* [ ] Proportional Share*
[ ]$ [ ]$ [ ] [ ]
[ ] %** [ ] %**

[ ] Education: [ ] Proportional Share* [ ] Proportional Share*

[ ]$ [ ]$ [ ] [ ]
[ ] %** [ ] %**

[ ] Long-distance
[ ] Proportional Share* [ ] Proportional Share*
transportation:
[ ]$ [ ]$ [ ] [ ]
[ ] %** [ ] %**

[ ] Other (specify): [ ] Proportional Share* [ ] Proportional Share*

[ ]$ [ ]$ [ ] [ ]
[ ] %** [ ] %**

* Proportional Share is each parent’s percentage share of the combined net income from line 6 of the
Child Support Schedule Worksheets.
** If any percentages ordered are different from the Proportional Share, explain why:

[ ] Other (give more detail about covered expenses here, if needed):

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order

Mandatory Form (07/2019)
FL All Family 130 p. 12 of 15
 A person receiving support can ask DCS to collect:
 expenses owed directly to him/her.
 reimbursement for expenses the person providing support was ordered to pay.
 an order for a money judgment that s/he got from the court.
22. Past due child support, medical support and other expenses
[ ] This order does not address any past due amounts or interest owed.
[ ] As of (date): , no parent owes (check all that apply):
[ ] past due child support [ ] interest on past due child support
[ ] past due medical support [ ] interest on past due medical support
[ ] past due other expenses [ ] interest on past due other expenses
to (check all that apply): [ ] the other parent or non-parent custodian. [ ] the state.
[ ] The court orders the following money judgments (summarized in section 1 above):

Judgment for Debtor’s name Creditor’s name Amount Interest

(person who must (person who must
pay money) be paid)
[ ] Past due child support $ $
from to
[ ] Past due medical support $ $
(health ins. & health care costs
not covered by ins.)
from to
[ ] Past due expenses for: $ $
[ ] day care
[ ] education
[ ] long-distance transp.
from to
[ ] Other (describe): $ $

The interest rate for child support judgments is 12%.

[ ] Other (specify):

23. Overpayment caused by change

[ ] Does not apply.
[ ] The Order signed by the court today or on date:
caused an overpayment of $ .
[ ] (Name): shall repay this amount
to (Name): by (date): .
[ ] The overpayment shall be credited against the monthly support amount owed each
month at the rate of $ each month until paid off.

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order

Mandatory Form (07/2019)
FL All Family 130 p. 13 of 15
 [ ] Other (specify):

24. Other Orders

All of the Warnings below are required by law and are incorporated and made part of this order.
[ ] Other (specify):
Ordered.

Date Judge or Commissioner

Petitioner and Respondent or their lawyers fill out below:

This document (check any that apply): This document (check any that apply):
[ ] is an agreement of the parties [ ] is an agreement of the parties
[ ] is presented by me [ ] is presented by me
[ ] may be signed by the court without notice to me [ ] may be signed by the court without notice to me

Petitioner signs here or lawyer signs here + WSBA # Respondent signs here or lawyer signs here + WSBA #

Print Name Date Print Name Date

[ ] If any parent or child received public assistance:

The state Department of Social and Health Services (DSHS) was notified about this order through the
Prosecuting Attorney’s office, and has reviewed and approved the following:
[ ] child support [ ] medical support
[ ] past due child support [ ] other (specify):

Deputy Prosecutor signs here Print name and WSBA # Date

[ ] Parent or Non-Parent Custodian applies for DCS enforcement services:

I ask the Division of Child Support (DCS) to enforce this order. I understand that DCS will keep $35 each year
($25 before 10/1/2019) as a fee if DCS collects more than $550 ($500 before 10/1/2019), unless I ask to be
excused from paying this fee in advance. (You may call DCS at 1-800-442-5437. DCS will not charge a fee if
you have ever received TANF, tribal TANF, or AFDC.)

Parent or Non-Parent Custodian signs here Print name Date

(lawyer cannot sign for party)

All the warnings below are required by law and are part of
the order. Do not remove.

Warnings!
If you don’t follow this child support order…  Dept. of Fish and Wildlife may suspend or refuse to
 DOL or other licensing agencies may deny, suspend, or issue your fishing and hunting licenses and you may
refuse to renew your licenses, including your driver’s not be able to get permits. (RCW 74.20A.320)
license and business or professional licenses, and
RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order
Mandatory Form (07/2019)
FL All Family 130 p. 14 of 15
If you receive child support…  Repay the other parent for any day care or special
You may have to: expenses included in the support if you didn’t actually
 Document how that support and any cash received for have those expenses. (RCW 26.19.080)
the children’s health care was spent.

Medical Support Warnings!

The parents must keep the Support Registry informed whether or not they have access to health care coverage for the
children at a reasonable cost, and provide the policy information for any such coverage.
* * *
If you are ordered to provide children’s health care coverage…
You have 20 days from the date of this order to send:
 proof that the children are covered , or
 proof that health care coverage is not available as ordered.
Send your proof to the other parent or to the Support Registry (if your payments go there).
If you do not provide proof of health care coverage:
 The other parent or the support agency may contact your employer or union, without notifying you, to ask for direct
enforcement of this order (RCW 26.18.170), and
 The other parent may:
 Ask the Division of Child Support (DCS) for help,
 Ask the court for a contempt order, or
 File a Petition in court.
Don’t cancel your employer or union health insurance for your children unless the court approves or your job ends and
you no longer qualify for insurance as ordered in section 19.
If an insurer sends you payment for a medical provider’s service:
 you must send it to the medical provider if the provider has not been paid; or
 you must send the payment to whoever paid the provider if someone else paid the provider; or
 you may keep the payment if you paid the provider.
If the children have public health care coverage, the state can make you pay for the cost of the monthly premium.
Always inform the Support Registry and any parent if your access to health care coverage changes or ends.

RCW 26.09.135; 26.26.132; 26.10.050 Child Support Order

Mandatory Form (07/2019)
FL All Family 130 p. 15 of 15
 EVALUATION FORM: How was this 3213EN CHILD SUPPORT ORDERS packet? Your
comments are appreciated and will help to make this packet more useful to others. Please
take a moment to complete this form and return it to:

LeeAnn Friedman
Northwest Justice Project
500 W. 8th, Suite 275
Vancouver, WA 98660
Or email to webmaster@nwjustice.org

1. Where did you get this packet?

 CLEAR  washingtonlawhelp.org  Court Clerk or Facilitator
 Other:
2. What is your primary language?
3. Are you low-income?  yes  no
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5. Did you read the instructions?  yes  no
6. Did you need the help of an agency, court facilitator, or advocate to complete your
case?  yes  no
If yes, what agency or individual helped you?
7. Did you find anything hard to understand?  yes  no
If yes, please tell us what.

8. Did you find any mistakes?  yes  no

Describe mistakes. Include the page #.

9. Additional Comments [use back if you need to]:

10. Today’s Date: