CHILD SUPPORT SERVICES - Medical Support Reasonable Cost Calculator
DATE
Obligated Parent
Case Number
Client Number(s) for Children on the Support Order
Support Order Number OF
Name of Employer Providing Insurance Coverage
Enter average monthly salary
OR Calculate average monthly income if paid hourly wages:
Enter regular hourly wage
Enter average number of hours worked per week
Enter overtime hourly wage
Enter average number of overtime hours worked per week
Enter total cost of providing medical insurance coverage for ordered dependant(s)
Notes:
REASONABLE COST DETERMINATION
Gross Monthly Income
Maximum Allowable Cost (5% of gross monthly income)
Cost of Providing Medical Support
If the cost of providing medical support is less than five percent (5%) of gross monthly income, determine
whether the amount of child support withheld plus the cost of providing medical support exceeds fifty
percent (50%) of disposable earnings.
Enter total amount of monthly child support withheld
Calculate total monthly deductions by entering the amount withheld for:
Semi-
Monthly OR Monthly OR Bi-weekly OR Weekly
FICA
Federal Taxes
State Taxes
MAXIMUM AMOUNT OF WITHHOLDING
Gross Monthly Income
Total Monthly Deductions
Monthly Disposable Earnings (Gross income less total deductions)
Maximum Amount of Withholding Allowable (50% of disposable earnings)
Total Withholding (Sum of child support withheld and cost of insurance coverage)