New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter A - Forms Authorized by Section 205.7 › Child Support Forms (Family Court Act Articles 4, 5-B) › Form UCS-111 - Child support summary form: supreme and family court

Current through Register Vol. 46, No. 28, July
					 10, 2024
UCS-111 (rev: 12/01)
CHILD SUPPORT SUMMARY FORM
SUPREME AND FAMILY COURT
COMPLETE FORM FOR EACH BASIC CHILD SUPPORT
						OBLIGATION ORDER[FN1]
A. Court: Supreme Family
B. County: ________
C. Index #/Docket #: ________
D. Date Action Commenced:
_____/_____/_____
E. Date Judgment/Order Submitted or
						Signed:
_____/_____/_____
F. # Of Children Subject to Child Support
						Order:
________
G. Annual Gross Income:
1. Father: $________ Mother: $
						________
H. Amount of Child Support Payment:
1. By Father: $________ 2. By Mother: $
						________
annually annually
I. Additional Child Support:
(Circle as many as appropriate)
By Father: By Mother:
1. Medical/Med. Ins. 1. Medical/Med.
						Ins.
2. Child Care 2. Child Care
3. Education 3. Education
4. Other 4. Other
J. Did the court make a finding that the
						child support award varied from the Child Support Standards Act amount? (Circle
						one)
1. Yes 2. No
K. If answer to "J" was yes, circle
						court's reason(s):
1. Financial resources of
						parent/child.
2. Physical/emotional health of child:
						special needs or aptitudes.
3. Child's expected standard of living had
						household remained intact.
4. Tax consequences.
5. Non-monetary contribution toward care
						and well-being of child.
6. Educational needs of either
						parent.
7. Substantial differences in gross income
						of parents.
8. Needs of other children of
						non-custodial parent.
9. Extraordinary visitation expenses of
						non-custodial parent.
10. Other (specify):
____________
____________
____________
L. Maintenance/Spousal Support: (Circle
						one)
1. None 2. By Father 3. By Mother
M. Value of Maintenance/Spousal Support:
$ ________ annually
SUPREME COURT ONLY
N. Allocation of Property:
________% To Father ________ % To
						Mother
UCS-111 (rev: 12/01)
NEW YORK STATE UNIFIED COURT SYSTEM
SUPPORT SUMMARY FORM: FAMILY & SUPREME
						COURT (UCS-111)
INSTRUCTION SHEET
Prepare one report for each proposed
						judgment or final order granted pursuant to Article 4 or 5 of the Family Court
						Act and DRL § 240 and § 236(9)(b) which includes a provision for
						child support (including modification of order).
SUBMIT COMPLETED FORM TO:
Office of Court Administration
Office of Court Research
25 Beaver Street, Room 975
New York, New York 10004
GENERAL INSTRUCTIONS: > ALL ITEMS MUST
						BE ANSWERED
10. If a number or amount in dollars is
						required and answer is none, write 0.
11. If a certain item is not applicable,
						write NA.
12. If the information is unknown or not
						known to the party filling out the form, write UK.
13. "mm/dd/yy" means
						"month/day/year".
SPECIAL INSTRUCTIONS FOR PARTICULAR
						ITEMS:
G. Use gross income figures from the last
						complete calendar year. Do not include maintenance or child support as
						income.
H. If the child suppport award is
						calculated weekly, multiply it by 52 for the annual amount; if biweekly,
						multiply it by 26, if monthly, multiply it by 12.
M. If the maintenance award is calculated
						weekly, multiply it by 52 for the annual amount; if biweekly, multiply it by
						26; if monthly, multiply it by 12. If the maintenance award calls for
						decreasing or increasing amounts (for example, a certain amount for five years
						and half that amount for another three years), then provide the average of the
						awards (total amount for all years divided by the number of years).
NOTE: THIS INFORMATION IS CONFIDENTIAL AND
						WILL BE USED FOR STATISTICAL PURPOSES ONLY. IT WILL NOT BE RETAINED IN THE CASE
						FILE.
[FN1] Defined by FCA 413(2) and DRL §
						240(1-b)(b)(2): "Child Support" shall mean a sum to be paid pursuant to court
						order or decree by either or both parents or pursuant to a valid agreement
						between the parties for care, maintenance and education of any unemancipated
						child under the age of twenty-one years.