The Uniform Support Declaration (USD) form is a critical document used when child or spousal support payments are an issue in a legal case. It collects detailed information on expenses and an individual's capacity to pay, ensuring that support determinations are fair and based on accurate financial data. Given its importance, it is imperative to approach filling out this form with careful attention, ensuring that all confidential information is appropriately protected and that all required documents are prepared according to instructions. To start the process and ensure you're well-prepared, click the button below to learn more about filling out the Uniform Support Declaration form properly.
The Uniform Support Declaration (USD) is a critical document used in legal settings involving the determination of child or spousal support payments. Its main function is to collect comprehensive financial information from the parties involved to assess their expenses, income, and ability to pay support. The form requires detailed inputs including the number of children involved, income sources, monthly gross income, and details regarding child and health care expenses, among others. Potential users are advised to follow specific instructions for completing the form, such as redacting sensitive information like social security numbers to protect privacy. Additionally, the requirement for users to provide copies of financial documents, while keeping the originals safe, emphasizes the form’s role in facilitating a transparent and efficient support determination process. This document finds its application in various legal contexts within the circuit courts, making its accurate completion a responsibility of the involved parties to ensure a fair and thorough evaluation of support needs. It encompasses information related to children, employment, other income sources, health care coverage, and medical expenses, thus providing a holistic view of each party's financial situation.
UNIFORM SUPPORT DECLARATION
The Uniform Support Declaration must be completed when the payment of child or spousal support is or could be an issue in the case.
The USD provides basic information about expenses and ability to pay.
CAUTION:
Please read the instructions for and use UTCR 2.130 forms to separate social security numbers, dates of birth and other private information from public records.
It is your responsibility to black out (redact) any confidential information on the attachments or copies. Examples of confidential information that should be redacted are social security numbers, dates of birth, checking account information, etc.
Do not bring the originals of your attachments, such as paystubs and tax returns, and expect the court to make photocopies to attach to your Uniform Support Declaration. You are responsible for making copies and ensuring they are on 8½” x 11” paper.
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR WASHINGTON COUNTY
In the Matter of:
Case No.
Judge Assigned:
Petitioner
Co-Petitioner
Check one box:
PETITIONER RESPONDENT
and
CO-PETITIONER
OTHER:
Respondent
OR CSP Case No.
SUMMARY INFORMATION—COMPLETE THIS PAGE LAST
After completing Sections 1 through 5, on Pages 2 through 5 below, insert the information and/or total MONTHLY amounts in this Summary Information section.
Date of Completion
_______________
mm/dd/year
1.
Number of Joint Children From This Relationship:
2.
Number of Joint Children Over 18 But Under 21 Attending School:
3.
Number of Nonjoint Additional Children:
4.
Gross Monthly Income From All Sources:
$_______________
5.
Receiving Temporary Assistance for Needy Families?
Yes
No
6.
Child(ren) on Oregon Health Plan/Healthy Kids or Other Public Health Plan?
7.
Social Security or Veteran’s Benefits Received for Child(ren):
Person with Disability is: Child Me
Other Parent
8.
Spousal Support RECEIVED by You:
9.
Spousal Support PAID by You:
10.
Mandatory Union Dues Paid:
11.
Health Care Premiums for Yourself Only if You Provide Insurance for Child(ren): $_______________
12.
Health Care Premiums Paid for Joint Child(ren):
13.
Out-of-Pocket Medical Expenses Paid for Joint Child(ren):
14.
Number of ANNUAL Overnights Child(ren) Spends With You:
15.
Childcare Expenses Paid for Joint Child(ren):
16.
City Where Childcare is Provided:
____________________________________________
Page 1—UNIFORM SUPPORT DECLARATION (December 2019)
This form is a DECLARATION under penalty of perjury required for support determinations. It must be completed in its entirety, signed, filed with the court or appropriate administrative agency, and served upon the other party (or their attorney).
INSTRUCTIONS: Answer all questions. Items marked with an * should be transferred to Page 1. If you are seeking spousal support, you need to complete Schedule 1. Attach additional page if needed.
IMPORTANT: This information will be disclosed to the other party and may be subject to public access. Protections are available using the court’s “Confidential Information Form” process.
1.CHILDREN
A. *List all JOINT CHILDREN (children under the age of 21 born or adopted during this relationship):
Children Living With:
Over 18 & Under
21
Attending School
Name of Child
Age
Me
Other Parent
Other
Yes
No
B.*List all NONJOINT ADDITIONAL CHILDREN (children under the age of 21 born to or adopted by you but not of this relationship).
Name
2.YOUR GROSS INCOME
A. From Your Employment:
Description
Monthly Amount
1
Gross hourly wage.
2
Average number of hours worked per pay period.
x
3
Convert to annual. If paid monthly, enter “12”. If paid twice
monthly, enter “24”. Every two weeks, enter “26”. Every
week, enter “52”.
4
Convert to monthly.
÷
12
5
Gross monthly income: 1. x 2. x 3. ÷ 4.
6
Gross monthly tips/commissions/bonuses (identify):
Subtotal of Monthly Income From Employment (5) + (6)
SUBTOTAL: 2.A.
Page 2—UNIFORM SUPPORT DECLARATION
B.Other Sources of Your Monthly Income:
(Attach verification of your gross monthly income as listed below):
Self-Employment
Dividends
Interest Income
Trust Income
Annuity Income
Social Security Income
Workers’ Compensation Benefits per week multiplied by 52; divided by 12
Unemployment Benefits per week multiplied by 52; divided by 12
Disability Income
Expense Reimbursements and/or Per Diem Allowance not listed in item A. above
Other (specify source/type)
Other (specify source/type):
SUBTOTAL: 2.B.
*Total of 2A + 2B Enter here and on Page 1, #4
TOTAL:
C. *Do you receive Temporary Assistance for Needy Families?
Yes, $________ monthly No
D.*Do you receive Social Security or Veteran’s benefits for any joint child(ren) due to parent’s disability?
Name of Beneficiary Child(ren) _______________________ Yes, $________ monthly No
Name of Disabled Parent ____________________________ Source
E.*Do you receive Social Security or Veteran’s benefits for any joint child(ren) due to child’s disability?
Name of Child(ren) _________________________________ Source
F. *Is there an order for you to RECEIVE spousal support from your spouse involved in this proceeding?
G. *Is there an order for you to RECEIVE spousal support from a former/subsequent spouse?
Yes, $________ monthly
H. *Are you ordered to PAY spousal support?
If Yes, to whom? __________________________________
I. *Do you pay mandatory union dues?
J.ATTACH A COPY OF YOUR FOUR MOST RECENT PAY STUB(S), BENEFIT STATEMENTS, AND COPIES OF YOUR MOST RECENTLY FILED STATE AND FEDERAL TAX RETURNS.
ATTACH COPIES OF SPOUSAL SUPPORT ORDERS AND ANY CHILD SUPPORT ORDERS FOR NONJOINT ADDITIONAL CHILD(REN) NOT LIVING WITH YOU.
Page 3—UNIFORM SUPPORT DECLARATION
3.HEALTH CARE COVERAGE AND MEDICAL EXPENSES
A.
*Is there a cost to insure just yourself if you provide insurance for the child(ren)?
B.
Do you provide health care coverage for your joint child(ren)?
C. Does someone else provide health care coverage for your joint child(ren)?
Name of person, or entity, providing, if other than you:
D.Are you or any member of your household:
i. Enrolled in the Oregon Health Plan, Healthy Kids, or any other public health care coverage?
ii. Receiving a state subsidy for public or private health care coverage?
E. Are any of the joint children enrolled in public health care coverage (Healthy Kids/Oregon Health Plan)? Name of child(ren) enrolled? _________________________________________ Yes No
If you answered “YES” to A, B, C, D, or E above:
i.Name all persons covered: Relationship to you:
ii.What is the source of the insurance? (such as through your employer, spouse, other):
iii. Insurance Co.:
Phone Number:
iv.Monthly amount of any state subsidy received by your household for public or private health-care coverage $____________.
v. Policy Number:
Group Number:
vi.Address for submission of claims:
vii.Your total monthly premium cost: (A)$____________; Cost to cover only you: (B)*$____________;
Total number of people enrolled (not counting yourself): (C)____________; Number of joint
children enrolled: (D)______
*The cost for the joint child(ren) only is (A – B) ÷ C = $____________ x D = *$____________
viii.ATTACH PROOF OF INSURANCE PREMIUMS.
F. *Do you pay any out-of-pocket medical expenses (not covered by insurance) for any joint child(ren) on
a monthly basis?
Yes No
If yes, list the name of the child, the reason for the cost(s), and the amount per month:
i.
; $
ii.
iii.
iv.
G.Does anyone pay a share of the monthly out-of-pocket medical costs for the child(ren)?
Yes No
If yes, who?
; amount they pay? $
H.ATTACH PROOF OF MONTHLY MEDICAL EXPENSES.
Page 4—UNIFORM SUPPORT DECLARATION
4.YOUR CHILDCARE EXPENSES
A. *Do you pay for childcare for the joint child(ren) so you can work, train, or look for work? Yes No
If yes,:
Paid to:
Average Monthly Payment
B. *Does anyone else share the cost of childcare for the joint child(ren)?
If yes, name:
Average Monthly Amount $
C.*City where childcare is provided:
D.ATTACH COPIES OF PROOF OF CHILDCARE EXPENSES.
5.*YOUR PARENTING TIME
PROPOSED
OCCURRING
EXISTING PLAN OR WRITTEN AGREEMENT
A.How many ANNUAL overnights does each joint child spend with YOU?
i.Name of Child: ___________________________________ # of overnights: _______________
ii.Name of Child: ___________________________________ # of overnights: _______________
iii.Name of Child: ___________________________________ # of overnights: _______________
iv.Name of Child: ___________________________________ # of overnights: _______________
B.ATTACH COPY OF MOST RECENT PARENTING PLAN OR WRITTEN AGREEMENT.
6.YOUR REBUTTAL FACTORS
A.The amount of child support to be paid may be rebutted under OAR 137-050-0760. http://oregonchildsupport.gov/laws/rules/docs/050_0760.pdf
Are you seeking a rebuttal (an adjustment to the support amount)?
Explain briefly:
B. ATTACH SUPPORTING EVIDENCE/ADDITIONAL INFORMATION.
I HEREBY DECLARE THAT THE ABOVE STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND THAT I UNDERSTAND THEY ARE MADE FOR USE AS EVIDENCE IN COURT AND ARE SUBJECT TO PENALTY FOR PERJURY.
Signature
Printed Name
Date
I am: PETITIONER RESPONDENT CO-PETITIONER OTHER:
Page 5—UNIFORM SUPPORT DECLARATION
ATTACHMENT CHECKLIST: Check the box and include the appropriate attachment(s).
Four most recent pay stubs or benefit statements
Most recent state and federal tax returns (including all applicable schedules)
Proof of insurance premiums
Proof of medical costs
Most recent parenting plan or written agreement
Proof of childcare costs
Copies of Spousal and Child Support Orders
Additional Page: Number items to correspond, include your name and case number
Other: _________________________________
CERTIFICATE OF MAILING
I hereby certify that I served a true and complete copy of this Uniform Support Declaration and all attachments
by mailing it first class mail, with postage prepaid, on(date) to the following people:
(Other Party/Attorney name)
Address:
(name)
Page 6—UNIFORM SUPPORT DECLARATION
SCHEDULE 1
Spousal/Partner and Child Support Factors
You must complete this schedule and prepare and submit the attachments requested in this schedule if either party seeks spousal support or deviation from the uniform child support guidelines. These are the total household expenses you must pay each month for yourself only and not for others in your household. Utility bills should be averaged over the year. Any other annual, quarterly, or other periodic payments should be converted to a monthly average. DO NOT LIST ANY EXPENSE IF IT IS DEDUCTED FROM YOUR WAGES.
1.FIXED COSTS:
RESIDENCE:
Mortgage or Rent
Second Mortgage/Home Equity Loan
Property Taxes (if not included in Mortgage)
Insurance (if not included in Mortgage)
UTILITIES:
Electricity
Gas
Water
Garbage
Telephone
Cable/Internet
C.
TRANSPORTATION:
Car Payments
Fuel
Maintenance and Repairs
Other (specify):
D.
INSURANCE:
Life
Automobile
Medical/Dental
E. Food and Household Items
F.
Medicine &Pharmaceutical – unreimbursed medical/dental costs
G. Court/DHR-Ordered Support Payments for other than child(ren)/spouse/RDP in
this case
TOTAL FIXED COSTS (A-G):
Page 7—UNIFORM SUPPORT DECLARATION
CONSUMER OBLIGATIONS:
Balance
Name of Creditor
Due
E.
TOTAL PAYMENTS ON CONSUMER OBLIGATIONS (A-F):
SUMMARY OF EXPENSES:
Fixed Costs (item 1 above)
Consumer Obligations (item 2 above)
TOTAL EXPENSES:
4.OTHER FACTORS:
Other factors that affect my income and expense or that should be considered (attach supporting documentation whenever possible).
My (printed) Name is: ____________________________________________
Page 8—UNIFORM SUPPORT DECLARATION
The Uniform Support Declaration is a critical document for cases involving child or spousal support. It compiles comprehensive information about an individual's financial status, including income, expenses, and the financial needs of children, if applicable. This form helps the court make informed decisions regarding support payments. It's important to approach filling out this form with accuracy and thoroughness, ensuring all required documentation is attached. Below are detailed instructions on how to complete this form correctly.
Before submission, double-check that all sections are completed accurately and all supporting documents are attached. Submitting complete and accurate information will enable a smoother process in addressing child or spousal support issues within your case.
What is the purpose of the Uniform Support Declaration form?
The Uniform Support Declaration (USD) form is used in legal cases where child or spousal support payments are, or may become, an issue. Its main purpose is to provide the court with basic yet comprehensive information regarding each party's financial circumstances, including their income, expenses, and their ability to pay support. This information helps in determining the appropriate amount of support that should be paid or received. It is a declaration made under the penalty of perjury, meaning that the information provided must be truthful and accurate to the best of the declarant's knowledge.
Who needs to complete the Uniform Support Declaration form?
This form must be completed by individuals involved in legal proceedings where child or spousal support is being considered. This can include divorce cases, separations, or other domestic relations cases involving the care and support of children or financial support between spouses. Both parties seeking to establish, modify, or enforce a support order are usually required to fill out and submit this form to the court or the appropriate administrative agency handling their case.
What information do I need to provide on the Uniform Support Declaration form?
When filling out the Uniform Support Declaration form, you will need to provide detailed information about your financial situation. This includes the number of children involved and their living arrangements, your gross income from all sources, any public assistance received, child or spousal support currently being paid or received, healthcare costs, and out-of-pocket medical expenses for joint children. Additionally, information regarding childcare expenses, union dues, and any benefits received, such as Social Security or veterans' benefits, must also be disclosed. Supporting documents, such as pay stubs and tax returns, are required to verify the information provided.
Are there any precautions I should take when completing the form?
Yes, it's important to carefully read the instructions accompanying the form to ensure that sensitive information like Social Security numbers, dates of birth, and bank account details are appropriately redacted from any public records. This is to safeguard your privacy and prevent identity theft or fraud. You are also responsible for making photocopies of the required documents, ensuring they are of the correct size, and that the originals are not brought to court unless specifically requested.
How is the information on the Uniform Support Declaration used?
The information provided on the USD form is used by the court to make informed decisions regarding child and spousal support orders. It allows the court to assess each party's financial capability and needs, ensuring that support orders are fair and equitable. The detailed financial data helps in calculating support amounts in accordance with state guidelines and ensures that the needs of any children involved are adequately met.
Where do I submit the Uniform Support Declaration form?
The completed Uniform Support Declaration form must be filed with the court handling your case or the appropriate administrative agency that oversees child or spousal support matters in your jurisdiction. It's also required to serve a copy of the form on the other party involved in the case or their attorney, following the legal requirements for service of documents in your state. It's crucial to check with your local court or consult with a legal professional to understand the specific filing and service procedures in your area.
Filling out the Uniform Support Declaration form is a crucial step when dealing with child or spousal support issues, yet it's common for individuals to make mistakes. One frequent error is not completely redacting confidential information such as social security numbers, dates of birth, and bank account details. This form will become part of the public record, so protecting your private information is essential.
Another common mistake is not providing copies of required attachments, like pay stubs, tax returns, and support orders for nonjoint additional children. The court will not make copies on your behalf, and these documents must be on standard 8½” x 11” paper. Failing to attach these important documents can delay the process and affect the outcome.
Individuals often overlook the requirement to fill out the summary information section last, after completing sections 1 through 5. This section is meant to provide a concise overview of the financial situation. Completing it prematurely or incorrectly can lead to inconsistencies in the information presented to the court or administrative agency.
Not accurately calculating gross monthly income from all sources is a mistake that can significantly impact the support determination. It's important to correctly total income from employment, self-employment, and any other sources to ensure the support amount is fair and accurate based on current financial circumstances.
Many people neglect to attach proof of health insurance premiums and out-of-pocket medical expenses for joint children, which are critical in determining who is responsible for healthcare costs. Without this evidence, it may be challenging to accurately allocate these expenses between the parties.
Underestimating or failing to report the number of overnights the child(ren) spend with each parent can also lead to inaccuracies in the calculation of support amounts. This information affects the amount of time-based adjustments in support calculations and must reflect the actual situation accurately.
Lastly, a common mistake is not updating or correctly reporting changes in circumstances that could affect support payments, such as a change in income, health insurance coverage, or childcare expenses. This can lead to discrepancies that may require legal adjustments down the line.
When people navigate through legal processes involving support payments, whether for children or a spouse, the Uniform Support Declaration form plays a pivotal role. However, to provide a comprehensive view of one's financial situation, often, several other documents are used alongside this declaration. These documents are crucial for ensuring that all aspects of one's financial responsibilities and capabilities are accurately represented.
Working through the complexities of support cases requires careful attention to detail and thorough documentation. The forms and documents listed complement the Uniform Support Declaration form by painting a complete picture of one's financial landscape. This ensures that all parties involved in a support case have a clear understanding of the financial implications, leading to fair and equitable support arrangements.
The Uniform Support Declaration form shares similarities with various other legal and financial documents. One such document is the Financial Affidavit used in divorce proceedings. Similar to the Uniform Support Declaration, a Financial Affidavit requires individuals to disclose their financial situation comprehensively, including income, expenses, assets, and liabilities. This information is crucial for determining spousal support, child support, and the division of assets. Both documents serve to ensure transparency between parties and assist the court in making informed decisions regarding financial issues.
Another document that resembles the Uniform Support Declaration is the Child Support Worksheet. This worksheet is specifically designed to calculate child support payments based on the parents' financial information, including income and expenses related to the care of the child. Like the Uniform Support Declaration, the Child Support Worksheet requires detailed financial information to ensure a fair calculation of support that meets the child's needs, reflecting the document's focus on accurately assessing financial capability and obligation.
The Income and Expense Declaration is another document with similarities to the Uniform Support Declaration. Used in family law, it requires detailed reporting of one's monthly income and expenses. The goal of both documents is to paint a clear picture of an individual's financial capacity, which is essential for determining support obligations and assessing one's ability to pay. The level of detail sought in both documents underscores the importance of financial transparency in legal proceedings concerning support.
Additionally, the Means Test Form, associated with bankruptcy filings, shares aspects with the Uniform Support Declaration. It assesses an individual's financial status to determine eligibility for certain types of bankruptcy by comparing income to expenses and debt obligations. Both forms require detailed financial disclosures to evaluate the person's financial health and ability to meet obligations, either in the context of support payments or debt relief. This comparison underscores the role of structured financial disclosure in various legal contexts.
Last but not least, the Schedule A/B form of the bankruptcy petition has similarities with the Uniform Support Declaration. Schedule A/B requires a detailed list of an individual's assets, similar to how the Uniform Support Declaration asks for income and expense details. Both documents are used to assess an individual’s financial standing, albeit for different purposes: one for understanding an individual’s capacity to satisfy debt obligations, the other for determining support obligations. The commonality lies in their use to achieve fair and informed legal outcomes based on a thorough review of financial information.
When you're filling out the Uniform Support Declaration form, it's critical to ensure accuracy and completeness. Here’s a guide covering what you should and shouldn't do:
Do:
Read the instructions carefully. The form has specific requirements for handling sensitive information such as social security numbers and birthdates, as well as instructions on using UTCR 2.130 forms to separate private information from public records.
Black out (redact) any confidential information on attachments or copies. This includes social security numbers, checking account information, and dates of birth.
Make copies of your supporting documents, like pay stubs and tax returns, ensuring they are on 8½” x 11” paper as required by the court.
Answer all questions thoroughly. If an item is not applicable, make sure to indicate that to avoid any appearance of incomplete information.
Attach all required documentation, including your four most recent pay stubs or benefit statements, your most recently filed state and federal tax returns, and copies of spousal support orders or child support orders if applicable.
Sign the form under penalty of perjury. Your signature attests that all information provided is true and complete to the best of your knowledge.
Don’t:
Leave any sections blank unless specifically directed. Incomplete forms may delay the processing of your case or affect the outcome.
Bring original documents to the court expecting them to make copies. It's your responsibility to provide all necessary documentation in the proper format.
Ignore the requirement for redaction of personal and confidential information. Failing to do so could result in unnecessary exposure of sensitive data.
Forget to include financial documentation and proof of expenses, such as medical expenses or health insurance premiums. These details are critical for the court to make informed decisions regarding support.
Submit the form without double-checking your entries for accuracy. Mistakes or inaccuracies can lead to complications in your case.
Underestimate the importance of attaching proof of insurance premiums and monthly medical expenses. These figures play a significant role in calculating support obligations.
When dealing with the Uniform Support Declaration (USD) form, it's essential to separate fact from fiction. Let's explore some common misconceptions:
It’s only about child support. While child and spousal support are significant components, the USD encompasses much more. It also provides a comprehensive overview of one's financial situation, detailing expenses, income, and the ability to pay.
Completing it is optional. If child or spousal support is a potential issue in a case, completing the USD is not just recommended; it's required. This form plays a crucial role in support determinations.
Confidential information is safe. Although one might assume all provided information is automatically protected, the individual is responsible for redacting (blacking out) confidential details from public records. Such details include social security numbers and bank account information.
Original documents are needed. It's a misconception that bringing original documents like pay stubs or tax returns to court is necessary. Instead, photocopies should be made, and it's the individual's responsibility to ensure these copies adhere to the standard paper size.
Only current income is relevant. The USD requires information about all sources of income, not just one's current job. This includes self-employment, dividends, and any benefits such as social security or veteran’s benefits, providing a full picture of financial status.
The form is complicated. While detailed, the instructions provided help break down each step, making it manageable to complete. Accurately following these instructions ensures all necessary information is included.
Privacy is guaranteed. Information filled out on the USD can be disclosed to the other party and might be accessible to the public. Utilizing the court’s confidentiality forms can offer protection for sensitive information.
Support determinations are final. The amounts calculated and submitted via the USD are important for initial determinations. However, they can be adjusted in the future based on changes to financial situations or the needs of the parties involved.
Health insurance details are minor. Contrary to what some believe, details regarding health insurance, especially for children or the person applying, are crucial. They significantly impact support calculations, emphasizing the form's comprehensive nature.
Understanding the purpose, requirements, and implications of the Uniform Support Declaration form is vital for accurately completing it and ensuring a fair evaluation of support needs and capabilities.
When navigating the complexities of family law and the process of determining child or spousal support, the Uniform Support Declaration (USD) form plays a key role. Knowing how to properly fill out and use this form can make a significant difference in the outcome. Here are four key takeaways to keep in mind:
Ultimately, the Uniform Support Declaration form is a tool designed to ensure that support determinations are fair and reflect the true financial situation of the parties involved. Approaching the process with honesty, diligence, and thorough preparation can help ensure that the outcome is equitable and meets the needs of those for whom support is being determined.
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