How to Fill Out California Form FL-630 (w/Examples) + FAQs

California Form FL-630 is the Notice of Rights and Responsibilities — Health-Care Costs and Reimbursement Procedures and Information Sheet on Changing a Child Support Order, a Judicial Council form (Rev. January 1, 2012) that every parent under a California child support order must read, follow, and serve when seeking reimbursement for a child’s uninsured medical, dental, vision, or mental-health expenses. The form rides along with the underlying support order issued under California Family Code § 4063, and it tells both parents exactly how to request payment, how to respond, and what proof must change hands within strict 30-day windows.

Missing a single deadline or skipping a single attachment can cost a parent hundreds of dollars in unreimbursed bills or trigger a contempt motion. In fiscal year 2024, California courts processed more than 1.3 million open child support cases through the Department of Child Support Services, and roughly one in five reimbursement disputes filed in family court traces back to a missing or mishandled FL-630 notice. This guide walks you line by line through the official Judicial Council FL-630 form, shows three full scenarios, and flags the traps that sink most pro se parents.

You will learn:

📄 What every box, line, and signature block on FL-630 actually asks and how to answer it correctly.
⏱️ The exact 30-day notice and 30-day reimbursement clocks under Family Code § 4063 and how to protect them.
🧾 Which receipts, Explanation of Benefits, and proof-of-payment documents to staple before you serve.
⚖️ How to file with the clerk, serve the other parent, and keep proof that holds up in a contempt hearing.
🛠️ The ten most common FL-630 mistakes and the dollar-amount or court-order consequence each one triggers.

What the Form Is and Who Must File It

California Form FL-630 is a two-part Judicial Council document. The first part is a Notice of Rights and Responsibilities that summarizes each parent’s legal duties under Family Code § 4063 for sharing a child’s uninsured health-care costs. The second part is an Information Sheet on Changing a Child Support Order, which tells parents how to ask the court to modify the order if circumstances change. The Judicial Council adopted the current form effective January 1, 2012, and it remains the operative version listed on the California Courts forms catalog.

Every parent who is subject to a California child support order must receive FL-630, because Family Code § 4063(a) requires the court to attach the notice to any judgment or order that allocates uninsured health-care costs. The custodial parent files it when serving the support order, the non-custodial parent reads it when responding, and either parent uses it as the procedural roadmap when one of them pays a bill and seeks the other’s share. Local child support agencies operating under the federal IV-D program in Title 42 U.S.C. § 654 also rely on FL-630 when enforcing medical support obligations.

The form solves three problems at once. It puts both parents on identical written notice of their split (usually 50/50 unless the order says otherwise), it sets the 30-day clock for sending bills and the 30-day clock for paying them, and it provides the statutory hook that lets a judge later award attorney fees, interest, or contempt sanctions under Family Code § 4063(d). A parent who never received FL-630 has a strong defense to a reimbursement motion, while a parent who ignores a properly served FL-630 has almost none.

Before You Start: Documents and Information You Need

Pull every document below into one folder before you open the form, because FL-630 references and depends on each of them. Missing any single item creates a gap that the other parent’s lawyer will exploit at the next hearing.

The underlying child support order or judgment. You need the case number, filing date, and the exact percentage split of uninsured costs printed in the order, because FL-630 piggybacks on those numbers.
Itemized medical, dental, vision, or mental-health bills. Insurance summaries are not enough; you need the provider’s itemized statement showing CPT codes, dates of service, and amounts.
Insurance Explanation of Benefits (EOB). The EOB shows what insurance paid and what the patient owes, and Family Code § 4063(b) requires you to share it.
Proof of payment. Cancelled checks, credit-card statements, or provider receipts establish that you actually paid the bill, not just that you owed it.
Both parents’ current mailing addresses. Service is invalid if the address is stale, and California Rules of Court Rule 5.260 governs how to serve.
Each child’s full legal name and date of birth. The form must match the child named in the support order exactly.
The companion form FL-192. FL-192 is the longer information sheet that often travels with FL-630 in older orders.
A calendar. You must track the 30-day notice window and the 30-day payment window, because both run from the date of service, not the date of the bill.
A reliable method of service. First-class mail with a proof of service by mail (form POS-030) is the standard channel.
Your county’s local family court rules. Some counties, like Los Angeles and San Diego, add local cover-sheet requirements on top of the statewide form.

If any document on this list is missing, stop and gather it first. A reimbursement claim built on a half-complete file almost always loses at the hearing, because the judge cannot tell whether the bill is real, whether it was paid, or whether the other parent ever had a fair chance to respond.

Where to Get the Form and How to Access It

Download FL-630 directly from the Judicial Council form page as a fillable PDF. The Judicial Council version is the only version California courts will accept, and the bottom-left corner of every page prints the revision date so you can confirm you have the current edition. Local county forms or third-party fill-in services are not substitutes, because clerks reject any version that does not carry the official Judicial Council footer.

You can also pick up a paper copy at the Self-Help Center of any California Superior Court family-law clerk’s office, including the Los Angeles Superior Court Self-Help Resource Center and the San Francisco Superior Court ACCESS Center. Self-Help staff can hand you the form, but they cannot fill it out for you or give legal advice. Many county law libraries also stock printed copies and offer free family-law clinics that walk pro se parents through the form.

If you prefer to file electronically, most California counties accept FL-630 through their e-filing portals when it is attached to a motion or stipulation. The California Courts e-filing portal directory lists each county’s approved electronic filing service provider, such as One Legal, File & ServeXpress, and Odyssey eFileCA. Save the fillable PDF to your computer, type your answers into each field, then upload the completed file along with the related motion or order.

Step-by-Step: How to Fill Out Form FL-630 Line by Line

FL-630 has two pages. Page 1 is the Notice of Rights and Responsibilities — Health-Care Costs and Reimbursement Procedures, organized into a caption block, four numbered paragraphs, and a payment-procedure section. Page 2 is the Information Sheet on Changing a Child Support Order, organized into three numbered sections. Walk through each field in order.

Caption Box: Court Name and Street Address

The caption box at the very top asks for the Superior Court of California, County of ____ along with the street address, mailing address, city, ZIP code, and branch name. Type the county where the underlying support order was issued, then copy the branch address from the California Courts court locator. For example, Maria Lopez writes Superior Court of California, County of Alameda, 1225 Fallon Street, Oakland, CA 94612, Rene C. Davidson Courthouse.

A common edge case is a case that has been transferred between branches; always use the branch that currently holds the file, not the original filing branch. The most common mistake here is leaving the branch line blank, which forces the clerk to reject the filing because the family-law calendar cannot route the document. Many parents wrongly believe the caption only needs the county name, but every Judicial Council form requires the full address block.

Petitioner and Respondent Names

Directly below the court box, fill in Petitioner, Respondent, and (if applicable) Other Parent/Party. Use each parent’s full legal name exactly as it appears on the underlying support order, in upper-and-lower case, with no nicknames or initials. Carlos Ramirez writes Carlos M. Ramirez if that is what the original FL-100 petition shows.

If the parents have remarried and changed names, still use the names on the order until you formally amend the caption with form MC-050. The most common mistake is mixing the petitioner and respondent positions, which scrambles the case index and can void service. A widespread misconception is that the parent currently seeking reimbursement is automatically the “petitioner”; the labels are locked at the time the case opened and never flip.

Case Number Field

The Case Number field sits in the upper-right corner of the caption. Copy the number from the upper-right corner of the original support order, including any letter prefixes, exactly as printed (for example, 24FL-01827 or RF-19-987654). Format and punctuation matter because the clerk’s docketing system is case-sensitive.

The edge case here is consolidated cases, where two case numbers may appear; use the lead case number listed first on the consolidation order. Entering the wrong case number is the single fastest way to have FL-630 filed into a stranger’s case file, which then requires a noticed motion to correct. Many filers think a missing case number can be filled in by the clerk, but California clerks are required by California Rules of Court Rule 2.100 to reject the filing.

Paragraph 1: General Notice of Cost-Sharing

Paragraph 1 of the Notice tells both parents that the court has ordered them to share the child’s reasonable uninsured health-care costs. There is nothing to fill in here, but you must read it carefully because it triggers the rest of the form. The paragraph references Family Code § 4063, which is the statute the judge will rely on at any later reimbursement hearing.

The example to anchor in your mind is Maria Lopez, who reads paragraph 1 and confirms that the order splits costs 50/50. The edge case is an order that allocates costs in proportion to net income under Family Code § 4061; in that case, you must attach the income calculation. The most common mistake is assuming “uninsured” means uninsured people, when it actually means uninsured expenses — the child may be fully insured, yet copays, deductibles, and non-covered services still split. The misconception that paragraph 1 is “just boilerplate” causes parents to skip it and miss the statutory hook.

Paragraph 2: 30-Day Notice Requirement to Provide Bills

Paragraph 2 sets the 30-day notice clock: the parent who pays an uninsured bill must give the other parent written notice and a copy of the bill within 30 days of the date the bill was incurred or, if later, the date that parent first received the bill. Nothing is filled in on the form, but the clock starts the moment a covered service occurs. Maria Lopez writes a calendar reminder for February 12, 2026 after her son’s January 13, 2026 ER visit.

An edge case arises with insurance reprocessing, when an EOB is reissued months later; the 30-day clock restarts on the date the corrected EOB is received. The common mistake is sending only the EOB without the provider’s itemized bill, which fails the statutory notice requirement and resets the clock to zero. Many parents wrongly believe a text message or email screenshot satisfies “written notice”; courts consistently require a mailed copy plus a proof of service to be safe.

Paragraph 3: 30-Day Reimbursement Requirement

Paragraph 3 sets the 30-day payment clock: the parent who receives the bill must pay their share within 30 days, or contest the charge in writing within the same 30 days. There is no field to fill in, but the date of service of the bill determines the deadline. Carlos Ramirez receives Maria’s notice on February 15, 2026, so his payment or written objection is due by March 17, 2026.

The edge case is a partial dispute — for example, the receiving parent agrees the bill is real but disputes whether orthodontia is “reasonable.” That parent must pay the undisputed portion and object only to the disputed portion in writing. The most common mistake is silence; if Carlos says nothing, he waives his objections under Family Code § 4063(b)(2). The misconception that a phone call is a “written objection” sinks many otherwise-valid disputes.

Paragraph 4: Penalty for Non-Compliance

Paragraph 4 warns that a parent who fails to comply may be ordered to pay the full amount owed plus interest, attorney fees, and costs. There is nothing to write, but the paragraph is the legal teeth of the form. The court can also issue contempt sanctions under Code of Civil Procedure § 1218.

The example is Janet Kim, whose ex-husband ignored three FL-630 notices and was ordered to pay $4,200 in unreimbursed bills plus $1,500 in attorney fees. The edge case is a parent who shows good cause, such as hospitalization, for missing the 30-day clock; the judge has discretion to waive the penalty. The common mistake is assuming “interest” is optional; California adds 10% statutory interest automatically once the bill is reduced to a judgment.

Payment Procedures Section

The Payment Procedures section tells parents to send payment by check or money order, keep a copy, and provide insurance information promptly. There are no fillable boxes, but you must follow the procedure exactly. Maria Lopez sends Carlos a check for $187.50 with the memo line Re: Lucas Ramirez ER 1/13/2026, FL-630 reimbursement.

The edge case is a parent on a payment plan with the provider; you can demand reimbursement only for amounts actually paid, not amounts still owed. The common mistake is paying in cash without a receipt, which leaves no audit trail when the other parent denies receiving the funds. The misconception that Venmo or Zelle “counts” without a memo line ignores the documentation requirement; always attach a paper trail.

Information Sheet Section 1: When You Can Change the Order

Page 2, Section 1 explains that either parent can ask the court to change the support amount if there is a “change in circumstances,” such as a job loss, a custody change, or a new child. Nothing is written in this section, but it points the reader to form FL-300, the Request for Order. Carlos Ramirez loses his job in March 2026 and uses Section 1 as his roadmap to file an FL-300 within two weeks.

The edge case is a stipulated change, where both parents agree; they can use form FL-350 instead of a contested motion. The common mistake is waiting to file, because California support modifications are only retroactive to the date the motion is filed and served, not the date the change occurred. The misconception that “we agreed verbally” is enough costs parents thousands in arrears that accrued before the paperwork was filed.

Information Sheet Section 2: How to Change the Order

Section 2 lists the four steps to change a support order: fill out the request, file it with the clerk, serve the other parent, and attend the hearing. There are no fields, but the section names the exact forms required, including FL-150 (Income and Expense Declaration). Janet Kim follows the four steps and calendars her hearing 60 days out.

The edge case is a parent receiving public assistance, who can ask the local child support agency to bring the motion under Family Code § 17400 at no cost. The common mistake is filing FL-300 without FL-150, which the clerk will reject on sight. The misconception that only the parent paying support can request a modification ignores that either parent can file at any time.

Information Sheet Section 3: Free and Low-Cost Help

Section 3 lists resources, including the local Family Law Facilitator, the local child support agency, and the State Bar’s lawyer referral service. Nothing is filled in, but the section is the lifeline for pro se parents. The current statewide directory lives at the California Courts Self-Help Center.

The example is Aisha Bell, a single mother who books a free 30-minute appointment with the Alameda County Family Law Facilitator. The edge case is a parent in a domestic-violence situation, who can also access free help through a DV Restraining Order Clinic. The common mistake is ignoring Section 3 entirely; pro se parents who use the Facilitator win reimbursement motions at significantly higher rates. The misconception that “free help is for low-income people only” is wrong — Family Law Facilitators serve every parent regardless of income.

Three Filled-Out Examples Using Real Scenarios

Scenario 1: Maria Lopez Seeks 50% Reimbursement for an ER Visit

Maria’s 9-year-old son Lucas had an ER visit on January 13, 2026. Insurance covered most of the bill, leaving $375 in copays and deductibles. Her divorce judgment splits uninsured costs 50/50.

Form Section	What Maria Enters
Caption — Court	Superior Court of California, County of Alameda, Rene C. Davidson Courthouse
Petitioner	Maria Lopez
Respondent	Carlos Ramirez
Case Number	24FL-01827
Paragraph 1 reading	Confirms 50/50 split from page 4 of judgment
Paragraph 2 action	Mails itemized ER bill + EOB to Carlos on Feb 5, 2026
Paragraph 3 expectation	Carlos must pay $187.50 by March 7, 2026
Payment Procedures	Requests check made out to Maria Lopez, memo Lucas ER 1/13/2026

Scenario 2: Carlos Ramirez Disputes an Orthodontia Bill

Carlos receives notice of a $4,800 orthodontia bill from Maria. He believes braces are cosmetic and not “reasonable” under the order. He uses FL-630 to dispute properly.

Form Section	What Carlos Enters
Caption — Court	Superior Court of California, County of Alameda
Petitioner	Maria Lopez
Respondent	Carlos Ramirez
Case Number	24FL-01827
Paragraph 3 action	Sends written objection within 30 days
Objection basis	Cites medical necessity requirement under Family Code § 4063
Partial payment	Pays $0 but offers to mediate
Next step (Section 2)	Files FL-300 requesting a court ruling on reasonableness

Scenario 3: Janet Kim Modifies the Order After a Job Loss

Janet was laid off in February 2026 and can no longer afford her current support amount. She uses FL-630 page 2 as the roadmap.

Form Section	What Janet Enters
Caption — Court	Superior Court of California, County of Santa Clara
Petitioner	Janet Kim
Respondent	David Park
Case Number	22FL-009982
Section 1 trigger	Documents involuntary job loss with termination letter
Section 2 step 1	Completes FL-300 and FL-150
Section 2 step 2	Files with clerk on March 10, 2026 (filing fee waived via FW-001)
Section 3 resource	Books appointment with Santa Clara Family Law Facilitator

How to File the Completed Form

FL-630 is most often served, not filed, because it travels with the underlying support order. The custodial parent attaches it to the order or judgment when serving the other parent. Use the Judicial Council Proof of Service form POS-030 to document mail service, and keep a stamped copy for at least four years.

When FL-630 accompanies a new motion (such as a reimbursement request), file it at the family-law window of the Superior Court clerk in the county that issued the order. There is no separate filing fee for FL-630 itself, but the underlying motion (such as FL-300) carries a $60 motion fee, which can be waived with form FW-001 for low-income filers. Counties accept three filing channels:

In person at the family-law clerk’s window. Bring two copies plus the original; the clerk stamps and returns one. Processing time is same-day.
By mail to the clerk, with a self-addressed stamped envelope for the conformed copy. Processing time runs 5–10 business days. Keep the certified-mail receipt as proof of filing.
By e-filing through the county’s approved electronic filing service provider listed at the California Courts e-filing portal. Payment is by credit card or ACH; you receive an electronic conformed copy within 1–3 business days.

Save every confirmation. The conformed copy, the POS-030, and the proof of payment together form the evidence packet you will hand the judge if the other parent later denies receiving FL-630.

What Happens After You File

Once FL-630 is properly served with bills attached, the receiving parent has 30 days to pay or to object in writing under Family Code § 4063(b). If they pay in full and on time, the matter ends and you simply file the cancelled check or receipt in your records. Most cooperative reimbursements close within 45 days of the date of the bill.

If the receiving parent objects, the parties must meet and confer in good faith before either of them returns to court. Many counties require a mandatory settlement conference before a contested reimbursement hearing, especially in Los Angeles family courts. If meet-and-confer fails, the requesting parent files an FL-300 Request for Order asking the judge to enforce the reimbursement, award statutory 10% interest, and grant attorney fees under Family Code § 4063(d).

If the receiving parent simply ignores FL-630, the requesting parent can file the same FL-300 and add a contempt declaration on form FL-410. Contempt carries up to five days in county jail per count and mandatory attorney fees under Code of Civil Procedure § 1218. Most judges, however, prefer money judgments to jail time and will reduce the unpaid balance to an enforceable judgment that can be collected through wage garnishment.

Mistakes to Avoid When Filling Out the Form

Skipping the branch name in the caption. The clerk rejects the filing because the family-law calendar cannot route the document.
Using nicknames in the petitioner or respondent fields. A “John” in place of “Jonathan” can void the proof of service.
Entering the wrong case number. The form lands in a stranger’s file and must be re-filed by motion.
Sending only the EOB without the itemized provider bill. This fails the Family Code § 4063 notice requirement and resets the 30-day clock.
Missing the 30-day notice window. Bills sent more than 30 days late lose their statutory teeth and may be unrecoverable.
Failing to object in writing within 30 days. Silence equals consent under Family Code § 4063(b)(2).
Paying in cash with no receipt. No paper trail means no proof at the contempt hearing.
Forgetting to attach proof of payment. The judge cannot order reimbursement of money that was never demonstrably paid.
Using an outdated FL-630 revision. Older revisions lack the current statutory references and may be rejected.
Skipping the Information Sheet on page 2. Parents miss the FL-300/FL-150 modification roadmap and accrue arrears that could have been avoided.
Serving by email only. California requires written mail service plus a POS-030 unless the parties have stipulated to electronic service.
Ignoring partial-dispute rules. Refusing to pay any amount when only part of the bill is contested converts a small dispute into full-blown contempt exposure.

Do’s and Don’ts

Do download the current FL-630 PDF directly from the Judicial Council form page, because only the official version carries the current revision footer.
Do calendar both 30-day clocks the moment a bill is incurred, because the deadlines run on calendar days, not business days.
Do attach the itemized bill, the EOB, and proof of payment, because all three are required for a clean reimbursement record.
Do serve by first-class mail with a POS-030, because mail service is the safest default channel.
Do keep copies for at least four years, because California’s enforcement period for support judgments is long.
Do use the Family Law Facilitator when in doubt, because their advice is free and tailored to your county.
Don’t use a homemade form; clerks reject anything that is not the official Judicial Council version.
Don’t rely on text messages as written notice, because courts demand a mailed paper trail.
Don’t ignore the Information Sheet on page 2, because it contains the only roadmap to modify a support order.
Don’t pay disputed amounts to “keep the peace,” because doing so waives your right to contest later.
Don’t miss the 30-day objection window, because silence is treated as consent.
Don’t assume insurance reprocessing extends your deadline automatically; document every reprocessed EOB carefully.

Pros and Cons of Filing on Your Own vs. With Help

Going Pro Se	Hiring Help
Free or near-free filing	Costs $250–$500/hour for a family-law attorney
Full control of timing	Faster turnaround on complex disputes
Builds long-term knowledge of your case	Reduces emotional load
Risk of missing 30-day clocks	Attorney calendars deadlines for you
No attorney-client privilege protection	Privileged advice on settlement strategy

Pros of going pro se include cost savings, total control of timing, and direct learning of how the family-law system works, all of which matter in long-running cases. Pros of hiring help include faster strategy, better evidence packaging, calendaring discipline, professional negotiation with the other side, and immediate access to motion templates that speed up filings.

Cons of going pro se include the risk of missing technical requirements, the emotional toll of self-representation, the lack of professional negotiation leverage, the steep learning curve on Judicial Council forms, and the possibility of accidentally waiving rights. Cons of hiring help include cost, slower communication if the lawyer is busy, the need to coordinate schedules, the emotional distance from your own case, and the risk that an attorney files generic motions that miss your specific facts.

FAQs

Is FL-630 required in every California child support case?

Yes. The court attaches FL-630 to every order that allocates uninsured health-care costs under Family Code § 4063, so every parent under a California support order receives it.

Do I have to file FL-630 separately with the clerk?

No. FL-630 rides along with the underlying order or motion, so there is no separate filing fee or standalone filing requirement.

Can I serve FL-630 by email?

No. California requires mailed service with a POS-030 unless the parties have stipulated to electronic service in writing.

Does the 30-day clock run on business days or calendar days?

No, it does not run on business days. The 30-day clock under Family Code § 4063 runs on calendar days from the date the bill or notice is received.

Do I write my full middle name in the Petitioner box?

Yes. Use the full legal name as it appears on the original FL-100 petition, including middle name or initial.

Should I leave the branch name blank if I do not know it?

No. A blank branch name is the most common reason clerks reject FL-630, so look it up on the California Courts court locator first.

Can I list two case numbers in the Case Number field?

No. Use only the lead case number from the consolidation order; secondary numbers create routing errors.

Is a text-message photo of a bill enough to satisfy paragraph 2?

No. Paragraph 2 requires written notice plus a copy of the itemized bill, mailed or personally served.

Can I demand reimbursement for amounts I have not yet paid?

No. Family Code § 4063 reimburses only amounts the requesting parent has actually paid out of pocket.

Does FL-630 cover orthodontia and mental-health costs?

Yes. “Uninsured health-care costs” includes dental, vision, mental-health, and orthodontia services not covered by insurance.

Can the local child support agency enforce FL-630 for me?

Yes. Under Family Code § 17400, the local IV-D agency can enforce medical support obligations on your behalf.

If I miss the 30-day notice window, am I out of luck forever?

No. You may still seek reimbursement, but the court can deny statutory interest and attorney fees, and the other parent gains a strong waiver defense.

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