How to Fill Out Pennsylvania Domestic Relations Income and Expense Statement + FAQs

The Pennsylvania Domestic Relations Income and Expense Statement is the sworn financial disclosure form that every party in a child support, spousal support, alimony pendente lite (APL), or alimony case must file with the county Domestic Relations Section (DRS) under Pa.R.C.P. 1910.27(c). The form drives the support calculation that controls your paycheck, your bank account, and in some counties your driver’s license, so a sloppy entry today becomes a wage attachment tomorrow.

Pennsylvania’s child support program collected over $1.7 billion in support in a single year, and the Pennsylvania Bureau of Child Support Enforcement reports that roughly 1 in 4 support cases are delayed because of incomplete or inconsistent Income and Expense Statements, according to data published through the PA Child Support Program portal. Filing this form correctly the first time is the difference between a 30-day support order and a six-month nightmare.

• 📋 How to read every box on the statewide Rule 1910.27(c) form and the county versions used in Philadelphia, Allegheny, Montgomery, and Bucks
• 💵 Exactly how to convert gross pay, self-employment income, and benefits into the monthly net income PA uses
• 🧾 Which 8 attachments your DRS officer expects and what happens when one is missing
• ⚖️ How earning capacity, Mascaro imputation, and shared-custody overnights change your number
• 🛡️ The notarization, perjury, and contempt rules under 23 Pa.C.S. § 4305 that turn a typo into a sanction

What the Form Is and Who Must File It

The Income and Expense Statement is a four-page sworn affidavit adopted under Pennsylvania Rule of Civil Procedure 1910.27(c) and used in every one of Pennsylvania’s 67 counties. The current statewide version carries a revision date in the lower-left footer; confirm you are using the version posted on the Unified Judicial System forms page before you write a single entry. Counties such as Philadelphia, Allegheny, Montgomery, and Bucks publish a local hybrid that adds budget lines and county-specific verification language, but the federal-mandated guideline data on pages one and two is identical statewide.

You must file the statement if you are a party in a support action under Pa.R.C.P. 1910.11, which covers child support, spousal support, APL, and alimony cases. Both the obligor (the person paying) and the obligee (the person receiving) file. The conference officer uses the two statements side by side to calculate guideline support under Pa.R.C.P. 1910.16-1 through 1910.16-7.

The form is required even when one party has zero earned income. A stay-at-home parent still files to disclose unearned income, household assistance, and claimed expenses. Filing zero on every line without explanation invites the court to assign earning capacity under Mascaro v. Mascaro, 803 A.2d 1186 (Pa. 2002), which can impute full-time minimum-wage income or higher.

Before You Start: Documents and Information You Need

Pull every document below before you open the PDF. The DRS conference officer will ask for each one at the support conference, and a missing item can trigger a continuance, an interim order based on the other party’s numbers, or income imputation under Pa.R.C.P. 1910.16-2(d)(4).

• Last 6 pay stubs. They prove year-to-date gross, taxes, and mandatory retirement. Without them, the officer estimates from the highest stub you do produce.
• Most recent W-2 and any 1099-NEC, 1099-MISC, 1099-K. These confirm prior-year earnings and catch side income. Missing W-2s lead to averaging from tax transcripts ordered directly from the IRS.
• Last 2 federal tax returns with every schedule. Schedule C, E, K-1, and SE drive self-employment add-backs. A return without schedules is treated as incomplete.
• Profit and loss statement year-to-date if self-employed. The officer needs current numbers, not last year’s.
• Proof of health insurance premiums for you and the children, broken out by who is covered. Only the child’s portion is credited under Pa.R.C.P. 1910.16-6(b).
• Daycare or work-related child-care receipts for the past 90 days. These are added on top of guideline support.
• Unemployment award letter, Social Security award, workers’ comp printout, or pension statement. Each is income under PA’s broad definition in 23 Pa.C.S. § 4302.
• Custody order or written shared-parenting schedule. Overnights drive the substantial-shared-custody adjustment in Pa.R.C.P. 1910.16-4(c).
• Bank statements for the last 3 months. Conference officers use deposits to test the accuracy of self-employment income.
• Mortgage or lease, utility bills, and credit card statements. These support the monthly expense pages used in spousal support and APL deviations.

Where to Get the Form and How to Access It

The official statewide statement lives on the Pennsylvania Courts forms portal under the Domestic Relations forms heading. Click the Rule 1910.27(c) link to download the fillable PDF, which opens in Adobe Reader, Preview, or any browser PDF viewer. Save a blank copy first, then save a working copy with your case caption already typed in.

Each county’s Domestic Relations Section also posts the form on its own site, and a few counties require the local hybrid version. Philadelphia filers use the First Judicial District Family Court forms page, Allegheny County filers use the Allegheny County DRS portal, Montgomery County publishes its packet through the Montgomery County DRS, and Bucks County hosts its version on the Bucks County DRS site. When the county version is required, the statewide form is rejected at intake.

You can also pick up a paper packet at the DRS counter inside your county courthouse during business hours. Walk-in packets include the Income and Expense Statement, the complaint or modification form, and a verification page. Most counties charge nothing for the blank form itself; filing fees come later.

If you already have an open PACSES case, log in to the PA Child Support Program portal and upload the completed PDF directly into your case file. PACSES timestamps the upload, which protects you if the other side claims you filed late.

Step-by-Step: How to Fill Out the Pennsylvania Income and Expense Statement Line by Line

The statement is divided into a caption block, an income section, a deduction section, an expense section, an asset and debt block, and a verification page. Work through each H3 below in the order the boxes appear on the official PDF. Use blue or black ink if you print and write by hand, or type directly into the fillable fields and then print for signature.

Caption Block: Court, County, Docket Number, and Parties

The caption asks for the Court of Common Pleas, the county, the docket number, the PACSES number, and the names of the plaintiff and defendant. Type the county in all caps and use the exact docket number printed on your complaint or your prior order, formatted as the county uses it (for example, 2025-DR-01234). The PACSES number is a 10-digit number that begins with a county prefix.

Janet Reyes, filing for spousal support in Montgomery County, types MONTGOMERY on the county line, 2026-DR-00892 on the docket line, and 4602345678 on the PACSES line. If you do not yet have a PACSES number because you are filing the original complaint, write PENDING in that box.

A common edge case is a counterclaim in a divorce case where the docket number is a civil “CV” number, not a “DR” number. Use whichever number the prothonotary assigned, and add a second line if both numbers control. The most common mistake here is transposing two digits in the docket, which routes your filing to the wrong file and can let an interim order enter without your input. Filers often believe the caption is “just paperwork,” but the caption is what tells the clerk which judge and which conference officer get the file.

Section I, Personal Information: Name, Address, SSN, DOB, Phone, Employer

Section I asks for your full legal name, current mailing address, the last four digits of your Social Security number, your date of birth, your phone number, and your current employer’s name and address. Use the name on your driver’s license, not a nickname. Format the date of birth as MM/DD/YYYY, and write the SSN as –-1234.

Marcus Hill, a W-2 obligor in Allegheny County, enters Marcus A. Hill, 812 Forbes Avenue, Pittsburgh, PA 15219, –-7741, 04/12/1987, (412) 555-0144, and UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213.

If you live at a confidential address because of a Protection From Abuse order, do not write your real address. Use the Pennsylvania Address Confidentiality Program substitute address and check the confidentiality box. The biggest mistake on this section is listing an old employer because you “just started” the new job, which produces a wage attachment that bounces and a contempt petition. A misconception filers carry is that the SSN is optional; it is not, because 42 U.S.C. § 666(a)(13) requires SSN collection in every IV-D case.

Section II, Box 1: Gross Monthly Income From Employment

Box 1 asks for gross monthly wages, salary, commissions, bonuses, and tips before any deductions. Convert weekly pay by multiplying by 4.33, biweekly pay by multiplying by 2.167, and semi-monthly pay by multiplying by 2. Pull the year-to-date gross from your most recent stub, divide by the number of months elapsed, and use that number when overtime or commission swings the total.

Marcus Hill earns $1,950 biweekly. He multiplies $1,950 by 2.167 and writes $4,225.65 in Box 1.

The classic edge case is overtime. Pennsylvania includes overtime as income under 23 Pa.C.S. § 4302, and the conference officer averages it across at least the last 6 months. The most common mistake is writing net in this box because the filer copied from a take-home pay calculator; the consequence is a support order roughly 25-35% higher than the guideline number once the officer corrects the entry. The misconception that bonuses are “extra” and not income is wrong; every dollar reported on the W-2 in Box 1 counts.

Section II, Box 2: Self-Employment and Business Income

Box 2 captures net profit from self-employment, partnership distributions, and S-corp pass-through income after legitimate ordinary business expenses. Start with Schedule C line 31, Schedule E, or the K-1, then add back depreciation, Section 179, accelerated depreciation, personal vehicle use, and any expense the IRS allows but Pennsylvania does not under Pa.R.C.P. 1910.16-2(c).

Carlos Nguyen runs a small landscaping LLC and reports $62,400 of Schedule C net profit, plus $7,800 of Section 179 add-back. He divides $70,200 by 12 and writes $5,850.00 in Box 2.

A frequent edge case is a brand-new business with a loss year. You still report the loss, but you also disclose draws taken from the business account, because draws are income under PA case law. The most common mistake is leaving Box 2 blank because “the business lost money,” which the officer treats as concealment and may meet with imputed earning capacity. Filers often believe Schedule C deductions for a home office or vehicle automatically reduce support income; they do not when the deduction is more aggressive than PA allows.

Section II, Box 3: Unemployment Compensation, Workers’ Comp, Disability

Box 3 collects unemployment compensation, workers’ compensation, short-term and long-term disability payments, and Social Security Disability Insurance. Use the gross weekly benefit and convert to monthly using the same 4.33 multiplier. Attach the most recent award letter or printout from the PA Department of Labor & Industry UC portal.

Janet Reyes receives $573 per week in UC. She multiplies $573 by 4.33 and writes $2,481.09 in Box 3.

An edge case is a lump-sum workers’ comp settlement. Pennsylvania treats the present value of the settlement as income spread over a reasonable period under Pa.R.C.P. 1910.16-2(a)(2). The most common mistake is forgetting to include workers’ comp because “it’s not a paycheck,” which leads to an arrears modification once the officer finds the payment. The misconception that SSDI for the child is the parent’s income is wrong; SSDI dependent benefits paid to the child offset the obligor’s support under Pa.R.C.P. 1910.16-2(b).

Section II, Box 4: Social Security, Pensions, Annuities, Retirement

Box 4 lists Social Security retirement, private pensions, IRA distributions, 401(k) withdrawals, and annuity payments. SSI (Supplemental Security Income) is the one exception and is excluded from income under Pa.R.C.P. 1910.16-2(b)(2). Write the gross monthly amount before Medicare premiums are deducted.

Aisha Brown, a 67-year-old grandparent obligee, receives $2,140 per month in Social Security retirement. She writes $2,140.00 in Box 4 and attaches the SSA-1099.

The edge case is a one-time IRA withdrawal to pay legal fees. Conference officers can prorate a one-time withdrawal across 12 months or treat it as a non-recurring event depending on the facts. The most common mistake is including SSI, which incorrectly inflates income and triggers a wrong order. The misconception that 401(k) loans are income is wrong; loans are not income, but the missed contributions are not deductible either.

Section II, Box 5: Rental Income, Royalties, Interest, Dividends

Box 5 covers passive income. Use Schedule E for rentals, the 1099-INT and 1099-DIV totals divided by 12, and any royalty 1099-MISC. Add back depreciation on rental property the same way you do for Schedule C.

Carlos Nguyen nets $9,600 per year on a duplex after legitimate expenses, plus $3,200 in depreciation add-back. He divides $12,800 by 12 and writes $1,066.67 in Box 5.

The edge case is a rental that runs at a loss. Pennsylvania does not allow rental losses to offset W-2 income for support purposes, so the loss line still gets reported but does not reduce Box 1. The most common mistake is netting rental losses against wages, which produces an artificially low support number that the officer reverses. The misconception that interest “under $10” is too small to report is wrong; every penny counts in Box 5.

Section III, Mandatory Deductions From Gross Income

Section III is where Pennsylvania departs from the federal tax view of income. You may deduct only federal, state, and local income taxes; FICA (Social Security and Medicare); mandatory union dues; and mandatory retirement contributions under Pa.R.C.P. 1910.16-2(c). Health insurance premiums, voluntary 401(k) contributions, and garnishments are not deducted here.

Marcus Hill lists $462 federal tax, $185 PA state tax, $134 Pittsburgh local tax, $323 FICA, and $0 union dues, totaling $1,104.00 per month.

The edge case is a public employee with a mandatory pension contribution like PSERS or SERS; that contribution is deductible, while a voluntary 457(b) contribution is not. The most common mistake is deducting voluntary 401(k), which inflates the deduction column and produces a low monthly net the officer corrects on the spot. The misconception that “pre-tax” automatically equals “deductible for support” is wrong; the IRS pre-tax label and PA’s mandatory-deduction label do not match.

Section IV, Monthly Net Income

Section IV is the arithmetic line. Add Boxes 1 through 5, subtract Section III deductions, and write the monthly net. This number, paired with the other party’s number, drops directly into the schedule at Pa.R.C.P. 1910.16-3 to produce the basic support obligation.

Marcus Hill writes $3,121.65 on the Section IV line.

The edge case is a combined monthly net above the Pa.R.C.P. 1910.16-3.1 high-income cap of $30,000 per month, where the formula switches to the Melzer analysis. The most common mistake is rounding aggressively, which produces a $5-$15 monthly miscalculation that compounds into hundreds over the life of the order. The misconception that the officer “will fix the math” is risky; signed numbers are presumed accurate.

Section V, Monthly Expenses

Section V lists rent or mortgage, utilities, food, transportation, insurance, child care, medical, and miscellaneous categories. These expenses do not change a basic guideline child-support number, but they drive deviation requests under Pa.R.C.P. 1910.16-5 and they are central to spousal support and APL calculations. Use 12-month averages, not the highest month.

Janet Reyes lists $1,425 rent, $185 electric, $95 gas, $240 car payment, $140 car insurance, and $650 groceries.

The edge case is a household with a roommate or new partner sharing expenses. Pennsylvania asks you to list only your share of the bill, and lying about cohabitation can terminate spousal support entirely under 23 Pa.C.S. § 3706. The most common mistake is inflating expenses to look needier, which is perjury under the verification page and undermines credibility on every other number. The misconception that expenses control child support is wrong; child support is income-driven, not need-driven, except in deviation cases.

Section VI, Assets and Liabilities

Section VI captures real estate, vehicles, bank accounts, retirement accounts, and outstanding debts. Use fair market value for assets and current balance for debts, both as of a date within 30 days of filing. Attach the most recent statement for each account.

Carlos Nguyen lists his home at $285,000 with a $198,400 mortgage, two trucks at $22,000 combined, a business account at $14,820, and a SEP-IRA at $76,300.

The edge case is an inherited account titled in your name during the marriage. Disclose the full balance; the marital portion is sorted out at equitable distribution, not on this form. The most common mistake is omitting an account “because the other side already knows about it,” which converts a routine disclosure into a credibility problem. The misconception that retirement accounts are “off limits” is wrong; they are reported here even though they are usually not used to pay current support.

Section VII, Health Insurance and Child Care

Section VII asks who carries health insurance for the children, the monthly premium attributable to the children only, and the monthly work-related child-care cost. Pennsylvania allocates these between the parties in proportion to income under Pa.R.C.P. 1910.16-6.

Marcus Hill pays $412 per month for a family plan that covers himself and two children. He divides $412 by 3 and writes $274.67 as the children’s portion.

The edge case is an employer who only offers “employee plus family” with no incremental cost for adding children. In that case, the entire premium minus the employee-only rate is the children’s portion. The most common mistake is writing the full family premium as the child portion, which over-allocates and gets corrected at conference. The misconception that dental and vision are “extras” is wrong; they are added to the basic premium when employer-provided.

Verification, Signature, and Notarization

The verification page contains the language required by Pa.R.C.P. 76 and 18 Pa.C.S. § 4904 (unsworn falsification). Sign in blue ink, print your name beneath, and date the line as MM/DD/YYYY. Some counties also require notarization; check the local rule before you sign.

Aisha Brown signs Aisha M. Brown, prints AISHA M. BROWN, and dates 05/22/2026.

The edge case is electronic filing through PACFile, where a typed “/s/ Aisha M. Brown” satisfies the signature rule under Pa.R.J.A. 205.4. The most common mistake is signing before the form is finished and then changing a number after, which voids the verification. The misconception that “I can fix it at the conference” is wrong; the signed form is the sworn baseline used to test your live testimony.

Three Filled-Out Examples Using Real Scenarios

Each scenario below follows one named filer through the most important sections of the statement. Use them as templates, not as copy-paste answers.

Scenario 1: Marcus Hill, W-2 Obligor, Two Children, Allegheny County

Form Section	What Marcus Enters
Caption	ALLEGHENY, Docket 2026-DR-00455, PACSES 0212398765
Section I	Marcus A. Hill, 812 Forbes Ave, Pittsburgh, PA 15219, DOB 04/12/1987
Box 1 Gross Wages	$4,225.65 (biweekly $1,950 × 2.167)
Box 2 Self-Employment	$0.00
Section III Deductions	$1,104.00 (fed, state, Pittsburgh local, FICA)
Section IV Monthly Net	$3,121.65
Section V Rent	$1,250.00
Section VII Child Health Premium	$274.67
Verification	Signed 05/15/2026, notarized at AAA

Scenario 2: Carlos Nguyen, Self-Employed Obligor, APL Case, Bucks County

Form Section	What Carlos Enters
Caption	BUCKS, Docket 2026-DR-00781, PACSES 0908765432
Section I	Carlos T. Nguyen, 47 Maple Lane, Doylestown, PA 18901
Box 2 Self-Employment	$5,850.00 (Sch C net + §179 add-back)
Box 5 Rental	$1,066.67 (duplex net + depreciation add-back)
Section III Deductions	$1,742.00 (SE tax, fed, state)
Section IV Monthly Net	$5,174.67
Section VI Assets	Home $285,000, SEP-IRA $76,300
Section VI Liabilities	Mortgage $198,400, business LOC $22,400
Verification	Signed 05/18/2026 in blue ink

Scenario 3: Janet Reyes, Spousal Support Obligee, 22-Year Marriage, Montgomery County

Form Section	What Janet Enters
Caption	MONTGOMERY, Docket 2026-DR-00892, PACSES 4602345678
Section I	Janet L. Reyes, 118 Walnut Street, Norristown, PA 19401
Box 1 Gross Wages	$0.00 (out of workforce since 2008)
Box 3 Unemployment	$2,481.09 (UC $573/week × 4.33)
Section IV Monthly Net	$2,231.00
Section V Rent	$1,425.00
Section V Groceries	$650.00
Section VI Assets	Joint checking $2,140 (her half)
Verification	Signed 05/20/2026, notarized at UPS Store

How to File the Completed Form

Pennsylvania accepts the Income and Expense Statement through four channels, and each channel has its own proof-of-filing rules.

Online through PACSES. Log in to the PA Child Support Program portal and use the document upload tool inside your case. There is no fee for the upload itself. Processing time is usually 1-2 business days, and your proof-of-filing is the timestamped confirmation page; print it or save the PDF.

E-filing through PACFile. Use PACFile for divorce-related filings that include support claims. Filing fees are set county-by-county and run roughly $0 for support-only matters to $300+ for combined divorce filings; pay by credit card or e-check inside the portal. Processing is typically same-day, and the proof-of-filing is the PACFile receipt email.

By mail. Send the original signed and notarized form to the county Domestic Relations Section by USPS certified mail with return receipt. Addresses are listed on each county’s DRS page, such as the Philadelphia Family Court page and the Allegheny County DRS page. No fee is charged for the form itself. Processing runs 5-10 business days, and the green return-receipt card is your proof.

In person at the DRS counter. Walk in during business hours, hand the original to the intake clerk, and ask for a date-stamped copy. There is no walk-in fee for the statement. Processing is immediate, and the date-stamped duplicate is your proof.

Whichever channel you pick, file at least 20 days before your scheduled support conference. Late filings under Pa.R.C.P. 1910.11(c) can result in a default order based entirely on the other party’s numbers.

What Happens After You File

Within a few days of filing, the DRS schedules a support conference, usually 30-45 days out. The conference officer reviews both parties’ Income and Expense Statements, runs the guideline calculation under Pa.R.C.P. 1910.16-4, and proposes a recommended order. If both parties agree, the officer drafts a Consent Order that the judge signs the same day or shortly after.

If the parties disagree, the officer enters an interim order and the case proceeds to a de novo hearing before a hearing officer or judge under Pa.R.C.P. 1910.12. You file exceptions within 20 days, and the hearing officer reviews all evidence again, including the same Income and Expense Statement. The statement does not get re-filed at that stage; it controls the entire case unless updated.

Once the order is final, PACSES issues a wage attachment to the obligor’s employer under 23 Pa.C.S. § 4348. The first paycheck withholding usually appears within 30-60 days. Arrears that build during the conference period are added to the wage attachment as a separate line.

If your income changes by 15% or more, file a Petition for Modification and attach a fresh Income and Expense Statement. The new statement starts the same review cycle.

Mistakes to Avoid When Filling Out the Form

• Writing net pay instead of gross in Box 1, which inflates monthly net by 25-35% and produces an order well above guideline.
• Leaving Box 2 blank in a loss year, which the officer treats as concealment and meets with imputed earning capacity under Mascaro.
• Including SSI in Box 4, which is excluded by rule and produces an incorrectly high obligation.
• Deducting voluntary 401(k) contributions in Section III, which is reversed at conference and damages credibility.
• Forgetting Section 179 and depreciation add-backs for self-employment, which understates Box 2 and triggers a contested de novo hearing.
• Listing the full family health insurance premium instead of the child-only portion, which over-allocates the credit.
• Inflating Section V expenses, which is perjury under the verification and undermines every other number on the form.
• Forgetting to attach the last 6 pay stubs, which delays the conference and may lead to imputation.
• Signing before the form is complete, which voids the verification and forces a re-file.
• Using an outdated revision of the form, which counties reject at intake.
• Writing the docket number with transposed digits, which routes the file to the wrong officer and lets a default order enter.
• Skipping the PACSES upload after a paper file, which leaves the case without a digital record and slows wage attachment.

Do’s and Don’ts

Do:

• Pull every supporting document before you start, because the form needs concrete numbers, not estimates.
• Use 6-month or 12-month averages for variable income, because Pennsylvania favors averaging to smooth seasonal swings.
• File at least 20 days before the conference, because late filings invite default orders.
• Save a fillable PDF copy, because you will refile a version every time income changes.
• Sign in blue ink on the original, because clerks need to tell the original from copies.
• Re-read every box twice, because the verification is sworn under 18 Pa.C.S. § 4904.

Don’t:

• Don’t guess at self-employment income, because the conference officer will pull tax transcripts.
• Don’t deduct anything that is not in Pa.R.C.P. 1910.16-2(c), because the officer reverses everything else.
• Don’t include SSI in income, because it is excluded by rule.
• Don’t list a confidential address if you have a PFA, because it can be unsealed in court files.
• Don’t skip Section VI assets because “they’re not income,” because the form is a complete financial picture.
• Don’t sign for someone else, because forged verifications are criminal under 18 Pa.C.S. § 4904.

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

Pros of filing pro se:

• Saves $1,500-$5,000 in attorney fees that you can put toward the children directly.
• Forces you to learn your own numbers, which helps at the conference.
• Faster turnaround for simple W-2 cases, because you control the schedule.
• No conflict of interest, because no one else is filtering your story.
• Free help is available at most county Self-Help Centers.

Cons of filing pro se:

• Self-employment add-backs are easy to miss without an attorney, costing thousands per year.
• Earning capacity arguments under Mascaro are technical and hard to rebut alone.
• Counties differ on local rules, and pro se filers often miss the local hybrid form.
• Spousal support and APL deviations require careful framing under Pa.R.C.P. 1910.16-5.
• A small math error becomes a 7-year wage attachment that is expensive to undo.
• High-income cases above $30,000 monthly net trigger a Melzer analysis that is difficult without counsel.

Pennsylvania Income and Expense Statement vs. Federal Financial Disclosures

Feature	PA Income and Expense Statement
Governing rule	Pa.R.C.P. 1910.27(c)
Use	State support, APL, alimony
Income standard	Gross income with mandatory deductions only
Verification	Sworn under 18 Pa.C.S. § 4904
Filing forum	County Domestic Relations Section

FAQs

Do I have to file this form if I make zero dollars?

Yes. Every party files the statement even with zero earned income, because the conference officer still needs to evaluate earning capacity and unearned income under Pa.R.C.P. 1910.16-2(d).

Is overtime included in Box 1?

Yes. Overtime, bonuses, commissions, and tips are all gross income, and the officer averages them across at least 6 months under Pennsylvania support guidelines.

Do I write my maiden name or married name in Section I?

Yes, use the legal name on your driver’s license today, and add your former name in parentheses if the docket lists it differently.

Can I deduct my voluntary 401(k) in Section III?

No. Only mandatory retirement contributions like PSERS or SERS are deductible; voluntary 401(k), 457(b), and 403(b) contributions are not deductible under Pa.R.C.P. 1910.16-2(c).

Should I include SSI in Box 4?

No. Supplemental Security Income is expressly excluded from income, while Social Security retirement and SSDI are included.

Do I write the full family health premium or only the child portion in Section VII?

Yes, write only the child portion, calculated as the family premium minus the employee-only premium, or the family premium divided by the number of people covered if no employee-only rate exists.

Is my new spouse’s income reported on this form?

No. A new spouse’s income is not your income, but it can affect deviation analysis under Pa.R.C.P. 1910.16-5.

Do I need to notarize the form?

Yes in counties that require it, and no in counties that accept verification under Pa.R.C.P. 76; always check your local DRS rule first.

Can I file the form online?

Yes, through the PA Child Support Program portal or PACFile, and a timestamped confirmation page serves as your proof of filing.

What happens if I lie on the form?

Yes, lying is criminal. False statements are unsworn falsification under 18 Pa.C.S. § 4904 and can also lead to civil contempt and reversal of any favorable ruling.

How often do I update the form?

Yes, update any time income changes by 15% or at every modification petition; the new statement controls the next calculation.

Do I list my car loan in Section VI?

Yes, list the car as an asset at fair market value and the loan as a liability at current balance, both dated within 30 days of filing.

Does shared 50/50 custody zero out child support?

No. Shared custody with 40% or more overnights triggers an adjustment under Pa.R.C.P. 1910.16-4(c), but support rarely drops to zero unless incomes are nearly identical.

Can the conference officer ignore my form?

No, but the officer can reject entries that conflict with attached documents, and unsupported numbers are replaced with figures pulled from tax transcripts and pay stubs.