Total Monthly Income: Include income from all sources including, self-employment, rent, royalties, business
income, salaries, wages, commissions, bonuses, dividends, pensions, interest, trusts, annuities, social security
benefits, workers compensation, unemployment benefits, disability benefits, alimony or maintenance received,
tips, income from side jobs, severance pay, capital gains, gifts, prizes, lottery winnings, etc. Do not report
benefits from means-tested public assistance programs such as food stamps or AFDC.
E
xtraordinary Medical Expenses: Uninsured expenses in excess of $250 in a calendar year for medical
treatment, including orthodontia, dental treatment, vision care, asthma treatment, physical therapy, treatment
for any chronic health problems, and professional counseling or psychiatric therapy for diagnosed mental
disorders.
C
hild Care Expenses: Actual child care expenses incurred on behalf of a child due to employment or job
search of either parent with amount to be determined by actual experience or the level required to provide
quality care from a licensed source.
Sc
hool and Transportation Expenses: Any expenses for attending a special or private elementary or
secondary school to meet the particular needs of the child and expenses for transportation of the child between
the homes of the parents.
CC-DR-030
(Rev. 12/2020) Page 2 of 2
FISTA