Uniform Child Support Order Form - Michigan
1. Item 1 (continued).
Uninsured Health-Care Expenses. All uninsured health-care expenses exceeding the annual ordinary medical amount will be
paid % by the plaintiff and % by the defendant. Uninsured expenses exceeding the annual ordinary
medical amount for the year they are incurred that are not paid within 28 days of a written payment request may be enforced by
the friend of the court. The annual ordinary medical amount is .
Obligation Ends. Except for child care, or as otherwise ordered, support obligations for each child end on the last day of the month
the child turns age 18. The child-care obligation for each child ends August 31 following the child's 12th birthday. The parties must
notify each other of changes in child-care expenses and must additionally notify the friend of the court if the changes end those
expenses.
Post-majority Support: The following children will be attending high school on a full-time basis after turning 18 years of age.
Therefore, the support obligation for each specific child ends on the last day of the month as follows, except in no case may
it extend beyond the time the child reaches 19 years and 6 months of age: (Specify name of child and date obligation ends.)
2. Insurance. For the benefit of the children, the plaintiff defendant shall maintain health-care coverage
through an insurer (as defined in MCL 552.602) that includes payment for hospital, dental, optical, and other health-care expenses
when that coverage is available at a reasonable cost, including coverage available as a benefit of employment or under an
individual policy
up to a maximum of $ for plaintiff. up to a maximum of $ for defendant.
not to exceed 5% of the plaintiff's/defendant's gross income.
3. Income Withholding. Income withholding takes immediate effect. Payments shall be made through the Michigan State
Disbursement Unit unless otherwise ordered in item 13.
.
4. Qualified Medical Support Order. This order is a qualified medical support order with immediate effect pursuant to 29 USC
1169. To qualify this order, the friend of the court shall issue a notice to enroll pursuant to MCL 552.626b. A parent may contest
the notice by requesting a review or hearing concerning availability of health care at a reasonable cost.
5. Retroactive Modification, Surcharge for Past-Due Support, and Liens for Unpaid Support. Except as provided by MCL
552.603, support is a judgment the date it is due and is not modifiable retroactively. A surcharge may be added to past-due
support. Unpaid support is a lien by operation of law and the payer's property can be encumbered or seized if an arrearage
accrues in an amount greater than the periodic support payments payable for two months under the payer's support order.
6. Address, Employment Status, Health Insurance. Both parties shall notify the friend of the court in writing of: a) their mailing
and residential addresses and telephone numbers; b) the names, addresses, and telephone numbers of their sources of
income; c) their health-maintenance or insurance companies, insurance coverage, persons insured, or contract numbers; d)
their occupational or drivers' licenses; and e) their social security numbers unless exempt by law pursuant to MCL 552.603.
Both parties shall notify the friend of the court in writing within 21 days of any change in this information. Failure to do so may
result in a fee being imposed.
7. Foster-Care Assignment. When a child is placed in foster care, that child's support is assigned to the Department of Human
Services while under the state's jurisdiction and to the funding county while placed in a county-funded program.
Court address
Court telephone no.
FOC 10 / 52 (8/14)
UNIFORM CHILD SUPPORT ORDER, PAGE 2
Defendant's name
Plaintiff's name
v
Approved, SCAO
STATE OF MICHIGAN CASE NO.
JUDICIAL CIRCUIT
COUNTY
MCL 552.14, MCL 552.517, MCL 552.517b(3), MCR 3.211
Original - Court
1st copy - Plaintiff
2nd copy - Defendant
3rd copy - Friend of the court
UNIFORM CHILD SUPPORT ORDER (PAGE 2)
EX PARTE TEMPORARY
MODIFICATION FINAL
(Continued on page 3.)
Page 2/3
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Uniform Child Support Order Form - Michigan PDF
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