Uniform Support Declaration

Before you begin

Each party files a Uniform Support Declaration and the required attachments. No declaration is needed if you and the other party have already agreed to every term of the judgment. If that is your situation, call the office before filling this out.

You do not need a notary. Your signature on this declaration is enough. It is signed under penalty of perjury.

Do you and the other party have joint children under 21?

Joint children are children of the two of you together, including unmarried children age 18, 19, or 20.

Yes No

Is anyone asking for spousal or partner support?

Yes No Not sure

Is anyone asking for child support different from the guideline amount?

Yes No Not sure

If either answer is yes or not sure, the household-expense supplement is included. Credit cards and other consumer debts go there, not in the income section.

Case caption

The petitioner is the person who filed the case first. The review screen asks you to confirm these names before you sign.

Your first name *

Middle

Your last name *

Who filed the case first?

I filed first. I am the petitioner. The other party filed first. I am the respondent. I am neither the petitioner nor the respondent.

Other party's first name *

Other party's last name *

Other party's middle name

Enter the two people on the caption. Your own name is used for the signature, not for those lines.

Petitioner first name *

Petitioner last name *

Respondent first name *

Respondent last name *

I am the other: *

For the county of *

Case No.

Optional for a new case.

CSP No.

Unmarried children age 18, 19, or 20 years old (per ORS 107.108) are parties

Names of those children

1. Number of children

a. Joint minor children (children of the parties together) *

b. Joint adult children (age 18, 19, or 20) *

i. Joint adult children attending school

unknown

Number of overnights the joint children spend with me (per year)

i. Current order, judgment, or written agreement

ii. Proposed

Use a whole number from 0 to 366. Required when there is at least one joint minor child.

c. Non-joint minor children (children of only one party)

2. Sources of income

Monthly averages, before taxes. Every amount is per month unless you choose another period. Weekly × 52 ÷ 12. Every two weeks × 26 ÷ 12. Twice a month × 2. Quarterly ÷ 3. Yearly ÷ 12.

Wages / salary

I am paid by the hour I know the hours in each paycheck I am paid a salary (enter the monthly amount)

$ per hour *

hours/week *

$ per hour *

Hours each paycheck *

Paydays each year *

Wages/Salary (monthly, before taxes)

Other monthly income

Do you have self-employment income?

Self-employment amount

This is printed on an Other line as “Self-employment.” The office copy keeps the full description: self-employment (gross receipts less ordinary and necessary expenses). The official form’s explain box is too short for that whole sentence.

Other (explain)

Up to five lines on the form, including self-employment if you checked it. A description is required when the amount is more than zero.

Social Security

Is this the amount before Medicare (Part B/D) premiums are taken out (gross), or the amount deposited (net)?

Gross — before Medicare premiums Net — the amount deposited

Monthly Medicare premium deducted

Section 2 is before taxes, so the form reports the gross benefit. Please also check benefit statements so we get your SSA letter.

3. Spousal / partner support (monthly)

4. Health insurance (monthly)

Use a real monthly average. Weekly costs × 4.33 (52 weeks ÷ 12). Yearly costs ÷ 12. Include a premium even if you pay it once a year or put it on a card. Enter 0 only if you truly have none.

Helper for the premium paid for joint children

Child share = (total premium − cost for you only) ÷ people covered besides you × joint children covered. You can type a different amount above.

Total premium

Cost for you only

People covered besides you

Joint children covered

e. Oregon Health Plan (or other public health insurance) *

Yes No

5. Other (monthly)

i. Person with disability is:

child me other parent

i. City or ZIP where childcare is provided

ii. Does anyone else share the cost of childcare?

Yes No

1. Name

Amount $

6. Rebuttal factors

(The amount of child support is based on statewide guidelines. The guideline amount can be rebutted (challenged) under OAR 137-050-0760, click here to read the rule: https://www.doj.state.or.us/wp-content/uploads/2017/08/050_0760.pdf)

I am challenging the guideline amount (explain rebuttal factors)

Explanation

About 450 characters fit on the form. Anything longer is continued on an additional page.

Attachments

Attachments (be sure to black out (redact) personal identifying information like Social Security Numbers, account numbers, and dates of birth)

This checklist does not upload files. Send the documents through the client portal, or bring them to the office.

4 most recent pay stubs Benefit statements (Social Security, SNAP, disability, etc.) Most recent tax return Copies of currently effective spousal/partner support, child support, and parenting time orders or judgments Proof of health insurance premiums and any subsidies received Proof of out-of-pocket medical expenses Proof of childcare expenses Evidence supporting any rebuttal factors for child support

Uniform Support Declaration Supplement

These are the total household expenses you must pay each month for yourself only - not for others in your household. Any other annual, quarterly, or other periodic payments should be converted to a monthly average.

Use real monthly averages from the last 6–12 months of bank and card statements. Divide a yearly cost by 12. A weekly cost × 4.33 (that is 52 weeks ÷ 12, so $100 a week is $433.33 a month). A quarterly cost ÷ 3.

Include a cost even if you pay it irregularly, pay it by credit card, or someone else is covering it for now. Add a short note when that is temporary.

Do not leave a blank for something you pay. Enter 0 only if you truly have none. It is normal for total expenses to be higher than income. Do not shrink the numbers to make them match.

DO NOT LIST ANY EXPENSE IF IT IS DEDUCTED FROM YOUR WAGES

2. Debts

Examples — don't forget

Each credit card, separately (issuer, balance, and the minimum or usual payment) → Debts
Personal loans and buy-now-pay-later → Debts
Medical bills you are paying off → Debts
Tax payment plans → Debts
Back support (arrears) → Debts
Student loans → Debts. The monthly car payment stays in 1.C, and the mortgage or HELOC stays in 1.A.

List each credit card separately: card issuer, current balance, and the minimum or usual monthly payment. Also list student loans, personal loans, medical debt, and buy-now-pay-later.

If the payment is yearly or weekly, choose that frequency and we will convert it. The first seven debts print on the form. More than seven continue on an added page, and “additional page attached” is checked.

Other expenses with no line of their own

The 2025 form has no general line for these. They are still included in Total Fixed Costs and in Fixed Costs plus Debts. Parking, tolls, and other transportation go on Transportation → Other when that line is open, and an insurance item goes on Insurance → Other. Anything else is noted next to Total Fixed Costs as “plus $… other itemized expenses, see attached itemized page,” and the items are listed on that page.

Examples — don't forget

Children: school fees and supplies, clothing, activities, sports, lessons, camps, tutoring, allowance, birthday gifts, diapers → Other factors
Personal: clothing, haircuts, gym → Other factors
Gifts, holidays, vacations, charitable giving → Other factors
Subscriptions and memberships that are not your phone or internet bill → Other factors
Pet food and vet care → Other factors
HOA, repairs, yard, pest control, furniture or appliance replacement → Other factors
Education costs that are not a student-loan payment → Other factors. The loan payment itself is a debt.
Licenses and dues, if they are not union dues (union dues go in section 5.a) → Other factors

4. Other factors you want the court to consider

About 600 characters fit on the form. Yard care, clothing, activities, and vacations are included in Total Fixed Costs even though they have no line of their own.

Declaration and signature

Declaration I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use as evidence in court. I understand I am subject to penalty for perjury.

You do not need a notary. Your signature on this declaration is enough.

Signature (type your full legal name) *

Date *

I agree that typing my name is my signature on this declaration, under penalty of perjury.

The PDF shows your signature as /s/ followed by the name you type.

Email *

Contact phone *

Name (printed) *

Contact address *

City, State, ZIP *

Review

Check the caption. The totals below are the same figures the server prints. You cannot type a total.

UNIFORM SUPPORT DECLARATION

Before you begin

Do you and the other party have joint children under 21?

Is anyone asking for spousal or partner support?

Is anyone asking for child support different from the guideline amount?

Case caption

Who filed the case first?

1. Number of children

Number of overnights the joint children spend with me (per year)

2. Sources of income

Wages / salary

Other monthly income

Other (explain)

Social Security

3. Spousal / partner support (monthly)

4. Health insurance (monthly)

Helper for the premium paid for joint children

e. Oregon Health Plan (or other public health insurance) *

5. Other (monthly)

6. Rebuttal factors

Attachments

Uniform Support Declaration Supplement

2. Debts

Other expenses with no line of their own

4. Other factors you want the court to consider

Declaration and signature

Review

Thank You