COLVILLE CONFEDERATED TRIBES

COLVILLE CONFEDERATED TRIBES

CHILD SUPPORT PROGRAM

PO BOX 468 | NESPELEM, WA 99155

Toll Free (800) 515-2544 | Phone (509) 634-2030 | (509) 634-2031

MODIFICATION REQUEST

During the enforcement of an existing order, a modification may arise due to a showing of

change in circumstances by the parties. The parties may initiate the request for modification of

an existing order in writing, by completing the Request for Review of Child Support Order form.

Requests should be made with careful consideration, by the requesting party, as the

modification of an order may result in increases or decreases of the child support obligation.

Our staff is prohibited from rendering legal advice, but we can assist you with completing the

forms and explain the modification process.

Once the Case Manager receives the completed Request for Review of Child Support Order

form, they will review your statements and supporting documentation. If the evidence meets the

standards outlined in the Colville Tribal Resolution #2018-423, specifically under the Standards

for Determining Support Obligations, #9...

“Any order of child support may be modified upon a claiming of substantial changes in

circumstances at any time, and be modified when necessary to serve the best interest of the

children, and when inconsistent between the existent child support award amount and the

amount of child support which results from application of Tribal guidelines. Application for a

modification should be made to the Tribal Court. This is not a limit to Tribal member's right to

review and adjustment of support”

Including the Colville Tribal Code, Title 5, § 1-258,

“The Court has continuing jurisdiction to prospectively modify a judgment and order for future

education and future support upon showing a substantial change of circumstances unless

otherwise provided by the Business Council.”

The Case Manager, will then mail you a Modification or Adjustment Review Findings, letting you

know the determination they made after reviewing your request. The determinations that the

Case Manager can make are:

1) Your case will be referred to the Spokesperson to Motion the Administrative

Law Court for a Hearing of your Modification request as it meets the standards

outlined above, and the Case Manager has prepared a Worksheet as our

agencies recommendation to the Court as to what your order should be modified

to, you will be served with the Motion certified mail or in-person, (note that, if you

do not make yourself available for service of the documents, your request will be

Dismissed Without Prejudice) or

2) CTCSP will not refer your case to the Administrative Law Court for a hearing,

as it does not meet the above standards, and if you would like to still have a

hearing — your case can still be brought to the Administrative Law Court to hear

your request, it will just not include the agencies recommendation of what your

support should be modified to.

REQUEST FOR REVIEW OF CHILD SUPPORT ORDER — updated 07/31/19

COLVILLE CONFEDERATED TRIBES

CHILD SUPPORT PROGRAM

REQUEST FOR REVIEW OF CHILD SUPPORT ORDER

TO: IV-D CASE NUMBER:

INSTRUCTIONS :

1. Complete this form, a Colville Tribal Child Support Worksheet (optional). Attach copies of your last two CURRENT

pay stubs for the last two pay periods and any other income information.

2. Except for your signature, print or type all responses on the forms. Use blue or black ink only.

3. Return the completed forms and attachments to the Colville Confederated Tribes Child Support Program (CTCSP)

address listed on page 2.

4. CTCSP may deny your request for review if you do not provide all of the required information.

5. \falV-D agency is making this request, a representative of the IV-D agency must sign the request.

| want CTCSP to review my child support order. | believe my order needs modification or adjustment because (check all that

apply to your case):

1.0) The income of one or both parents involved in my case has changed significantly.

2.00 At least one of the children involved in my case.

a. C)Was less than 12 years old when the child support order was entered and is now 12 years old or more.

b. CIHas changed residences.

c. Ols no longer a dependent.

3.41 My order does not have a health insurance obligation.

4.01 | have become disabled or incarcerated since the order was entered.

5.1 Other: (BE SPECIFIC):

REQUEST FOR REVIEW OF CHILD SUPPORT ORDER

| understand that:

1. This review may result in the modification of my order and that CTCSP will address only child support and health

insurance for the children. Other issues are not CTCSP’s responsibility.

2. CTCSP will not represent me or the other party to my support order. Both parties to the support order have the right

to have an attorney represent them in court or have an attorney or other person represent them in an administrative

hearing.

3. CTCSP may use information | provide to establish, modify, or enforce child support. CTCSP shares this information

with other governmental agencies only for those purposes. You may request the other parent’s personal and

confidential information from CTCSP. CTCSP releases information only as state and federal laws and regulation allow.

4, CTCSP may ask a court to modify my child support order.

WARNING: CTCSP spokesperson/authorized representative may share any documents you submit with the other

party to your support order and may file the documents in the public court file. The other party to your support order

has a right to see your financial information. Please remove your personal identification information (address, birth

date, social security number) from these documents before your submit them.

5. CTCSP may deny my request to adjust or modify my support order if my order does not meet legal standards or

review requirements.

6. If the spokesperson decides to proceed with adjustment or modification of my support order or arrearage rate, the

adjusted or modified order is effective from the date spokesperson files the petition in court, not the day | requested

a review.

7. An adjustment or modification of my support order may result in an order that requires a higher or lower support

amount than my current order requires.

8. | always have the right to pursue adjustment or modification of my support order on my own.

Date Parent’s Signature

Date Parent’s Authorized Representative’s Signature

Send completed forms, tax information, and pay information to:

Colville Confederated Tribes

Child Support Program

PO BOX 468

Nespelem, WA 99155

Phone: 509-422-7700

Fax: 509-422-7705

Toll Free: 877-515-2544

REQUEST FOR REVIEW OF CHILD SUPPORT ORDER

MONTHLY CHILD SUPPORT OBLIGATION WORKSHEET

A. Gross Monthly Income and Percentage

Custodial Absent Combined

Parent Parent

1. Gross Monthly $ $ $

2. Percentage ofCombined §$ $ 100%

Income (Each parent’s income divided by combined income)

B. Computation of Basic Support

3. Number of Children for Whom Support is sought

4. Basic Support for Number of Children

C. Additional Support Costs

Children’s Health and Dental

Work Related Child Care

Extraordinary Costs

Total Additional Support

D. Calculation of Support Amount

9. Total Basic and Additional Support Cost

(Add Combined Column Figures

from Line 4 and Line 8)

10. Each parent’s Obligation $

11. Enter each Parent’s Total $

Additional Support Costs

From Line 8

. Each Parent’s Net Child $

Support Obligation

(Subtract Line 11 from Line 10)

Paying Parent Pays $ each Month, to Custodial Parent

Colville Tribal Child Support Schedule

Worksheets

Mother: Father:

County: OKANOGAN/COLVILLE RESERVATION Tribal Court Case No: AC-CS-

Children and Ages:

Part | Basic Child Support Obligation

1. Gross Monthly Income (See Guidelines, Sec 1) Father Mother

a. Wages and Salaries (ncp/cp 4 qtr ave)

b. Commissions

c. Revenue From Sales of Goods and Products

Received in the Normal Course of Business

(Business Income)

d. Deferred Compensation

. Overtime

. Contract-related Income

e

f

g. Income From Second Job (Limited to obligated parent)

h. Dividends

i. Interests

j. Severance Pay

k. Annuities

|. Capital Gains

m. Pension Retirement Benefits

n, Workers Compensation

. Unemployment Benefits

°

p. Spousal Maintenance Actually Received

q. Bonuses

r. Social Security Benefits

w

. Disability Insurance Benefits

t. Gifts and Prizes ( greater than or equal to $250 in value)

u. Total Gross Monthly Income $ - |$

2. Monthly Deductions From Gross Income (See Guidelines §3)

a. Federal and State Income Taxes (20%IMPUTED) S - S

b. Federal, Tribal Insurance Contributions and Deductions

. Mandatory Pension Plan Payments

. Mandatory Union or Professional Dues

. State or Tribal Industiral Insurance Premiums

Court-ordered Spousal Maintenance Actually Paid

. Up to $2,000 per year in Voluntary Pension Payments Actually Made

Tim irlolTasia

. Normal Business Expenses and Self-Employment Taxes

i. Total Deductions from Gross Income

( Add lines 2a through 2h) S = S

3. Monthly Net Income

(Line 1u minus line 2) s = 5 =

4. Combined Monthly Net Income

(Add Father's and Mothers Net Incomes From line3)} S “

5. Basic Child Support Obligation (based on 80/20 split, then divided by two like Ok. Co. Sup)

Child #1: Child #3:

Child #2: Child #4: $0.00

6. Proportional Share of Income

( Each Parent's net income fromline 3 divided by line 4) #DIV/0! #DIV/0!

7. Each Parent's Basic Child Support Obligation

(Multiply each number on line 6 by line 5) #DIV/O! #DIV/O!

Part Il. Health Care, Day Care, and Special Child Rearing Expenses

8. Health Care Expenses (See Guidelines, §4b,4f)

a. Monthly Health Insurance Premiums Paid for Child(ren) S e $ -

b. Uninsured Monthly Healthcare Expenses Paid for Child(ren) S - S -

c. Total Monthly Health Care Expenses

(Line 8a plus line 8b) S zs S$ =

d. Combined Monthly Health Care Expenses

(Add Father's and Mothers Totals fromline &c) S -

e. Maximum Ordinary Monthly Health Care Expenses

(Multiply line 5 times 0.05) $ -

f. Extraordinary Monthly Health Care Expenses

(Line 8d minus line 8e, if "O" or negative enter "0") S -

9. Day Care and Special Child Rearing Expenses (See Guidelines, §4a)

. Day Care Expenses

a

b. Education Expenses

c. Long Distance Tranportation Expenses

Wn 1h 1H

'

WiwM lM 1a

'

d. Other Special Expenses ( Describe)

e. Total Day Care and Special Expenses

( Add lines 9a through 9d) iS Ss S =

10. Combined Monthly Total of Day Care & Speical Expenses

(Add Father's and Mother's Totals from line 9e) 0

11. Total Extraordinary Health Care, Day Care, Special Expenses

( Line 8 f plus line 10) ) =

12. Each Parent's Obligation for Extraordinary Health Care, Day Care, and Special Expenses

(Multiply each number on line 6 by line 11) #DIV/0! #DIV/0!

13. Standard Calculation Support Obligation

(Line 7 Plus line 12)

#DIV/O!

#DIV/O!

Part Ill: Child Support Credits

14. Child Support Credits

a. Custom or Cultural Services and Resources Credit (Describe) (See Guidelines, §5-5)

b. In-Kind Services Credit (Describe) (See Guidelines, § 5-6)

. Indian Health Services Credit ( For Part Il, 8; See Guidelines, §4b, 4f)

. Monthly Health Care Expenses Credit

. Day Care and Special Expenses Credit

. Total Support Credit ( Add lines 14 a through 14f)

Bee ee oe ee eae eee es

‘

WMA TMH PH Th PN

‘

c

d

e

f. Other Ordinary Expense Credit (Describe)

&

h

. Total Allowable Credit Per Month

( Subtract fromline g 30% or 50 % of Basic Support Obligation )

Part IV: Net Monetary Obligation/Presumptive Transfer Payment

15. Net Support Obligation (See Guidelines§5)

(Line 13 minus 14h)

Part V: Items Disclosed But Not Included in Gross Monthly Income

16. Household Assets ( List the estimated present value of all major household assets)

Father's

Mothers

. Real Estate

o |

. Stocks and Bonds

. Vehicles

. Boats

. Pensions/ IRAs/ Bank Accounts

Cash

. Insurance Plans

asym jmiol;ajia

. Other (Describe)

17. Household Debt (List liens against household assets, extraordinary debt)

Father's

Mother's

18. Other Houshold Income

a. Income of Current Spouse ( See Guidelines, §2-1)

(If not the other Parent of this action)

Name:

Name:

b. Income of Other Adults in Household (See Guidelines, §2-1)

Name:

Name:

c. Income of Children (If considered extraordinary)

Name:

Name:

d. Income From Child Support Received From Other Relationships (See Guidelines, §2-2)

Name:

Name:

e. Gifts and prizes Less than $250 In Value (See Guidelines, §2-3)

f. Income From Aid to Families with Dependent Children ( See Guidelines, §2-4)

g. Supplemental Security Income (See Guidelines, §2-5)

h. General Assistance (See Guidelines, §2-6)

i. Food Stamps ( See Guidelines §2-7)

j. Trust Income (See Guidelines, §2-8)

k, Other Income (Describe)

19. Other Non-recurring Income (Describe) ( See Guidelines, §5-4)

20. Child Support Paid For Other Children

Name/ Age:

Name/ Age:

21. Children From Other Relationships Living In Each Household ( See Guidelines, §5-3)

( First Names and Ages)

22. Disability Payments (See Guidelines, Sec 5-7)

23. Other Factors For Consideration (See Guidelines)

| declare, under penalty of perjury under the laws of the Colville Tribes, the information contained in these

worksheets is complete, true and correct.

Mother's Signature Father's Signature

Date City Date City

Judge/Reviewing Officer Date

CHILD SUPORT INCOME CHART

Combined One Child Two Children Three Children Four Children Five Children

Monthly Family Family Family Family Family

Net a ee il

Income A B A B —A— B A L:} A 8B

600 8a 109 68 84 57 | | 70 43 60 42 52

700 103 | 127 80 98 66 82 56 70 49 60

800 118 145 91 113 76 94 64 80 56 69

900 132 163 102 127 86 106 72) 90 63 78

1000 146 181 114 140 35 118 80 99 7a 86

I 1100 161 199 125 154 104 129 8& 109 7? 95

1200 17S 217 136 168 114 140 96 119 84 104

1300 189 234 147 182 123 151 104 128 390 112

i 1400 204 252 158 195 132 163 112 138 93 | 120

1500 217 268 169 208 141 174| 119] 147] 104 128

1600 231 284 179 221 149 185 126 156 110 136

1700 244 301 189 234 158 195 134 165 116 144

— 1800 257 318 199 2465 167 206 141 174 123 151

1900 270 334 210 259 175 217 148 183 129 159

I 2000 284 350 220 272 184 227 156 192 136 167

2100 297 357 231 285 192 238 163 201 142 175

2200 310 383 241 | 298 201 248 170 210 148 183

2300 324 399 251 310 209 259 177 219 155 191

2400 336| 416] 261| 323| 218 270 185 228 161 199

2500 3a9 432 271 336 227 280 191 237 167 207

a 2600 355 439 276 341 230 284 195 241 170 210

__ 2700 360 445 280 345 233 239 198 244 172 213

2800 365 451 284 350 237 292 200 247 174 215

2900 369 456 288 354 239 296 203 250 177 218

3000 373 460 290 357 242 298 205 252 178 220

3100 376 464 292 361 244 301 206 254 179 222

3200 378 468 294 363 245 304 207 256 181 223

3300 381 470 296 365 246 305 2093 258 181 225

3400 381 472 296 366 247 306 209 258 182 226_

3500 382 472 297 367 248 306 210 259 183 227

3600 383 473 298 367 248 307 | 211 260 183 227

3700 384 A74 298 368 249 308 211 260 184 228

3300 386 478 300 371 250 310 212 262 185 229

3900 396 4a9g __ 308 380 256 317 217 268 189 234

4000 405 500 314 388 262 324 222 274 193 239

4100 414 §12 322 _397 268 332 227 280 198 244

4200 424 524 329 406 274 340 233 286 203 250

4300 433 535 336 415 230 347 237 293 207 256

4400 441 54s 343 423 286 353 242] 296] 211 260

4500 450 555 349 431 291 360 246 304 215 266

4600 458 565 355 439 296 367 250 310 219 270

4700 466 575 362 447 302 373 255 316 223 275 _

4800 474 586 368 4ss 308 380 260 a21 227 280

4900 482 596 375 463 312 386 264 326 231 285

5000 490 606 381 470 318 393 268 332 235 290

5100 499 617 338 476 324 400 273 338 239 294

5200 507 627 394 486 328 406 278 343 243 30D

5300 516 637 400 494 334 413 282 349 246 304

5400 524 647 407 502 340 420 287 454 250 310

5500 532 687 413 510° 344 426 292 36D 254 314

5600 539 667 420 518 350 433 296 366 258 319

5700 543 677 426 526 355 439 300 371 262 324

5800 556 688 432 534 361 446 305 377 266 329

5900 565 698 439 541 366 452 310 382 270 334

6000 $73 708 445 549 371 459 314 388 274 338

6100 581 718 452 557 377 466 318 394 278 343

6200 589 728 458 565 382 472 323 399 282 343

6300 597 739 464 573 387 479 328 405 256 353

6400 605 749 471 581 393 486 332 410 290 358

6500 614 759 477 589 398 492 336 416 294 363

6600 622 769 484 597 403 498 341 422 298 368

6700 631 779 490 605 409 506 345 427 302 373

6800 638 7893 496 613 414 512 350 433 305 377

6900 647 7993 503 621 419 518 a54 438 310 382

Phat

7000 655 809 510 629 425 525 359 444 314 387

7100 663 819 515 636 423 531 363 449 317 392

7200 670 829 $21 645 434 537 368 4354 321 397

7300 678 838 527 652 439 $43 372 460 325 402

7400 686 347 533 659 445 sso 376 465 329 407

7500 693 857 539 667 449 556 381 471 333 411

7600 700 866 545 674 4ss S61 385 476 336 416

7700 708 876 551 681 459 567 389 482 340 421

7800 716 885 557 688 46S S74 394 437 344 426

7900 723 893 563 695 469 580 499 492 348 431

8000 730 903 569 703 474 586 403 498 352 435

___8100 738 912 574 709 473 592 407 504 355 440

8200 746 921 580 717 484 598 411 509 360 445

8300 753 930 586 724 488 604 416 514 364 449

8400 760 939 591 731 493 610 420 520 367 456

8500 767 948 597 733 4938 616 425 525 a71 4s9

8600 774 957 &03 748 503 621 429 530 375 463

8700 782 966 608 753 508 627 433 536 379 468

8800 788 975 615 759 512 634 438 541 383 473

8900 796 984 620 766 518 633 442 546 387 473

9000 802 991 625 772 522 645 446 551 390 482

9100 809 1000 630 779 §26 651 450 556 393 486

9200 816 1009 635 785 530 656 452 562 397 450

9300 823 1017 641 792 535 661 459° 567 401 495

9400 830 1026 647 799 540 667 463 572 404 soo

9500 837 1034 652 80S 544 673 467 S77 407 504

9600 843 1043 657_ 812 548 678 471 582 411 508

9700 850 1051 662 819 553 6484 475 587 415 513

9800 857 10S9 667 825 558 689 479 592 419 517

s900 863 1067 673 331 S62 694 483 597 422 522

10000 870 1075 678 838 S66 700 487 602 425 526

10100 876 1083 683 B44 570 705 491 607 429 530

10200 882 1051 688 851 575 710 495 612 433 $35

10300 889 1039 693 857 579 716 499 617 436 539,

10400 gags 1106 698 863 584 721 503 G22 439 $44

10500 902 1114 703 869 587 726 507 627 443 548

10600 908 1122 708 875 591 732 $11 632 447 552

10700 914 1130 712 881 S596 736 $15 637 450 556

10800 920 1178 718 887 600 742 519 641 453 560

10900 926 1145 722 893 604 747 523 647 457 565

11000 932 1153 727 899 608 752 527 651 460 569

11100 938 1160 732 905 612 757 530 656 463 373

11200 944 1168 737 910 616 762 534 661 467 577

11300 950 1175 742 916 620 7G7 538 665 470 582

11400 956 1182 746 922 624 772 sA2 670 474 586

11500 962 1189 751 928 628 777 546 675 477 sao

11600 968 1197 754 934 632 781 550 680 480 593

11700 974 1204 760 940 6436 786 $54 684 483 597

11800 979 1211 764 945 640 791 557 689 487 601

11900 985 1218 769 950 644 796 561 694 490 605

12000 991 1225 774 956 647 801 565 698 493 610