The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

LIT Lab Home | About The Explorer | Find & Compare | Explore: California Lists

Here is the text we could read:

PETITIONER: 

RESPONDENT:

OTHER PARTY:

CASE NUMBER:

FL-490

APPLICATION TO DETERMINE ARREARS
Attachment to Request for Order (                    ) 

Child Support

Spousal or partner support

Family support

Medical support

Unreimbursed expenses

Unreimbursed medical expenses

Other(specify):

1.

I ask that the amount of past due support payments (arrears) be decided in this case because (check all that apply):

I have already paid

some

all

of the support ordered. Proof of payment is attached.

The children for whom support is to be paid were living with me full time for the period
to:
explaining these facts and supporting documentation, including any proof that the children were living with me.

. I provided all of their support during that period. I am attaching a detailed declaration

from:

I could not pay child support because

(1) After December 31, 2020, my child support order was entered or modified, and I was confined against my will for more 

than 90 days in a row in jail, prison, juvenile detention, a mental health facility, or other institution (attach proof).

(a) Start date:

(b) End date:

(2)

I was not confined for
(a) domestic violence against the other parent or our child; or
(b)

failing to pay a child support order.

(3)

I had no money available to pay child support while I was confined.

The child support order entered on (date):
would stop

by operation of law (specify the reasons why and attach applicable proof):

was stopped (suspended) because

the order says it

Other (specify):

I have previously asked the other parent for payment and provided the other parent with an itemized statement of the
unreimbursed
payments that you have made on these bills.)

medical expense. (Attach copies of all bills being claimed and proof of any

childcare expense

I am asking the other person to pay
My Income and Expense Declaration ( 

attorney fees

costs.

) is attached.

4.

I have attached (check all that apply):

a Declaration of Payment History (                    ).

a Payment History Attachment (                   ).

Other (specify):

5. Facts in support of the relief requested are (specify):

contained in the attached declaration. 

I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.

(TYPE OR PRINT NAME)

(SIGNATURE OF DECLARANT)

Petitioner/plaintiff

Respondent/defendant

Other parent/party

Other (specify):

NOTICE: This form must be attached to Request for Order (form FL-300). 

For help completing this form, talk to the

or

in your county. 

NOT A COURT ORDER

APPLICATION TO DETERMINE ARREARS

Page _____ of  _____

Family Code, §§ 4007.5, 4720–4732 

Form Adopted for Mandatory Use 
Judicial Council of California 
FL-490 [Rev. January 1, 2022]

a.

b.

c.

d.

e.

a.

b.

c.

2.

3.

Date:

Application to Determine Arrears

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 1
Fields(s): 49
Average fields per page: 49
Reading Level: Grade 10
LIST Grouping(s): FA-00-00-00-00, FA-06-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

f_page_p_title_party_name__1 was FL-490[0].Page1[0].P1Caption[0].TitlePartyName[0].Party1[0] (0.50 conf)
f_page_p_title_party_name__2 was FL-490[0].Page1[0].P1Caption[0].TitlePartyName[0].Party2[0] (0.37 conf)
f_page_p_title_party_name__3 was FL-490[0].Page1[0].P1Caption[0].TitlePartyName[0].Party3[0] (0.37 conf)
f_l_page_p_case_number was FL-490[0].Page1[0].P1Caption[0].CaseNumber_ft[0] (0.43 conf)
f_page_issue_c_child_b_cb was FL-490[0].Page1[0].IssueCBs[0].ChildSupportCB[0].cs_cb[0] (0.33 conf)
f_page_issue_c_b_ss_cb was FL-490[0].Page1[0].IssueCBs[0].SpousalSupportCB[0].ss_cb[0] (0.35 conf)
page_issue_bs_family_support_fs_cb was FL-490[0].Page1[0].IssueCBs[0].FamilySupportCB[0].fs_cb[0] (0.38 conf)
f_page_issue_c_b_ms_cb was FL-490[0].Page1[0].IssueCBs[0].MedicalSupportCB[0].ms_cb[0] (0.39 conf)
f_l_page_issue_c_b_u was FL-490[0].Page1[0].IssueCBs[0].UnreimbursedCB[0].u_cb[0] (0.37 conf)
f_l_page_issue_c_b_um was FL-490[0].Page1[0].IssueCBs[0].UnreimbursedMedCB[0].um_cb[0] (0.38 conf)
f_l_page_issue_c_bs_b_cb was FL-490[0].Page1[0].IssueCBs[0].OtherCB[0].o_cb[0] (0.35 conf)
f_page_issue_c_b_area_text was FL-490[0].Page1[0].IssueCBs[0].OtherCB[0].#area[7].TextField2[0] (0.39 conf)
f_l_page_list_area_cb was FL-490[0].Page1[0].List1[0].LI2[0].#area[0].petitioner_cb[0] (0.35 conf)
f_l_page_list_area_c_bpay__1 was FL-490[0].Page1[0].List1[0].LI2[0].#area[1].CBpay[0] (0.37 conf)
f_l_page_list_area_c_bpay__2 was FL-490[0].Page1[0].List1[0].LI2[0].#area[2].CBpay[1] (0.37 conf)
f_l_page_list_area_c_b__1 was FL-490[0].Page1[0].List1[0].LI3[0].#area[0].CB[0] (0.37 conf)
f_l_page_list_area_c_b__2 was FL-490[0].Page1[0].List1[0].LI4[0].Li1[0].#area[0].CB1[0] (0.38 conf)
f_l_page_list_start_date was FL-490[0].Page1[0].List1[0].LI4[0].Li1\.1[0].StartDate[0].DateField1[0] (0.37 conf)
f_l_page_list_end_date_field was FL-490[0].Page1[0].List1[0].LI4[0].Li1\.1[0].EndDate[0].DateField1[0] (0.37 conf)
f_l_page_list_area_c_b__3 was FL-490[0].Page1[0].List1[0].LI5[0].#area[0].CB[0] (0.37 conf)
f_l_page_list_date_field was FL-490[0].Page1[0].List1[0].LI5[0].DateField1[0] (0.34 conf)
f_l_page_list_area_c_b__4 was FL-490[0].Page1[0].List1[0].LI5[0].#area[1].CB1[0] (0.37 conf)
f_l_page_list_area_c_b__5 was FL-490[0].Page1[0].List1[0].LI5[0].#area[2].CB3[0] (0.37 conf)
f_l_page_list_text_field__1 was FL-490[0].Page1[0].List1[0].LI5[0].TextField6[0] (0.33 conf)
f_l_page_list_area_check_box__1 was FL-490[0].Page1[0].List1[0].LI6[0].#area[0].CheckBox61[0] (0.37 conf)
f_l_page_list_text_field__2 was FL-490[0].Page1[0].List1[0].LI6[0].TextField6[0] (0.33 conf)
f_l_page_list_check_box__1 was FL-490[0].Page1[0].List2[0].LI1[0].CheckBox1[0] (0.37 conf)
f_l_page_list_area_c_b__6 was FL-490[0].Page1[0].List2[0].LI1[0].#area[0].CB1[0] (0.37 conf)
f_l_page_list_area_c_b__7 was FL-490[0].Page1[0].List2[0].LI1[0].#area[1].CB2[0] (0.37 conf)
f_l_page_list_check_box__2 was FL-490[0].Page1[0].List3[0].LI1[0].CheckBox1[0] (0.37 conf)
f_l_page_list_area_c_b__8 was FL-490[0].Page1[0].List3[0].LI1[0].#area[0].CB[0] (0.37 conf)
f_l_page_list_area_c_b__9 was FL-490[0].Page1[0].List3[0].LI1[0].#area[1].CB[1] (0.37 conf)
f_l_page_list_area_c_b__10 was FL-490[0].Page1[0].List4[0].LI2[0].#area[0].CB[0] (0.37 conf)
f_l_page_list_area_c_b__11 was FL-490[0].Page1[0].List4[0].LI3[0].#area[0].CB[0] (0.37 conf)
f_l_page_list_area_check_box__2 was FL-490[0].Page1[0].List4[0].LI4[0].#area[0].CheckBox61[0] (0.37 conf)
f_page_list_area_text_field was FL-490[0].Page1[0].List4[0].LI4[0].#area[0].TextField6[0] (0.33 conf)
f_l_page_list_text_field__3 was FL-490[0].Page1[0].List5[0].LI1[0].TextField6[0] (0.33 conf)
f_l_page_list_area_c_b__12 was FL-490[0].Page1[0].List5[0].LI1[0].#area[0].CB[0] (0.37 conf)
f_l_page_signature_sig_date was FL-490[0].Page1[0].Signature[0].SigDate[0] (0.36 conf)
f_l_page_signature_print_name was FL-490[0].Page1[0].Signature[0].PrintName[0] (0.38 conf)
f_l_page_signature_area_petitioner_cb__1 was FL-490[0].Page1[0].Signature[0].#area[0].petitioner_cb[0] (0.37 conf)
f_l_page_signature_area_petitioner_cb__2 was FL-490[0].Page1[0].Signature[0].#area[1].petitioner_cb[1] (0.37 conf)
f_l_page_signature_area_petitioner_cb__3 was FL-490[0].Page1[0].Signature[0].#area[2].petitioner_cb[2] (0.37 conf)
f_l_page_signature_area_petitioner_cb__4 was FL-490[0].Page1[0].Signature[0].#area[3].petitioner_cb[3] (0.37 conf)
f_l_page_signature_text_field was FL-490[0].Page1[0].Signature[0].TextField6[0] (0.37 conf)
f_l_page_number_text_field__1 was FL-490[0].Page1[0].PageNumber[0].TextField7[0] (0.38 conf)
f_l_page_number_text_field__2 was FL-490[0].Page1[0].PageNumber[0].TextField6[0] (0.38 conf)
f_l_page_date_field__1 was FL-490[0].Page1[0].DateField1[0] (0.37 conf)
f_l_page_date_field__2 was FL-490[0].Page1[0].DateField1[1] (0.37 conf)

Create an Interactive Version of this Form:

The Weaver creates a draft guided interview from a template form, like the one provided here. You can use the link below to open this form in the Weaver. To learn more, read "Weaving" your form into a draft interview.

Launch Form in Weaver

The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Application to Determine Arrears

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02