FL-490 - Application to Determine Arrears

Summary

Application to Determine Arrears

Text

Form ID: FL-490
Title: Application to Determine Arrears
Effective Date: 2024-01-01
Mandatory Form: yes
Languages: 汉语, 한국어, español, Tagalog, Tiếng Việt
Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-490
Primary Download URL: https://www.courts.ca.gov/documents/fl490.pdf
Alternate Download URLs: https://www.courts.ca.gov/documents/fl490c.pdf, https://www.courts.ca.gov/documents/fl490k.pdf, https://www.courts.ca.gov/documents/fl490s.pdf, https://www.courts.ca.gov/documents/fl490t.pdf, https://www.courts.ca.gov/documents/fl490v.pdf
Form Detail Page:
Application to Determine Arrears
(FL-490)
Ask the judge to figure out how much back support is owed. It must be attached to Request for Order (form FL-300).
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(Vietnamese)
Effective: January 1, 2024
PDF Text:
Form Adopted for Mandatory Use 
Judicial Council of California 
FL-490 [Rev. January 1, 2024]
APPLICATION TO DETERMINE ARREARS Family Code, §§ 4007.5, 4720–4732 
www.courts.ca.gov
PETITIONER: 
RESPONDENT:
OTHER PARTY:
CASE NUMBER:
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):
a. I have already paid some all of the support ordered. Proof of payment is attached.
b. The children for whom support is to be paid were living with me full time for the period
. I provided all of their support during that period. I am attaching a detailed declaration
explaining these facts and supporting documentation, including any proof that the children were living with me.
from:
to:
c. I could not pay child support because on or after September 27, 2022, 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).
(1) I was confined during the following dates:
(a) Start date: (b) Release date:
Additional dates of confinement are listed on an attached page. (Form MC-025 may be used for this purpose.)
(2) I had no ability to pay child support while I was confined.
d. I could not pay child support because from October 8, 2015, through December 31, 2019, or January 1, 2021, through
September 26, 2022, 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).
(1) I was confined during the following dates:
(a) Start date: (b) Release date:
Additional dates of confinement are listed on an attached page. (Form MC-025 may be used for this purpose.)
(2) I had no ability to pay child support while I was confined.
(3) I was not confined for
(a) Domestic violence against the other parent or our child; or
(b) Failing to pay a child support order.
e. Other (specify):
2. I have previously asked the other parent for payment and provided the other parent with an itemized statement of the
unreimbursed childcare expense medical expense. (Attach copies of all bills being claimed and proof of any
payments that you have made on these bills.)
3. I request the other person pay my attorney's fees and costs. My Income and Expense Declaration (form FL-150) is attached.  
4. I have attached (check all that apply):
a. a Declaration of Payment History (form FL-420).
b. a Payment History Attachment (form FL-421).
c. 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.
Date:
(TYPE OR PRINT NAME)
 (SIGNATURE OF DECLARANT)
NOTICE: This form must be attached to Request for Order (form FL-300).  
For help completing this form, talk to the family law facilitator or self-help center in your county.
NOT A COURT ORDER Page _____ of  _____
(form FL-300) 
FL-490

Retrieval chunks

• #1

  Form ID: FL-490 Title: Application to Determine Arrears Effective Date: 2024-01-01 Mandatory Form: yes Languages: 汉语, 한국어, español, Tagalog, Tiếng Việt Info Page: https://selfhelp.courts.ca.gov/jcc-form/FL-490 Primary Download URL: https://www.courts.ca.gov/documents/fl490.pdf Alternate Download URLs: https://w…

• #2

  (2) I had no ability to pay child support while I was confined. d. I could not pay child support because from October 8, 2015, through December 31, 2019, or January 1, 2021, through September 26, 2022, my child support order was entered or modified, and I was confined against my will for more than 90 days in a row …