FL-676 - Request for Determination of Support Arrears (Governmental)

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Request for Determination of Support Arrears (Governmental)

Text

Form ID: FL-676
Title: Request for Determination of Support Arrears (Governmental)
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-676
Primary Download URL: https://www.courts.ca.gov/documents/fl676.pdf
Alternate Download URLs: https://www.courts.ca.gov/documents/fl676info.pdf, https://www.courts.ca.gov/documents/fl676c.pdf, https://www.courts.ca.gov/documents/fl676k.pdf, https://www.courts.ca.gov/documents/fl676s.pdf, https://www.courts.ca.gov/documents/fl676t.pdf, https://www.courts.ca.gov/documents/fl676v.pdf
Form Detail Page:
Request for Determination of Support Arrears (Governmental)
(FL-676)
Tell the judge you want them to decide how much in back support is owed.
Get form FL-676
Get instructions for form FL-676
汉语
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(Chinese Simplified)
한국어
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(Korean)
español
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(Spanish)
Tagalog
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(Tagalog)
Tiếng Việt
Get form FL-676 in Vietnamese
(Vietnamese)
Effective: January 1, 2024
PDF Text:
Page 1 of 2
REQUEST FOR DETERMINATION OF SUPPORT ARREARS 
(Governmental)
Family Code, §§ 4007.5, 17526 
www.courts.ca.gov 
Form Adopted for Mandatory Use  
Judicial Council of California  
FL-676 [Rev. January 1, 2024]
PARTY WITHOUT ATTORNEY OR ATTORNEY (name, state bar number, and address):  
NAME: STATE BAR NO.:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
EMAIL ADDRESS:
ATTORNEY FOR (name):
FL-676
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:  
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
RESPONDENT:
OTHER PARTY:
REQUEST FOR DETERMINATION OF SUPPORT ARREARS
FOR COURT USE ONLY
CASE NUMBER:
INSTRUCTIONS 
 
 
 
 
 
 
 
 
 
 
• Use this form if you disagree with the local child support agency about how much back support (arrears) is owed.
• Complete items 4–7. For more information about completing this form, see Information Sheet: Request for Determination of Support 
Arrears  
• After you fill out the request and any attachments, take the originals plus three copies to the court clerk to file.
• After you file, copies of your court papers must be "served" on the local child support agency and the other party in the case, and 
you must file a proof of service with the court. See                                 for more information about serving the request.
• Make sure you go to the court hearing listed in item 1. 
• For help completing this form, talk to the                                 in your county. 
NOTICE OF HEARING 
1. A hearing on this application will be held as follows:
a.   Date: Time: Dept: Div: Room:
same as noted aboveb.   The address of the court is Other (specify):
2. WARNING to the person served with this request: The court may make the requested orders without you if you do not file a 
Response to Governmental Notice of Motion or Order to Show Cause                        and appear at the hearing. See 
INFO for more information about filing a response.
3. The local child support agency is providing support enforcement services in this case.
4. Person making this request
a. My name is:
b. I am the:
(1) Petitioner
(2) Respondent
(3) Other (specify):
5. a. I did did not request an administrative review of support received by the local child support agency. 
A printout listing support payments received by the local child support agency is is not attached.b.

FL-676 [Rev. January 1, 2024] REQUEST FOR DETERMINATION OF SUPPORT ARREARS
(Governmental)
Page 2 of 2
FL-676
PETITIONER:
RESPONDENT:
OTHER PARTY:
CASE NUMBER:
6. I ask that the amount of past due support payments (arrears) be adjusted in this case (check all that apply).
a. I disagree with how much support the local child support agency says was paid. I am attaching my own payment history 
with a monthly breakdown of how much was ordered and how much was paid.
b. 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. may be used for this purpose.)
(2) I had no ability to pay child support while I was confined.
c.  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).
(a)
(1) I was confined during the following dates:
Start date: (b) Release date:
Additional dates of confinement are listed on an attached page. 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.
d. The child support order entered on (date): was stopped (suspended) because the order says it would
stop (specify the reasons why and attach applicable proof):
Other (specify):e.
7. I have attached (check all that apply):
a. a Declaration of Payment History 
b. a Payment History Attachment 
c. a printout listing support payments received by the local child support agency.
d. proof of incarceration or confinement.
e. Other (specify):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME)
 (SIGNATURE)
This case may be referred to a court commissioner for hearing. By law, court commissioners do not have the authority to issue final  
orders and judgments in contested cases unless they are acting as temporary judges. The court commissioner in your case will act as 
a temporary judge unless, before the hearing, you or any other party objects to the commissioner’s acting as a temporary judge. If a 
party objects, the court commissioner may still hear your case to make findings and a recommended order to a judge. If you do not like 
the recommended order, you must object to it within 10 court days in writing (use Notice of Objection (form FL-666)); otherwise, the 
recommended order will become a final order of the court. If you object to the recommended order, a judge will make a temporary 
order and set a new hearing.

Retrieval chunks

• #1

  Form ID: FL-676 Title: Request for Determination of Support Arrears (Governmental) 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-676 Primary Download URL: https://www.courts.ca.gov/documents/fl676.pdf Alterna…

• #2

  • Make sure you go to the court hearing listed in item 1. • For help completing this form, talk to the in your county. NOTICE OF HEARING 1. A hearing on this application will be held as follows: a. Date: Time: Dept: Div: Room: same as noted aboveb. The address of the court is O…

• #3

  Additional dates of confinement are listed on an attached page. 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. d. The child support o…