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Child support shared care questionnaire 2012 IR120

(published November 2010) 

About this form

Questionnaire to use so we can determine whether care of the child/ren meets the shared care criteria for the child support year. This information is helpful if you and the other carer disagree about the level of care provided. For use in the 2012 assessment year (1/4/2011 - 31/3/2012).

Adobe Acrobat PDF | 286kb | 4 pages

This form can be completed on-screen by typing content directly into the PDF document. Once you have completed the form it is important that you print it out as you will not be able to save the information you enter into the form.

When to use this form

You need to fill out this questionnaire so that we can determine whether the care of the child/ren meets the shared care criteria for the child support year.

What you will need

You will need to provide dates of shared care on the attached calendar.

You may need to provide proof in case there is a dispute.

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After you finish

Please print, sign and post the completed form to your nearest Inland Revenue office.

You may wish to keep a copy of this form for your personal records.

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