(self-calculating with "table look up" ) If you need to print a blank version, go here. September 2011 Note: We believe that we have fixed all outstanding issues involving the "self-support reserve." But if you detect problems, please let us know.
Use when parents provide "substantially equal care" - includes FM-040. If you use this form more than once be sure to click "Reset" after each use. Low-income families relying on TANF: Be careful. You will most likely lose TANF benefits with an "equal care" agreement.
If you need to print a blank version, use this.
The interactive Financial Statement Forms take a lot of computer memory and time to download. Be patient. If you're having trouble, you can downoad the blank version and enter your information by hand or try some of the tips on our troubleshooting page.
Beginning September 2011 Maine courts are using this form, in lieu of the old FM-133 Immediate Withholding Order, as required by the federal government. USDHHS has also issued these instructions for filling out the form.