Application for Post Separation Income to be Excluded form (CS4120)

Use this form to apply to exclude additional income from your child support assessment. This is income you earned after you separated from the child's other parent.

Download and complete the Application for Post Separation Income to be Excluded form.

This must be income you have earned in addition to income you earned before your separation. For example it doesn't include any of the following:

  • income from a second job you had before separation
  • overtime if you were already doing overtime before separation
  • standard pay rises.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 3 March 2022