This form contains 89 fields organized into 32 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Calculated Gross Income
Debtor 1 Calculated Gross Income Number
Provide the calculated gross income for Debtor 1 by adding the amounts from line 2 and line 3. Fill only if 'Debtor 1 Monthly Gross Wages', 'Debtor 1 Monthly Overtime Pay' is filled, any.
Depends on: Debtor 1 Monthly Gross Wages, Debtor 1 Monthly Overtime Pay
Debtor 2 Calculated Gross Income Number
Provide the calculated gross income for Debtor 2 or non-filing spouse by adding the amounts from line 2 and line 3. Fill only if 'Debtor 2 Monthly Gross Wages', 'Debtor 2 Monthly Overtime Pay' is filled, any.
Depends on: Debtor 2 Monthly Gross Wages, Debtor 2 Monthly Overtime Pay
Calculated Monthly Income
Debtor 1 Calculated Monthly Income Number
Enter the calculated monthly income for Debtor 1.
Debtor 2 or Non-Filing Spouse Calculated Monthly Income Number
Enter the calculated monthly income for Debtor 2 or the non-filing spouse.
Total Calculated Monthly Income Number
Enter the total calculated monthly income, which is the sum of Debtor 1 and Debtor 2 or the non-filing spouse's monthly income.
Case Identification
Debtor 1 Full Name Text
Enter the complete first, middle, and last name of the first debtor.
Debtor 2 Full Name (Spouse, if filing) Text
Enter the complete first, middle, and last name of the second debtor, if the spouse is filing.
Case Number Text
Enter the official case number, if it is known.
Combined Monthly Income
Combined Monthly Income Number
Enter the total combined monthly income, which is the sum of the last column of line 10 and the amount from line 11.
Copied Line 4
Debtor 1 Copied Line 4 Amount Number
Provide the amount to be copied from line 4 for Debtor 1. Fill only if 'Calculate gross income' is filled
Depends on: Debtor 1 Calculated Gross Income
Debtor 2 or Non-Filing Spouse Copied Line 4 Amount Number
Provide the amount to be copied from line 4 for Debtor 2 or a non-filing spouse. Fill only if 'Calculate gross income' is filled
Depends on: Debtor 2 Calculated Gross Income
Debtor 1 Employment Information
Debtor 1 Employed Checkbox
Check this box if Debtor 1 is currently employed.
Debtor 1 Not Employed Checkbox
Check this box if Debtor 1 is currently not employed.
Debtor 1 Occupation Text
Enter the occupation of Debtor 1. Fill only if 'Debtor 1 Employed' is 'Yes'.
Depends on: Debtor 1 Employed
Debtor 1 Employer's Name Text
Enter the name of Debtor 1's employer. Fill only if 'Debtor 1 Employed' is 'Yes'.
Depends on: Debtor 1 Employed
Debtor 1 Employer Address Street Text
Enter the street number and street name of Debtor 1's employer. Fill only if 'Debtor 1 Employed' is 'Yes'.
Depends on: Debtor 1 Employed
Debtor 1 Employer Address Line 2 Text
Enter any additional address information for Debtor 1's employer, such as apartment, suite, or unit number. Fill only if 'Debtor 1 Employed' is 'Yes'.
Depends on: Debtor 1 Employed
Debtor 1 Employer Address Line 3 Text
Enter any further additional address information for Debtor 1's employer. Fill only if 'Debtor 1 Employed' is 'Yes'.
Depends on: Debtor 1 Employed
Debtor 1 Employer Address City Text
Enter the city of Debtor 1's employer. Fill only if 'Debtor 1 Employed' is 'Yes'.
Depends on: Debtor 1 Employed
Debtor 1 Employer Address State Text
Enter the state of Debtor 1's employer. Fill only if 'Debtor 1 Employed' is 'Yes'.
Depends on: Debtor 1 Employed
Debtor 1 Employer Address ZIP Code Text
Enter the ZIP code of Debtor 1's employer. Fill only if 'Debtor 1 Employed' is 'Yes'.
Depends on: Debtor 1 Employed
Debtor 1 Employment Duration Text
Enter how long Debtor 1 has been employed at this job. Fill only if 'Debtor 1 Employed' is 'Yes'.
Depends on: Debtor 1 Employed
Debtor 2 or Non-filing Spouse Employment Information
Debtor 2 Employed Checkbox
Check this box if Debtor 2 or the non-filing spouse is currently employed.
Debtor 2 Not employed Checkbox
Check this box if Debtor 2 or the non-filing spouse is not currently employed.
Debtor 2 Occupation Text
Enter the occupation for Debtor 2 or the non-filing spouse. Fill only if 'Debtor 2 Employed' is 'Yes'.
Depends on: Debtor 2 Employed
Debtor 2 Employer's Name Text
Enter the name of the employer for Debtor 2 or the non-filing spouse. Fill only if 'Debtor 2 Employed' is 'Yes'.
Depends on: Debtor 2 Employed
Debtor 2 Employer Address Street Number Text
Enter the street number part of the employer's address for Debtor 2 or the non-filing spouse. Fill only if 'Debtor 2 Employed' is 'Yes'.
Depends on: Debtor 2 Employed
Debtor 2 Employer Address Street Text
Enter the street name part of the employer's address for Debtor 2 or the non-filing spouse. Fill only if 'Debtor 2 Employed' is 'Yes'.
Depends on: Debtor 2 Employed
Debtor 2 Employer Address Line 2 Text
Enter any additional address information for the employer of Debtor 2 or the non-filing spouse, such as an apartment or suite number. Fill only if 'Debtor 2 Employed' is 'Yes'.
Depends on: Debtor 2 Employed
Debtor 2 Employer Address City Text
Enter the city of the employer's address for Debtor 2 or the non-filing spouse. Fill only if 'Debtor 2 Employed' is 'Yes'.
Depends on: Debtor 2 Employed
Debtor 2 Employer Address State Text
Enter the state of the employer's address for Debtor 2 or the non-filing spouse. Fill only if 'Debtor 2 Employed' is 'Yes'.
Depends on: Debtor 2 Employed
Debtor 2 Employer Address ZIP Code Text
Enter the ZIP code of the employer's address for Debtor 2 or the non-filing spouse. Fill only if 'Debtor 2 Employed' is 'Yes'.
Depends on: Debtor 2 Employed
Domestic Support Obligations
Domestic Support Obligations for Debtor 1 Number
Enter the amount for domestic support obligations for Debtor 1.
Domestic Support Obligations for Debtor 2 or non-filing spouse Number
Enter the amount for domestic support obligations for Debtor 2 or non-filing spouse.
Expected Income Change
No Checkbox
Check this box if you do not expect an increase or decrease in your income within the year after you file this form.
Yes, Explain Checkbox
Check this box if you expect an increase or decrease in your income within the year after you file this form, and be prepared to explain the change.
Expected Income Change Explanation Text
Provide a detailed explanation of any expected increase or decrease in income within the year after filing this form. Fill only if 'Yes, Explain' is 'Yes'.
Depends on: Yes, Explain
Family Support Payments
Family Support Payments Debtor 1 Number
Enter the amount of family support payments regularly received by Debtor 1.
Family Support Payments Debtor 2 or Non-Filing Spouse Number
Enter the amount of family support payments regularly received by Debtor 2 or non-filing spouse.
Filing Status
An amended filing Checkbox
Check this box if you are submitting an amended version of the filing.
A supplement showing postpetition Chapter 13 income Checkbox
Check this box if you are providing a supplement that details postpetition Chapter 13 income as of a specific date.
Supplement Income Date Date
Enter the date as of which the postpetition chapter 13 income supplement is being provided. Fill only if 'A supplement showing postpetition Chapter 13 income' is 'Yes'.
Depends on: A supplement showing postpetition Chapter 13 income
General
US Bankruptcy Court Combobox
Enter the name of the United States Bankruptcy Court for which this filing is made.
Southern District of Florida Central District of California Western District of New York Southern District of Texas Western District of Pennsylvania Eastern District of Tennessee Eastern District of North Carolina Southern District of New York District of Maine Southern District of California Southern District of Indiana Eastern District of Kentucky District of North Dakota Northern District of West Virginia Northern District of Florida District of New Jersey District of Idaho District of Virgin Islands Southern District of Iowa Southern District of Illinois Middle District of Pennsylvania Middle District of Georgia Eastern District of Texas District of Columbia Northern District of Ohio Northern District of California Southern District of Alabama __________ District of __________ District of New Mexico Central District of Illinois Western District of Louisiana Western District of Tennessee Northern District of Mississippi Western District of Texas District of Nevada District of Maryland Southern District of Mississippi Northern District of Iowa Eastern District of Oklahoma District of Vermont Southern District of Ohio Northern District of Oklahoma Northern District of Alabama Northern District of New York Eastern District of Washington District of Delaware District of South Carolina Western District of Michigan District of Puerto Rico Western District of Washington District of Alaska Northern District of Illinois Eastern District of Pennsylvania Eastern District of Wisconsin Eastern District of California District of Kansas Middle District of Louisiana District of Hawaii District of Oregon District of Minnesota Middle District of Alabama Eastern and Western District of Arkansas Northern District of Georgia Middle District of Tennessee Eastern District of Missouri Eastern District of New York Southern District of Georgia District of Guam Northern District of Indiana Western District of North Carolina Middle District of Florida District of Connecticut Middle District of North Carolina District of Rhode Island District of Nebraska District of New Hampshire Western District of Oklahoma District of South Dakota District of Northern Mariana Islands District of Arizona District of Massachusetts District of Montana District of Wyoming Western District of Kentucky District of Utah Northern District of Texas Western District of Missouri Eastern District of Louisiana Western District of Virginia Southern District of West Virginia Western District of Wisconsin Eastern District of Virginia Eastern District of Michigan District of Colorado
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Insurance Deductions
Debtor 1 Insurance Deduction Number
Enter the insurance deduction amount for Debtor 1.
Debtor 2 or Non-Filing Spouse Insurance Deduction Number
Enter the insurance deduction amount for Debtor 2 or non-filing spouse.
Interest and Dividends
Interest and Dividends for Debtor 1 Number
Enter the amount of interest and dividends received by Debtor 1.
Interest and Dividends for Debtor 2 or non-filing spouse Number
Enter the amount of interest and dividends received by Debtor 2 or non-filing spouse.
Mandatory Contributions for Retirement Plans
Debtor 1 Mandatory Contributions Number
Enter the mandatory contributions for retirement plans for Debtor 1.
Debtor 2 or Non-Filing Spouse Mandatory Contributions Number
Enter the mandatory contributions for retirement plans for Debtor 2 or the non-filing spouse.
Monthly Gross Wages
Debtor 1 Monthly Gross Wages Number
Enter Debtor 1's total monthly gross wages, salary, and commissions before any deductions.
Debtor 2 Monthly Gross Wages Number
Enter Debtor 2's or the non-filing spouse's total monthly gross wages, salary, and commissions before any deductions.
Monthly Overtime Pay
Debtor 1 Monthly Overtime Pay Number
Provide Debtor 1's estimated monthly overtime pay.
Debtor 2 Monthly Overtime Pay Number
Provide Debtor 2's or non-filing spouse's estimated monthly overtime pay.
Net Income from Business/Rental
Debtor 1 Net Income from Business/Rental Number
Enter the net income from rental property and from operating a business, profession, or farm for Debtor 1.
Debtor 2 Net Income from Business/Rental Number
Enter the net income from rental property and from operating a business, profession, or farm for Debtor 2 or non-filing spouse.
Other Deductions
Other Deductions - Specify Text
Enter a description for the other deductions. Fill only if 'Other Deductions Amount (Debtor 1)', 'Other Deductions Amount (Debtor 2 or non-filing spouse)' is filled, any.
Depends on: Other Deductions Amount (Debtor 1), Other Deductions Amount (Debtor 2 or non-filing spouse)
Other Deductions Amount (Debtor 1) Number
Enter the total amount for other deductions for Debtor 1.
Other Deductions Amount (Debtor 2 or non-filing spouse) Number
Enter the total amount for other deductions for Debtor 2 or a non-filing spouse.
Other Government Assistance
Other Government Assistance Type Text
Specify the type of other government assistance regularly received. Fill only if 'Other Government Assistance Amount for Debtor 1', 'Other Government Assistance Amount for Debtor 2 or Non-filing Spouse' is filled, any.
Depends on: Other Government Assistance Amount for Debtor 1, Other Government Assistance Amount for Debtor 2 or Non-filing Spouse
Other Government Assistance Amount for Debtor 1 Number
Enter the amount of other government assistance regularly received by Debtor 1.
Other Government Assistance Amount for Debtor 2 or Non-filing Spouse Number
Enter the amount of other government assistance regularly received by Debtor 2 or a non-filing spouse.
Other Monthly Income
Other Monthly Income Specify Text
Provide a description for the other monthly income source. Fill only if 'Debtor 1 Other Monthly Income', 'Debtor 2 Other Monthly Income' is filled, any.
Depends on: Debtor 1 Other Monthly Income, Debtor 2 Other Monthly Income
Debtor 1 Other Monthly Income Number
Enter the total amount for other monthly income for Debtor 1.
Debtor 2 Other Monthly Income Number
Enter the total amount for other monthly income for Debtor 2 or non-filing spouse.
Other Regular Contributions
Other Regular Contributions Amount Number
Enter the total amount of other regular contributions made to the expenses listed in Schedule J.
Pension or Retirement Income
Debtor 1 Pension or Retirement Income Number
Enter the monthly pension or retirement income received by Debtor 1.
Debtor 2 or Non-Filing Spouse Pension or Retirement Income Number
Enter the monthly pension or retirement income received by Debtor 2 or the non-filing spouse.
Required Repayments of Retirement Fund Loans
Required Repayments for Debtor 1 Number
Enter the amount of required repayments of retirement fund loans for Debtor 1.
Required Repayments for Debtor 2 or non-filing spouse Number
Enter the amount of required repayments of retirement fund loans for Debtor 2 or non-filing spouse.
Social Security Income
Social Security Income for Debtor 1 Number
Enter the Social Security income received by Debtor 1.
Social Security Income for Debtor 2 or Non-Filing Spouse Number
Enter the Social Security income received by Debtor 2 or the non-filing spouse.
Tax, Medicare, and Social Security Deductions
Debtor 1 Tax, Medicare, and Social Security Deductions Number
Enter the amount for Debtor 1's tax, Medicare, and Social Security deductions.
Debtor 2 or Non-filing Spouse Tax, Medicare, and Social Security Deductions Number
Enter the amount for Debtor 2's or the non-filing spouse's tax, Medicare, and Social Security deductions.
Total Monthly Take-Home Pay
Amount 7 Debtor 1 Text
Debtor 2 or Non-filing Spouse Total Monthly Take-Home Pay Number
Provide the total monthly take-home pay for Debtor 2 or a non-filing spouse.
Total Other Income
Debtor 1 Total Other Income Number
Enter the total amount of other income for Debtor 1.
Debtor 2 Total Other Income Number
Enter the total amount of other income for Debtor 2 or non-filing spouse.
Total Payroll Deductions
Debtor 1 Total Payroll Deductions Number
Enter the total sum of all payroll deductions for Debtor 1, calculated by adding amounts from lines 5a through 5h.
Debtor 2 Total Payroll Deductions Number
Enter the total sum of all payroll deductions for Debtor 2 or the non-filing spouse, calculated by adding amounts from lines 5a through 5h.
Unemployment Compensation
Debtor 1 Unemployment Compensation Number
Enter the amount of unemployment compensation received by Debtor 1.
Debtor 2 Unemployment Compensation Number
Enter the amount of unemployment compensation received by Debtor 2 or non-filing spouse.
Union Dues
Debtor 1 Union Dues Number
Enter the amount of union dues for Debtor 1.
Debtor 2 or Non-Filing Spouse Union Dues Number
Enter the amount of union dues for Debtor 2 or the non-filing spouse.
Voluntary Contributions for Retirement Plans
Debtor 1 Voluntary Contributions Number
Enter the amount of voluntary contributions for retirement plans made by Debtor 1.
Debtor 2 Voluntary Contributions Number
Enter the amount of voluntary contributions for retirement plans made by Debtor 2 or a non-filing spouse.