This form contains 90 fields organized into 33 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Mortgage Payments
Additional Mortgage Payments Number
Enter the total amount for additional mortgage payments for your residence, such as home equity loans.
Alimony, Maintenance, and Support Payments
18. Alimony, Maintenance, and Support Payments Number
Please enter the total amount of your alimony, maintenance, and support payments that you did not report as deducted from your pay on line 5, Schedule I, Your Income (Official Form 1061).
Case Identification
Debtor 1 Full Name Text
Enter the full name of Debtor 1, including their first, middle, and last name.
Debtor 2 Full Name Text
Enter the full name of Debtor 2 (Spouse, if filing), including their first, middle, and last name.
Case Number Text
Provide the case number, if known.
Charitable Contributions
14. Charitable Contributions Number
Enter the total amount for charitable contributions and religious donations.
Childcare and Children's Education Costs
Childcare and Children's Education Costs Number
Provide the total amount for childcare and children's education costs. Fill only if 'Do you have dependents?' is 'Yes'.
Depends on: Dependent Status Yes
Clothing, Laundry, and Dry Cleaning
9. Clothing, Laundry, and Dry Cleaning Expense Number
Enter the total amount spent on clothing, laundry, and dry cleaning expenses.
Debtor 2 Household Status
Debtor 2 Not Separate Household Checkbox
Check this box if Debtor 2 does not live in a separate household. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Debtor 2 Separate Household Checkbox
Check this box if Debtor 2 lives in a separate household and must file Official Form 106J-2, Expenses for Separate Household of Debtor 2. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Dependent Status
Dependent Status No Checkbox
Check this box if you do not have any dependents.
Dependent Status Yes Checkbox
Check this box if you have dependents and need to provide their information in the table below.
Entertainment and Recreation Expenses
Entertainment, Clubs, Recreation, Newspapers, Magazines, and Books Expense Number
Enter the total amount spent on entertainment, clubs, recreation, newspapers, magazines, and books.
Expected Change in Expenses
No Expected Change Checkbox
Check this box if you do not expect an increase or decrease in your expenses within the year after you file this form.
Yes Expected Change Checkbox
Check this box if you expect an increase or decrease in your expenses within the year after you file this form.
Explanation of Expected Change Text
Provide a detailed explanation for any expected increase or decrease in expenses within the year after filing this form. Fill only if 'Yes Expected Change' is 'Yes'.
Depends on: Yes Expected Change
Fifth Dependent Information
Fifth Dependent's Relationship Text
Enter the fifth dependent's relationship to Debtor 1 or Debtor 2. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Fifth Dependent's Age Text
Enter the fifth dependent's age. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Fifth Dependent Lives With You - No Checkbox
Check this box if the fifth dependent does not live with you. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Fifth Dependent Lives With You - Yes Checkbox
Check this box if the fifth dependent lives with you. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Filing Status
Amended Filing Checkbox
Check this box if the current submission is an amendment to a previously filed document.
Supplement for Postpetition Chapter 13 Expenses Checkbox
Check this box if you are providing a supplement that details postpetition Chapter 13 expenses, and then specify the effective date for these expenses.
Supplement Filing Date Date
Enter the date for the supplement showing postpetition chapter 13 expenses. Fill only if 'Supplement for Postpetition Chapter 13 Expenses' is 'Yes'.
Depends on: Supplement for Postpetition Chapter 13 Expenses
First Dependent Information
First Dependent Relationship Text
Enter the first dependent's relationship to Debtor 1 or Debtor 2. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
First Dependent Age Text
Enter the first dependent's age. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
First Dependent Lives With You - No Checkbox
Check this box if the first dependent does not live with you. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
First Dependent Lives With You - Yes Checkbox
Check this box if the first dependent lives with you. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Food and Housekeeping Supplies
Food and Housekeeping Supplies Amount Number
Enter the total amount spent on food and housekeeping supplies.
Fourth Dependent Information
Fourth Dependent's Relationship Text
Provide the fourth dependent's relationship to Debtor 1 or Debtor 2. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Fourth Dependent's Age Text
Enter the fourth dependent's age. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Fourth Dependent Does Not Live With You Checkbox
Check this box if the fourth dependent listed does not live with you. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Fourth Dependent Lives With You Checkbox
Check this box if the fourth dependent listed lives with you. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
General
Bankruptcy Court Combobox
Enter the name of the United States Bankruptcy Court where the case is filed.
District of Guam Northern District of Georgia District of Alaska Eastern District of Texas Eastern District of New York District of Delaware Southern District of Florida Southern District of Iowa Middle District of Alabama Western District of Oklahoma Southern District of West Virginia District of Connecticut Eastern District of Kentucky Southern District of Mississippi Eastern District of Michigan __________ District of __________ District of Vermont Western District of North Carolina Southern District of Georgia Northern District of Florida Northern District of Indiana Western District of Washington Northern District of New York Eastern District of Wisconsin District of Virgin Islands District of Nevada District of Kansas Western District of Wisconsin Western District of Kentucky Southern District of New York District of Columbia District of Idaho Middle District of Pennsylvania Eastern District of Tennessee Northern District of Mississippi Northern District of Illinois Western District of Pennsylvania District of South Dakota Middle District of North Carolina Western District of Tennessee District of Colorado Southern District of Indiana District of Puerto Rico District of Oregon Southern District of Illinois District of Maryland Middle District of Florida Northern District of West Virginia District of Hawaii District of Minnesota Southern District of California District of Arizona District of Maine Eastern District of Oklahoma Middle District of Georgia Middle District of Tennessee Western District of Virginia Western District of Texas Northern District of Iowa District of Massachusetts Eastern District of California Middle District of Louisiana District of New Mexico Eastern District of Virginia Northern District of Alabama Central District of California Eastern District of Louisiana District of Nebraska Northern District of Oklahoma District of Rhode Island Eastern District of Pennsylvania District of Montana District of New Jersey District of North Dakota District of South Carolina Eastern District of Washington Northern District of Ohio Northern District of Texas District of Wyoming Southern District of Alabama Western District of Missouri District of Northern Mariana Islands District of Utah Western District of Louisiana Eastern District of North Carolina Southern District of Ohio Western District of Michigan Southern District of Texas Eastern District of Missouri District of New Hampshire Western District of New York Eastern and Western District of Arkansas Central District of Illinois Northern District of California
Opens Print Menu Button
Allows you to give the file a new name when saving Button
Attach a file Button
Resets the entire form Button
Home Ownership Expenses
4. Rental or Home Ownership Expenses Number
Enter the total monthly expenses for your residence, including first mortgage payments and any rent for the ground or lot.
4a. Real Estate Taxes Number
Enter the monthly amount for real estate taxes.
4b. Property, Homeowner's, or Renter's Insurance Number
Enter the monthly amount for property, homeowner's, or renter's insurance.
4c. Home Maintenance, Repair, and Upkeep Expenses Number
Enter the monthly amount for home maintenance, repair, and upkeep expenses.
4d. Homeowner's Association or Condominium Dues Number
Enter the monthly amount for homeowner's association or condominium dues.
Installment or Lease Payments
Vehicle 1 Car Payment Amount Number
Enter the amount for car payments for Vehicle 1.
Vehicle 2 Car Payment Amount Number
Enter the amount for car payments for Vehicle 2.
Other Payment 1 Description Text
Describe the type of the first other installment or lease payment.
Other Payment 1 Amount Number
Enter the amount for the first other installment or lease payment. Fill only if 'Other Payment 1 Description' is specified.
Depends on: Other Payment 1 Description
Other Payment 2 Description Text
Describe the type of the second other installment or lease payment.
Other Payment 2 Amount Number
Enter the amount for the second other installment or lease payment. Fill only if 'Other Payment 2 Description' is specified.
Depends on: Other Payment 2 Description
Insurance
15a. Life Insurance Amount Number
Enter the amount paid for life insurance.
15b. Health Insurance Amount Number
Enter the amount paid for health insurance.
15c. Vehicle Insurance Amount Number
Enter the amount paid for vehicle insurance.
15d. Other Insurance Type Text
Specify the type of other insurance paid.
15d. Other Insurance Amount Number
Enter the amount paid for the specified other insurance. Fill only if '15d. Other Insurance Type' is specified.
Depends on: 15d. Other Insurance Type
Joint Case Status
No Checkbox
Check this box if the case is not a joint case.
Yes Checkbox
Check this box if the case is a joint case.
Medical and Dental Expenses
11. Medical and Dental Expenses Number
Enter the total amount for medical and dental expenses.
Monthly Expense Calculation
Total Monthly Expenses (22a) Number
Provide the sum of expenses from lines 4 through 21.
Debtor 2 Monthly Expenses (22b) Number
Provide the monthly expenses for Debtor 2, if any, from Official Form 106J-2. Fill only if 'Does Debtor 2 live in a separate household?' is 'Yes'.
Depends on: Debtor 2 Separate Household
Combined Monthly Expenses (22c) Number
Provide the sum of the amounts from line 22a and line 22b.
Monthly Net Income Calculation
23a Combined Monthly Income Number
Enter your combined monthly income as copied from Schedule I, line 12.
23b Monthly Expenses Number
Enter your total monthly expenses as copied from line 22c.
23c Monthly Net Income Number
Enter your monthly net income, calculated by subtracting your monthly expenses from your monthly income.
Other Expenses
Other Expense Specification Text
Provide a detailed description of the other expense.
Other Expense Amount Number
Enter the total monetary amount for the other expense.
Other Payments to Support Others
Other Support Payments Description Text
Provide a detailed description of the other payments made to support individuals who do not live with you. Fill only if 'Do your expenses include expenses of people other than yourself and your dependents?' is 'Yes'.
Depends on: Include Other People's Expenses: Yes
Total Other Support Payments Number
Enter the total monetary amount of other payments made to support individuals who do not live with you. Fill only if 'Other Support Payments Description' is specified.
Depends on: Other Support Payments Description
Other People's Expenses Inclusion
Include Other People's Expenses: No Checkbox
Check this box if your expenses do not include those for people other than yourself and your dependents.
Include Other People's Expenses: Yes Checkbox
Check this box if your expenses include those for people other than yourself and your dependents.
Other Real Property Expenses
20a Mortgages on Other Property Number
Enter the amount of expenses for mortgages on other property.
20b Real Estate Taxes Number
Enter the amount of real estate taxes incurred.
20c Property, Homeowner's, or Renter's Insurance Number
Enter the amount paid for property, homeowner's, or renter's insurance.
20d Maintenance, Repair, and Upkeep Expenses Number
Enter the amount of maintenance, repair, and upkeep expenses.
20e Homeowner's Association or Condominium Dues Number
Enter the amount of homeowner's association or condominium dues.
Personal Care Products and Services
Personal Care Products and Services Expense Number
Enter the total amount spent on personal care products and services.
Second Dependent Information
Second Dependent Relationship Text
Enter the relationship of the second dependent to Debtor 1 or Debtor 2. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Second Dependent Age Number
Enter the age of the second dependent. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Second Dependent Lives With You - No Checkbox
Check this box if the second dependent listed does not live with you. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Second Dependent Lives With You - Yes Checkbox
Check this box if the second dependent listed lives with you. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Taxes
Taxes Specify Description Text
Provide a description for the taxes being reported, ensuring they are not taxes deducted from your pay or already included in lines 4 or 20.
Total Taxes Amount Number
Enter the total amount for taxes. Fill only if 'Taxes Specify Description' is specified.
Depends on: Taxes Specify Description
Third Dependent Information
Third Dependent's Relationship Text
Enter the third dependent's relationship to Debtor 1 or Debtor 2. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Third Dependent's Age Text
Enter the third dependent's age. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Third Dependent No Checkbox
Check this box if the third dependent does not live with you. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Third Dependent Yes Checkbox
Check this box if the third dependent lives with you. Fill only if 'Dependent Status Yes' is 'Yes'.
Depends on: Dependent Status Yes
Transportation Expenses
Transportation Expenses Number
Enter the total amount for transportation expenses, including gas, maintenance, bus, or train fare, but excluding car payments.
Utilities
Utilities 6a Electricity, Heat, Natural Gas Cost Number
Enter the total cost for electricity, heat, and natural gas utilities.
Utilities 6b Water, Sewer, Garbage Collection Cost Number
Enter the total cost for water, sewer, and garbage collection utilities.
Utilities 6c Telephone, Cell Phone, Internet, Satellite, Cable Services Cost Number
Enter the total cost for telephone, cell phone, Internet, satellite, and cable services.
Utilities 6d Other Specify Text
Specify any other utility service not listed above.
Utilities 6d Other Utility Cost Number
Enter the cost for the other utility service specified. Fill only if 'Utilities 6d Other Specify' is specified.
Depends on: Utilities 6d Other Specify