Official Form 122A-1, Chapter 7 Statement of Your Current Monthly Income Instructions
This form contains 64 fields organized into 23 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Alimony and Maintenance Payments | ||
| Debtor 1 Alimony Payments | Number |
Enter the average monthly alimony and maintenance payments received by Debtor 1.
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| Debtor 2 or Non-Filing Spouse Alimony Payments | Number |
Enter the average monthly alimony and maintenance payments received by Debtor 2 or the non-filing spouse. Fill only if '2. Married, Spouse Filing With You', '4. Married, Spouse Not Filing, Living Together Not Separated' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 4. Married, Spouse Not Filing, Living Together Not Separated
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| Amended Filing | ||
| Amended Filing | Checkbox |
Check this box if this document is an amended filing.
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| Annual Income | ||
| 12b. Annual Income | Number |
Enter your total annual income for the year, calculated by multiplying your current monthly income from line 11 by 12.
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| Case Information | ||
| Case number | Text |
Enter the case number for the bankruptcy filing, if known.
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| Case information (Debtor names, Court, Case number) | ||
| United States Bankruptcy Court for the | Combobox |
Enter the full name of the U.S. Bankruptcy Court where the case is filed (for example, the district or division name).
Northern District of Texas
Northern District of Florida
District of South Carolina
District of North Dakota
Eastern District of Texas
Western District of Oklahoma
District of Columbia
Eastern District of Kentucky
District of Vermont
District of Arizona
District of Connecticut
District of Hawaii
Western District of Michigan
District of Nevada
Eastern District of Louisiana
Eastern District of Washington
Western District of Pennsylvania
Northern District of Alabama
Southern District of Mississippi
Southern District of Iowa
Eastern District of Missouri
District of Guam
District of Wyoming
Middle District of Florida
District of Nebraska
Middle District of North Carolina
District of South Dakota
Eastern District of Pennsylvania
Eastern District of Oklahoma
District of Alaska
Southern District of Illinois
Eastern and Western District of Arkansas
Central District of California
Western District of Texas
District of Delaware
Southern District of Florida
Southern District of West Virginia
Western District of New York
Western District of Louisiana
Eastern District of New York
Southern District of Alabama
District of Massachusetts
Western District of Virginia
Southern District of New York
Southern District of Ohio
Middle District of Georgia
District of Kansas
District of Montana
District of Virgin Islands
District of New Hampshire
Western District of Tennessee
Western District of Kentucky
District of Maine
Eastern District of Tennessee
Eastern District of Wisconsin
Middle District of Alabama
Eastern District of Virginia
Southern District of Indiana
Northern District of Indiana
District of Idaho
Southern District of Georgia
District of Utah
__________ District of __________
Western District of Wisconsin
Southern District of California
Northern District of Iowa
Northern District of California
Northern District of New York
Western District of North Carolina
Northern District of Georgia
Middle District of Pennsylvania
District of New Mexico
Western District of Washington
Middle District of Louisiana
Northern District of Ohio
Central District of Illinois
Northern District of West Virginia
Western District of Missouri
District of Minnesota
District of Maryland
District of Puerto Rico
District of Oregon
District of Colorado
Northern District of Oklahoma
Southern District of Texas
Northern District of Mississippi
Eastern District of California
Eastern District of Michigan
District of New Jersey
District of Rhode Island
Northern District of Illinois
Eastern District of North Carolina
Middle District of Tennessee
District of Northern Mariana Islands
|
| Comparison Outcome | ||
| Comparison Outcome 1: Line 12b is less than or equal to line 13 | Checkbox |
Check this box if the amount on line 12b is less than or equal to the amount on line 13. Fill only if '12b. Annual Income', 'Median Family Income' Line 12b (field 18) is less than or equal to line 13 (field 21).
Depends on:
12b. Annual Income, Median Family Income
|
| Comparison Outcome 2: Line 12b is more than line 13 | Checkbox |
Check this box if the amount on line 12b is greater than the amount on line 13. Fill only if '12b. Annual Income', 'Median Family Income' Line 12b (field 18) is more than line 13 (field 21).
Depends on:
12b. Annual Income, Median Family Income
|
| Debtor 1 | ||
| Debtor 1 Last Name | Text |
Enter the last name of Debtor 1.
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| Debtor 2 (Spouse, if filing) | ||
| Debtor 2 First Name | Text |
Provide the first name of Debtor 2 (Spouse, if filing). Fill only if '2. Married, Spouse Filing With You', '3. Married, Spouse Not Filing' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 3. Married, Spouse Not Filing
|
| Disputed Social Security Benefits | ||
| Debtor 1 Disputed Social Security Benefits | Number |
Enter the amount of unemployment compensation for Debtor 1 that is contended to be a benefit under the Social Security Act.
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| Spouse Disputed Social Security Benefits | Number |
Enter the amount of unemployment compensation for the spouse that is contended to be a benefit under the Social Security Act. Fill only if 'Married and your spouse is filing with you' is 'Yes'.
Depends on:
2. Married, Spouse Filing With You
|
| General | ||
| 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 | |
| Gross Wages, Salary, Tips, Bonuses, Overtime, and Commissions | ||
| Debtor 1 Gross Wages, Salary, Tips, Bonuses, Overtime, and Commissions | Number |
Enter the total gross wages, salary, tips, bonuses, overtime, and commissions for Debtor 1, before any payroll deductions.
|
| Debtor 2 or Non-filing Spouse Gross Wages, Salary, Tips, Bonuses, Overtime, and Commissions | Number |
Enter the total gross wages, salary, tips, bonuses, overtime, and commissions for Debtor 2 or the non-filing spouse, before any payroll deductions. Fill only if '2. Married, Spouse Filing With You', '4. Married, Spouse Not Filing, Living Together Not Separated' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 4. Married, Spouse Not Filing, Living Together Not Separated
|
| Income from Other Sources | ||
| Line 10 Row 1 - Other income source | Text |
Enter a brief description of the other income source not listed above (for example, rental income, pension, self-employment income, alimony, or other).
|
| Line 10 Row 1 - Column A amount (Debtor 1) | Number |
Enter the amount of current monthly income from the listed source that Debtor 1 receives.
|
| Line 10 Row 1 - Column B amount (Debtor 2 or non-filing spouse) | Number |
Enter the amount of current monthly income from the listed source that Debtor 2 or the non-filing spouse receives. Fill only if 'Married and your spouse is filing with you' is 'Yes'.
Depends on:
2. Married, Spouse Filing With You
|
| Line 10, Row 2 - Source description | Text |
Enter a brief description identifying the other income source for Line 10, Row 2 (for example, rental income, interest, alimony, royalties), so the reported amount can be understood.
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| Line 10, Row 2 - Column A amount (Debtor 1) | Number |
Enter the monthly amount of the other income on this row that is attributable to Debtor 1 to be included on Line 10.
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| Line 10, Row 2 - Column B amount (Debtor 2 or non-filing spouse) | Number |
Enter the monthly amount of the other income on this row that is attributable to Debtor 2 or the non-filing spouse to be included on Line 10. Fill only if 'Married and your spouse is filing with you' is 'Yes'.
Depends on:
2. Married, Spouse Filing With You
|
| Line 10 — Column A total (Debtor 1) | Number |
Enter the total of "Income from all other sources not listed above" reported on any separate pages for Line 10 for Debtor 1.
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| Line 10 — Column B total (Debtor 2 or non-filing spouse) | Number |
Enter the total of "Income from all other sources not listed above" reported on any separate pages for Line 10 for Debtor 2 or a non-filing spouse. Fill only if 'Married and your spouse is filing with you' is 'Yes'.
Depends on:
2. Married, Spouse Filing With You
|
| Interest, Dividends, and Royalties | ||
| Debtor 1 Interest, Dividends, and Royalties | Number |
Enter the amount of interest, dividends, and royalties received by Debtor 1.
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| Debtor 2 Interest, Dividends, and Royalties | Number |
Enter the amount of interest, dividends, and royalties received by Debtor 2 or a non-filing spouse. Fill only if '2. Married, Spouse Filing With You', '4. Married, Spouse Not Filing, Living Together Not Separated' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 4. Married, Spouse Not Filing, Living Together Not Separated
|
| Marital and Filing Status | ||
| 1. Not Married | Checkbox |
Check this box if you are not married.
|
| 2. Married, Spouse Filing With You | Checkbox |
Check this box if you are married and your spouse is filing with you.
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| 3. Married, Spouse Not Filing | Checkbox |
Check this box if you are married and your spouse is not filing with you, and your situation is not precisely described by options 4 or 5.
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| 4. Married, Spouse Not Filing, Living Together Not Separated | Checkbox |
Check this box if you are married, your spouse is not filing with you, and you and your spouse live in the same household and are not legally separated. Fill only if '3. Married, Spouse Not Filing' is selected.
Depends on:
3. Married, Spouse Not Filing
|
| 5. Married, Spouse Not Filing, Living Separately/Legally Separated | Checkbox |
Check this box if you are married, your spouse is not filing with you, and you and your spouse are living separately or are legally separated. Fill only if '3. Married, Spouse Not Filing' is selected.
Depends on:
3. Married, Spouse Not Filing
|
| Median Family Income Information | ||
| State of Residence | Text |
Enter the state in which you live.
|
| Household Size | Number |
Enter the number of people in your household.
|
| Median Family Income | Number |
Enter the median family income for your state and household size.
|
| Net Income from Operating a Business, Profession, or Farm | ||
| Gross Receipts Debtor 1 | Number |
Enter Debtor 1's gross receipts from operating a business, profession, or farm before any deductions.
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| Gross Receipts Debtor 2 | Number |
Enter Debtor 2's gross receipts from operating a business, profession, or farm before any deductions. Fill only if '2. Married, Spouse Filing With You', '4. Married, Spouse Not Filing, Living Together Not Separated' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 4. Married, Spouse Not Filing, Living Together Not Separated
|
| Operating Expenses Debtor 1 | Number |
Enter Debtor 1's ordinary and necessary operating expenses for the business, profession, or farm.
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| Operating Expenses Debtor 2 | Number |
Enter Debtor 2's ordinary and necessary operating expenses for the business, profession, or farm. Fill only if '2. Married, Spouse Filing With You', '4. Married, Spouse Not Filing, Living Together Not Separated' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 4. Married, Spouse Not Filing, Living Together Not Separated
|
| Net Monthly Income Debtor 1 | Number |
Enter Debtor 1's net monthly income from operating a business, profession, or farm.
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| Net Monthly Income Debtor 2 | Number |
Enter Debtor 2's net monthly income from operating a business, profession, or farm. Fill only if '2. Married, Spouse Filing With You', '4. Married, Spouse Not Filing, Living Together Not Separated' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 4. Married, Spouse Not Filing, Living Together Not Separated
|
| Net Income from Rental and Other Real Property | ||
| Debtor 1 Gross Receipts from Rental Property | Number |
Enter the gross receipts from rental and other real property for Debtor 1, before any deductions.
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| Debtor 2 Gross Receipts from Rental Property | Number |
Enter the gross receipts from rental and other real property for Debtor 2 or the non-filing spouse, before any deductions. Fill only if '2. Married, Spouse Filing With You', '4. Married, Spouse Not Filing, Living Together Not Separated' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 4. Married, Spouse Not Filing, Living Together Not Separated
|
| Debtor 1 Ordinary and Necessary Operating Expenses for Rental Property | Number |
Enter the ordinary and necessary operating expenses for rental and other real property for Debtor 1.
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| Debtor 2 Ordinary and Necessary Operating Expenses for Rental Property | Number |
Enter the ordinary and necessary operating expenses for rental and other real property for Debtor 2 or the non-filing spouse. Fill only if '2. Married, Spouse Filing With You', '4. Married, Spouse Not Filing, Living Together Not Separated' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 4. Married, Spouse Not Filing, Living Together Not Separated
|
| Debtor 1 Net Monthly Income from Rental Property | Number |
Enter the net monthly income from rental and other real property for Debtor 1.
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| Debtor 2 Net Monthly Income from Rental Property | Number |
Enter the net monthly income from rental and other real property for Debtor 2 or the non-filing spouse. Fill only if '2. Married, Spouse Filing With You', '4. Married, Spouse Not Filing, Living Together Not Separated' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 4. Married, Spouse Not Filing, Living Together Not Separated
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| Page 3 | ||
| Debtor 1 Signature | Text |
Provide the signature of Debtor 1.
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| Debtor 2 Signature | Text |
Provide the signature of Debtor 2. Fill only if 'Married and your spouse is filing with you' is 'Yes'.
Depends on:
2. Married, Spouse Filing With You
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| Debtor 1 Date Signed | Date |
Enter the date Debtor 1 signed the form. Fill only if 'Debtor 1 Signature' is signed.
Depends on:
Debtor 1 Signature
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| Debtor 2 Date Signed | Date |
Enter the date Debtor 2 signed the form. Fill only if 'Debtor 2 Signature' is signed.
Depends on:
Debtor 2 Signature
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| Pension or Retirement Income | ||
| Pension or Retirement Income - Debtor 1 | Number |
Enter the pension or retirement income for Debtor 1.
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| Pension or Retirement Income - Debtor 2 or non-filing spouse | Number |
Enter the pension or retirement income for Debtor 2 or non-filing spouse. Fill only if 'Married and your spouse is filing with you' is 'Yes'.
Depends on:
2. Married, Spouse Filing With You
|
| Presumption of Abuse Status | ||
| No Presumption of Abuse | Checkbox |
Check this box if there is no presumption of abuse.
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| Presumption of Abuse Calculation Applies | Checkbox |
Check this box if the calculation to determine if a presumption of abuse applies will be made under Chapter 7 Means Test Calculation (Official Form 122A-2).
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| Means Test Not Applicable Due to Military Service | Checkbox |
Check this box if the Means Test does not apply now because of qualified military service but it could apply later.
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| Regular Payments for Household Expenses | ||
| Debtor 1 Regular Payments for Household Expenses | Number |
Enter the total amount Debtor 1 receives from any source that is regularly paid for household expenses, including child support and regular contributions from others.
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| Debtor 2 Regular Payments for Household Expenses | Number |
Enter the total amount Debtor 2 or non-filing spouse receives from any source that is regularly paid for household expenses, including child support and regular contributions from others. Fill only if '2. Married, Spouse Filing With You', '4. Married, Spouse Not Filing, Living Together Not Separated' is selected (any).
Depends on:
2. Married, Spouse Filing With You, 4. Married, Spouse Not Filing, Living Together Not Separated
|
| Total Current Monthly Income | ||
| Column A Total Current Monthly Income | Number |
Enter the calculated total current monthly income for Debtor 1, which sums lines 2 through 10 for Column A.
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| Column B Total Current Monthly Income | Number |
Enter the calculated total current monthly income for Debtor 2 or non-filing spouse, which sums lines 2 through 10 for Column B. Fill only if 'Married and your spouse is filing with you' is 'Yes'.
Depends on:
2. Married, Spouse Filing With You
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| Overall Total Current Monthly Income | Number |
Enter the overall total current monthly income, which is the sum of Column A and Column B totals.
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| Unemployment Compensation | ||
| Line 8 — Column A (Debtor 1) Unemployment compensation | Number |
Enter the unemployment compensation amount to report for Debtor 1 in Column A on Line 8.
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| Line 8 — Column B (Debtor 2 or non-filing spouse) Unemployment compensation | Number |
Enter the unemployment compensation amount to report for Debtor 2 or the non-filing spouse in Column B on Line 8. Fill only if 'Married and your spouse is filing with you' is 'Yes'.
Depends on:
2. Married, Spouse Filing With You
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