CACB — Check if this is an amended filing (122C2)

CACB — 122C2.pdf¶

Source: https://www.cacb.uscourts.gov/sites/cacb/files/documents/forms/122C2.pdf

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Fill in this information to identify your case:

Debtor 1 __________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ (Spouse, if filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: ____________________ DistrictDistrictofof___________________

Case number ___________________________________________ (If known) Check if this is an amended filing

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income 04/25

To fill out this form, you will need your completed copy of Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period (Official Form 122C–1). Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for being accurate. If more space is needed, attach a separate sheet to this form. Include the line number to which the additional information applies. On the top of any additional pages, write your name and case number (if known).

Part 1: Calculate Your Deductions from Your Income

The Internal Revenue Service (IRS) issues National and Local Standards for certain expense amounts. Use these amounts to answer the questions in lines 6-15. To find the IRS standards, go online using the link specified in the separate instructions for this form. This information may also be available at the bankruptcy clerk’s office.

Deduct the expense amounts set out in lines 6-15 regardless of your actual expense. In later parts of the form, you will use some of your actual expenses if they are higher than the standards. Do not include any operating expenses that you subtracted from income in lines 5 and 6 of Form 122C–1, and do not deduct any amounts that you subtracted from your spouse’s income in line 13 of Form 122C–1.

If your expenses differ from month to month, enter the average expense.

Note: Line numbers 1-4 are not used in this form. These numbers apply to information required by a similar form used in chapter 7 cases.

5. The number of people used in determining your deductions from income
Fill in the number of people who could be claimed as exemptions on your federal income tax
return, plus the number of any additional dependents whom you support. This number may
be different from the number of people in your household.

National
You must use the IRS National Standards to answer the questions in lines 6-7.
Standards

6. Food, clothing, and other items: Using the number of people you entered in line 5 and the IRS National
Standards, fill in the dollar amount for food, clothing, and other items. $________

Out-of-pocket health care allowance: Using the number of people you entered in line 5 and the IRS National Standards, fill in the dollar amount for out-of-pocket health care. The number of people is split into two categories─people who are under 65 and people who are 65 or older─because older people have a higher IRS allowance for health care costs. If your actual expenses are higher than this IRS amount, you may deduct the additional amount on line 22.

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 1

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Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

People who are under 65 years of age

7a. Out-of-pocket health care allowance per person $______________

7b. Number of people who are under 65 X ______

Copy
7c. Subtotal. Multiply line 7a by line 7b. $______________ here $___________

People who are 65 years of age or older

7d. Out-of-pocket health care allowance per person $______________

7e. Number of people who are 65 or older X ______

Copy
7f. Subtotal. Multiply line 7d by line 7e. $______________ $__________ here+

7g. Total. Add lines 7c and 7f. ...................................................................................................... $___________ Copy here ....... $________

Local
You must use the IRS Local Standards to answer the questions in lines 8-15.
Standards

Based on information from the IRS, the U.S. Trustee Program has divided the IRS Local Standard for housing for bankruptcy purposes into two parts:

Housing and utilities – Insurance and operating expenses Housing and utilities – Mortgage or rent expenses

To answer the questions in lines 8-9, use the U.S. Trustee Program chart. To find the chart, go online using the link specified in the separate instructions for this form. This chart may also be available at the bankruptcy clerk’s office.

8. Housing and utilities – Insurance and operating expenses: Using the number of people you entered in line 5, fill
$________ in the dollar amount listed for your county for insurance and operating expenses.

9. Housing and utilities – Mortgage or rent expenses:

9a. Using the number of people you entered in line 5, fill in the dollar amount
$____________ listed for your county for mortgage or rent expenses.

9b. Total average monthly payment for all mortgages and other debts secured by
your home.
To calculate the total average monthly payment, add all amounts that are
contractually due to each secured creditor in the 60 months after you file
for bankruptcy. Next divide by 60.

Name of the creditor Average monthly
payment

_________________________________ $__________

_________________________________ $__________ _________________________________ + $__________ Copy this amount 9b. Total average monthly payment $__________ here─ $____________Repeaton line 33a.

9c. Net mortgage or rent expense.
Subtract line 9b (total average monthly payment) from line 9a (mortgage or $____________ Copy here ....... $________
rent expense). If this number is less than $0, enter $0.

10. If you claim that the U.S. Trustee Program’s division of the IRS Local Standard for housing is incorrect and affects $________
the calculation of your monthly expenses, fill in any additional amount you claim.
Explain _______________________________________________________________
why:
_______________________________________________________________

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 2

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Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

11. Local transportation expenses: Check the number of vehicles for which you claim an ownership or operating expense.
0. Go to line 14.
1. Go to line 12.
2 or more. Go to line 12.

12. Vehicle operation expense: Using the IRS Local Standards and the number of vehicles for which you claim the operating
expenses, fill in the Operating Costs that apply for your Census region or metropolitan statistical area. $_______

13. Vehicle ownership or lease expense: Using the IRS Local Standards, calculate the net ownership or lease expense for
each vehicle below. You may not claim the expense if you do not make any loan or lease payments on the vehicle. In
addition, you may not claim the expense for more than two vehicles.

Vehicle 1 Describe Vehicle 1: _________________________________________________________________

_________________________________________________________________

13a. Ownership or leasing costs using IRS Local Standard ....................................... $____________

13b. Average monthly payment for all debts secured by Vehicle 1.
Do not include costs for leased vehicles.

To calculate the average monthly payment here and on line 13e,
add all amounts that are contractually due to each secured
creditor in the 60 months after you file for bankruptcy. Then divide
by 60.

Name of each creditor for Vehicle 1 Average monthly
payment
_________________________________ $__________
_________________________________ + $__________
Copy Repeat this amount
Total average monthly payment ─ $___________ on line 33b. $__________ here

13c. Net Vehicle 1 ownership or lease expense Copy net Vehicle
Subtract line 13b from line 13a. If this number is less than $0, enter $0. ............ $___________ 1 expense here $_______

Vehicle 2 Describe Vehicle 2: _________________________________________________________________

_________________________________________________________________

13d. Ownership or leasing costs using IRS Local Standard ................................... $___________

13e. Average monthly payment for all debts secured by Vehicle 2.
Do not include costs for leased vehicles.

Name of each creditor for Vehicle 2 Average monthly payment _________________________________ $__________ _________________________________ + $__________ Copy Repeat this amount Total average monthly payment ─ $___________ on line 33c. $__________ here

13f. Net Vehicle 2 ownership or lease expense Copy net Vehicle
$__________ 2 expense here $_______
Subtract line 13e from 13d. If this number is less than $0, enter $0. ...................

14. Public transportation expense: If you claimed 0 vehicles in line 11, using the IRS Local Standards, fill in the Public
Transportation expense allowance regardless of whether you use public transportation. $_______

15. Additional public transportation expense: If you claimed 1 or more vehicles in line 11 and if you claim that you may also
deduct a public transportation expense, you may fill in what you believe is the appropriate expense, but you may not claim
more than the IRS Local Standard for Public Transportation. $_______

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 3

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Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

Other Necessary In addition to the expense deductions listed above, you are allowed your monthly expenses for the
Expenses following IRS categories.

16. Taxes: The total monthly amount that you actually pay for federal, state and local taxes, such as income taxes,
self-employment taxes, social security taxes, and Medicare taxes. You may include the monthly amount withheld
from your pay for these taxes. However, if you expect to receive a tax refund, you must divide the expected $_______
refund by 12 and subtract that number from the total monthly amount that is withheld to pay for taxes.
Do not include real estate, sales, or use taxes.

17. Involuntary deductions: The total monthly payroll deductions that your job requires, such as retirement contributions,
union dues, and uniform costs.
Do not include amounts that are not required by your job, such as voluntary 401(k) contributions or payroll savings. $_______

18. Life insurance: The total monthly premiums that you pay for your own term life insurance. If two married people are filing
together, include payments that you make for your spouse’s term life insurance.
Do not include premiums for life insurance on your dependents, for a non-filing spouse’s life insurance, or for any form of
life insurance other than term. $_______

19. Court-ordered payments: The total monthly amount that you pay as required by the order of a court or administrative
agency, such as spousal or child support payments. $_______
Do not include payments on past due obligations for spousal or child support. You will list these obligations in line 35.

20. Education: The total monthly amount that you pay for education that is either required:
as a condition for your job, or $_______
for your physically or mentally challenged dependent child if no public education is available for similar services.

21. Childcare: The total monthly amount that you pay for childcare, such as babysitting, daycare, nursery, and preschool.
Do not include payments for any elementary or secondary school education. $_______

Additional health care expenses, excluding insurance costs: The monthly amount that you pay for health care that is required for the health and welfare of you or your dependents and that is not reimbursed by insurance or paid by a health savings account. Include only the amount that is more than the total entered in line 7. $_______ Payments for health insurance or health savings accounts should be listed only in line 25.
1. Optional telephones and telephone services: The total monthly amount that you pay for telecommunication services for you and your dependents, such as pagers, call waiting, caller identification, special long distance, or business cell phone service, to the extent necessary for your health and welfare or that of your dependents or for the production of income, if it is not reimbursed by your employer. + $________ Do not include payments for basic home telephone, internet or cell phone service. Do not include self-employment expenses, such as those reported on line 5 of Form 122C-1, or any amount you previously deducted.
2. Add all of the expenses allowed under the IRS expense allowances. $________ Add lines 6 through 23.
Additional Expense These are additional deductions allowed by the Means Test. Deductions Note: Do not include any expense allowances listed in lines 6-24.
1. Health insurance, disability insurance, and health savings account expenses. The monthly expenses for health insurance, disability insurance, and health savings accounts that are reasonably necessary for yourself, your spouse, or your dependents.
Health insurance $__________

Disability insurance $__________

Health savings account + $__________ Total $__________ Copy total here ...................................................................... $________

Do you actually spend this total amount? No. How much do you actually spend? $__________ Yes
1. Continuing contributions to the care of household or family members. The actual monthly expenses that you will continue to pay for the reasonable and necessary care and support of an elderly, chronically ill, or disabled member of your household or member of your immediate family who is unable to pay for such expenses. These expenses may $_______ include contributions to an account of a qualified ABLE program. 26 U.S.C. § 529A(b).
2. Protection against family violence. The reasonably necessary monthly expenses that you incur to maintain the safety of you and your family under the Family Violence Prevention and Services Act or other federal laws that apply. $_______
By law, the court must keep the nature of these expenses confidential.

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 4

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Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

28. Additional home energy costs. Your home energy costs are included in your insurance and operating expenses on line 8.
If you believe that you have home energy costs that are more than the home energy costs included in expenses on line 8,
then fill in the excess amount of home energy costs. $_______
You must give your case trustee documentation of your actual expenses, and you must show that the additional amount
claimed is reasonable and necessary.

29. Education expenses for dependent children who are younger than 18. The monthly expenses (not more
$_______
than $214.58* per child) that you pay for your dependent children who are younger than 18 years old to attend a
private or public elementary or secondary school.
You must give your case trustee documentation of your actual expenses, and you must explain why the amount
claimed is reasonable and necessary and not already accounted for in lines 6-23.
* Subject to adjustment on 4/01/28, and every 3 years after that for cases begun on or after the date of adjustment.

30. Additional food and clothing expense. The monthly amount by which your actual food and clothing expenses are higher $_______
than the combined food and clothing allowances in the IRS National Standards. That amount cannot be more
than 5% of the food and clothing allowances in the IRS National Standards.
To find a chart showing the maximum additional allowance, go online using the link specified in the separate
instructions for this form. This chart may also be available at the bankruptcy clerk’s office.
You must show that the additional amount claimed is reasonable and necessary.

31. Continuing charitable contributions. The amount that you will continue to contribute in the form of cash or financial
instruments to a religious or charitable organization. 11 U.S.C. § 548(d)(3) and (4). + $________
Do not include any amount more than 15% of your gross monthly income.

32. Add all of the additional expense deductions. $_________
Add lines 25 through 31.

Deductions for Debt Payment

33. For debts that are secured by an interest in property that you own, including home mortgages, vehicle
loans, and other secured debt, fill in lines 33a through 33e.

To calculate the total average monthly payment, add all amounts that are contractually due
to each secured creditor in the 60 months after you file for bankruptcy. Then divide by 60.

Average monthly payment Mortgages on your home

33a. Copy line 9b here ................................................................................................... $___________

Loans on your first two vehicles
33b. Copy line 13b here. ............................................................................................... $___________

33c. Copy line 13e here. ............................................................................................... $___________

33d. List other secured debts:

Name of each creditor for other Identify property that Does
secured debt secures the debt payment
include taxes
or insurance?

No
$___________
___________________________________ ________________________ Yes
No
$___________
___________________________________ ________________________ Yes
No
$___________ ___________________________________ ________________________ Yes+

Copy total
33e. Total average monthly payment. Add lines 33a through 33d. .......................................... $___________ here $_______

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 5

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Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

34. Are any debts that you listed in line 33 secured by your primary residence, a vehicle, or other property necessary
for your support or the support of your dependents?

No. Go to line 35.
Yes. State any amount that you must pay to a creditor, in addition to the payments listed in line 33, to keep
possession of your property (called the cure amount). Next, divide by 60 and fill in the information below.

Name of the creditor Identify property that Total cure Monthly cure amount
secures the debt amount

_________________________ __________________ $__________ ÷ 60 = $___________

_________________________ __________________ $__________ ÷ 60 = + $___________

Copy
Total $___________ total $_______
here

35. Do you owe any priority claimssuch as a priority tax, child support, or alimony that are past due as of
the filing date of your bankruptcy case? 11 U.S.C. § 507.
No. Go to line 36.
Yes. Fill in the total amount of all of these priority claims. Do not include current or
ongoing priority claims, such as those you listed in line 19.
Total amount of all past-due priority claims. .................................................................... $______________ ÷ 60 $_______

36. Projected monthly Chapter 13 plan payment $______________

Current multiplier for your district as stated on the list issued by the Administrative
Office of the United States Courts (for districts in Alabama and North Carolina) or by
the Executive Office for United States Trustees (for all other districts).
x ______
To find a list of district multipliers that includes your district, go online using the link
specified in the separate instructions for this form. This list may also be available at the
bankruptcy clerk’s office.
Copy
Average monthly administrative expense $______________ total $_______
here

37. Add all of the deductions for debt payment. Add lines 33e through 36. $_______

Total Deductions from Income

38. Add all of the allowed deductions.

Copy line 24, All of the expenses allowed under IRS expense allowances ................................... $______________

Copy line 32, All of the additional expense deductions ...................................................................... $______________

Copy line 37, All of the deductions for debt payment .........................................................................+ $______________

Copy
Total deductions ........................................................................................................................................ $______________ total $_______
here

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 6

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Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

Part 2: Determine Your Disposable Income Under 11 U.S.C. § 1325(b)(2)

Copy your total current monthly income from line 14 of Form 122C-1, Chapter 13 $_______ Statement of Your Current Monthly Income and Calculation of Commitment Period. ...................................................................
Fill in any reasonably necessary income you receive for support for dependent children. The monthly average of any child support payments, foster care payments, or disability payments for a dependent child, reported in Part I of Form 122C-1, that you $____________ received in accordance with applicable nonbankruptcy law to the extent reasonably necessary to be expended for such child.
Fill in all qualified retirement deductions. The monthly total of all amounts that your employer withheld from wages as contributions for qualified retirement plans, as $____________ specified in 11 U.S.C. § 541(b)(7) plus all required repayments of loans from retirement plans, as specified in 11 U.S.C. § 362(b)(19).
Total of all deductions allowed under 11 U.S.C. § 707(b)(2)(A). Copy line 38 here ............ $____________
Deduction for special circumstances. If special circumstances justify additional expenses and you have no reasonable alternative, describe the special circumstances and their expenses. You must give your case trustee a detailed explanation of the special circumstances and documentation for the expenses.

Describe the special circumstances Amount of expense

______________________________________________________ $___________

______________________________________________________ $___________ ______________________________________________________ + $___________

Copy here
Total $___________ + $_____________

$____________
Total adjustments. Add lines 40 through 43. .................................................................................... Copy here – $______
Calculate your monthly disposable income under § 1325(b)(2). Subtract line 44 from line 39. $_______

Part 3: Change in Income or Expenses

Change in income or expenses. If the income in Form 122C-1 or the expenses you reported in this form have changed or are virtually certain to change after the date you filed your bankruptcy petition and during the time your case will be open, fill in the information below. For example, if the wages reported increased after you filed your petition, check 122C-1 in the first column, enter line 2 in the second column, explain why the wages increased, fill in when the increase occurred, and fill in the amount of the increase.

Form Line Reason for change Date of change Increase or Amount of change decrease?

122C─1 Increase ____ _______________________________ ____________ $____________ 122C─2 Decrease

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 7

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Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

Part 4: Sign Below

By signing here, under penalty of perjury you declare that the information on this statement and in any attachments is true and correct.

Signature of Debtor 1 Signature of Debtor 2

Date _________________ Date _________________ MM / DD / YYYY MM / DD / YYYY

Print Save As... Add Attachment Reset

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 8

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