Official Form 6I
Instructions for Schedule I: Your Income
United States Bankruptcy Court 12/01/13
How to fill out Schedule I
In Schedule I : Your Income (Official Form 6 I), you will
give the details about your employment and monthly
income as of the date you file this form. If you are married
and your spouse is living with you, include information
about your spouse even if your spouse is not filing with
you. If you are separ ated and your spouse is not filing with
you, do not include information about your spouse.
How to report employment and income
If you have nothing to report for a line, write $0.
In Part 1, line 1 , fill in employment information for you
and , if appropriate, for a non-filing spouse. I f either person
has more than one employer , attach a separate page with
information about the additional employment .
In Part 2, give details about the monthly income you
currently expect to receive . Show all totals as monthly
payments , even if income is not received in monthly
payments .
If your income is received in another time period, such as
daily , weekly, quarterly, annual ly, or irregularly, calculate
how much income would be by month, as described below.
If either you or a non-filing spouse has more than one
employer, calculate the monthly amount for each employer
separately, and then combine the income information fo r
all employers for that person on lines 2-7.
One easy way to calculate how much income per month is
to total the payments earned in a year, then divide by 12 to
get a monthly figure. For example, if you are paid
seasonally , you would simply divide the amount you
expect to earn in a year by 12 to get the monthly amount. Below are other examples
of how to calculate monthly
amount.
Example for quarterly payments:
If you are paid $15,000 every quarter, figure your monthly
income in this way:
$ 15,000 income every quarter
X 4 pay periods in the year
$60,000 total income for the year
$60,000 (income for year ) = $5,000 monthly income
12 (number of months in year )
Example for bi -weekly payments:
If you are paid $2,500 every other week, figure your
monthly income in this way: $2,500 income every other week
X 26 number of pay periods in the year
$65,000 total income for the year
$ 65,000 (income for year ) = $5,417 monthly income
12 (number of months in year )
Example for weekly payment:
If you are paid $1,000 every week, figure your monthly
income in this way:
$1,000
income every week
X 52 number of pay periods in the year
$52,000 total income for the year
$52,000 (income for year ) = $4,333 monthly income
12 (number of months in year )
Example for irregular payments:
If you are paid $4,000 8 times a year, figure your monthly
income in this way:
$4,000 income a payment
X 8 payments a year
$32,000 income for the year
$32,000 ( income for year ) = $2,667 monthly income
12 (number of months in year )
Example for daily payments:
If you are paid $75 a day and you work about 8 days a
month, figure your monthly income in this way:
$ 75 income a day
X 96 days a year
$7,200 total income for the year
$7,200 (income for year ) = $600 monthly income
12 (number of months in year )
or this wa y:
$ 75
income a day
X 8 payments a month
$600 income for the month
In Part 2, line 11 , fill in amounts that other people provide to
pay the expenses you list on Schedule J: Your Expenses . For
example, if you and a person to whom you are not married
pay all household expenses together and you list all your joint
household expenses on Schedule J, you must list the amounts
that person contributes monthly to pay the household
expenses on line 11. If you have a roommate and you divide
the rent and utilities, do not list the amounts your roommate
pays on line 11 if you have listed only your share of those
expenses on Schedule J. Do not list on line 11 contributions
that you already disclosed elsewhere on the form. Note that the i
ncome you report on Schedule I may be
different from the income you report on other bankruptcy
forms. For example, the Statement of Current Monthly
Income and Means Test Calculation (Chapter 7) (Official
Form 22A), Statement of Current Monthly Incom e (Cha pter
11) (Official Form 22B), and the Statement of Current
Monthly Income and Calculation of Commitment Period
(Chapter 13) (Official Form 22C) all use a different
definition of income and apply that definition to a different
period of time. Schedule I asks about the income that you are
now receiving , while the other forms ask about income you
received in the applicable time period before filing. So the
amount of income reported in any of those forms may be
different from the amount reported here.
If, af ter filing Schedule I , you need to file an estimate of
income in a chapter 13 case for a date after your
bankruptcy, you may complete a supplemental Schedule I.
To do so you must check the “supplement” box at the top
of the form and fill in the date.
Unde rstand the terms used in th is form
This form uses you and Debtor 1 to refer to a debtor filing
alone. A married couple may file a bankruptcy case
together— called a joint case —and in joint cases, this form
uses you to ask for information from both debtors. When
information is needed about the spouses separately, the
form uses Debtor 1 and Debtor 2 to distinguish between
them. In joint cases, one of the spouses must report
information as Debtor 1 and the other as Debtor 2. The
same person must be Debtor 1 in all of the forms.
Things to remember when filling out this form
Be as complete and accurate as possible.
If more space is needed, attach a separate sheet to this
form. On the top of any additional pages, write your
name and case number (if known).
If two married people are filing together, both are
equally responsible for supplying correct information.
Do not file these instructions with your bankruptcy filin g package. Keep them for your records.
Official Form B 6I Schedule I: Your Income page 1
Official
Form B 6I
Schedule I : Your Income
12/13
Be as complete and accurate as possible. If two married people are filing together (Debtor 1 and Debtor 2), both are equally responsible for
supplying correct information. If you are married and not filing jointly , and your spouse is living with you, include information about your spouse.
If you are separated and your spouse is not filing with you, do not include infor mation about your spouse. If more space is needed, attach a
separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question.
Part 1: Describe Employment
1.Fill in your employment
information.
If you have more than one job,
attach a separate page with
information about additiona l
employers.
Include part -time, seasonal, or
self -employed work.
Occupation may Include student
or homemaker, if it applies . Debtor 1 Debtor 2 or non -filing spouse
Employment status
Employed
Not employed
Employed
Not emp loyed
Occupation __________________________________
__________________________________
Employer’s name __________________________________ __________________________________
Employer’s address ______ ____________________ __________ ___
Number Street
_________________ _____________________ _
_____________ _________________________ _
____________ __________________________ _
City State ZIP Code
_______ ______________ ______ __________ ___
Number Street
__________________ _____________________ _
______________ ____ _____________________ _
_____________ __________________________ _
City State ZIP Code
How long employed there? _______ _______
Part 2: Give Details About Monthly Income
Estimate monthly income as of the date you file this form . If you have nothing to report for any line, write $0 in the space. Include your non-filing
spouse unless you are separated .
If you or your non -filing spouse have more than one employer, combine the information for all employers for that person on the lines
below. If you need mo re space, attach a separate sheet to this form .
For Debtor 1 For Debtor 2 or non-filing spouse
2.List monthly gross wages, salary, and commissions (before all payroll
deductions ). If not paid monthly, calculate what the monthly wage would be. 2.
$________ ___ $_____ _______
3. Estimate and list monthly overtime pay. 3. + $__ _________ + $_____ _______
4. Calculate gross income. Add line 2 + line 3. 4.
$__________ $____________
Debtor 1 __________________________________________________________ _________
First Nam e Middle Nam e Last Name
Debtor 2 _____________________________________________________________ _____
( Spouse, if filing ) First Nam e Middle Nam e Last Name
United States Bankruptcy Court for the: ______________________ District of __________
Case number ___________________________________________
(If known)
Fill in this information to identify your case:
Check if this is :
An amended filing
A supplement showing post -petition
chapter 13 income as of t he following date:
________________ MM / DD / YYYY
___________________________ District of ________
Debtor 1 _______________________________________________________ Case number (if known )_____________________________________
First Nam e Middle Nam e Last Name
Official Form B 6I Schedule I: Your Income page 2
For Debtor 1 For Debtor 2 or
non -filing spouse
Copy line 4 here ............................................................................................ 4. $_____
___ ___
$_____________
5.List all payroll deductions:
5a. Tax , Medicare , and Social Security deductions 5a.
$___ _________ $___ __________
5b. Mandatory contributions for retirement plans 5b.
$________ ____ $_________ ____
5c. Voluntary contributions for retirement plans 5c.
$________ ____ $_________ ____
5d. Required repayments of retirement fund loans 5d.
$_____ ___ ____ $_____________
5e. Insurance 5e.
$_____ ___ _ ___ $_________ ____
5f. Domestic support obligations 5f.
$_____ ___ ____ $_____________
5g. Union dues 5g. $_________ ___ $_____________
5h. Other deductions. Specify: __________________________________ 5h. + $__ _____ _____ + $_____________
6. Add the payroll deductions . Add lines 5a + 5b + 5c + 5d + 5e +5f + 5g +5h. 6.
$____________ $___________ __
7. Calculate total monthly take -home pay. Subtract line 6 from line 4. 7.
$________ ____ $_______
______
8. List all other income regularly received:
8a. Net income from rental property and from operating a business, profession, or farm
Attach a statement for each property and business showing gross
receipts, ordinary and necessary business expenses, and the total
monthly net income. 8a.
$_____ ___ ____ $_____ ________
8b. Interest and dividends 8b. $_____ _______ $____ _________
8c. Family support payments that you, a non -filing spouse, or a dependent
regularly receive
Include alimony, spousal support, child support, maintenance, divorce
settlement, and property settlement. 8c. $___
____ _____ $____
_____ ____
8d. Unemployment compensation 8d. $____________ $_____________
8e. Social Security 8e.
$____________ $_________ ____
8f. Other government assistance that you regularly receive
Include cash assistance and the value (if known) of any non -cash assistance
that you receive, such as food stamps (benefits under the Supplemental
Nutrition Assistance Program) or housing subsidies.
Specify: ________________ ___________________________________ 8f. $______
______
$_____________
8g. Pension or retirement income 8g.
$____________ $_________ ____
8h. Other monthly income. Specify: __________________ _____________ 8h. + $____________ + $___ __________
9. Add all other income . Add lines 8a + 8b + 8c + 8d + 8e + 8f +8g + 8h. 9.
$_______ __ ___ $________ _____
10. Calculate monthly income. Add line 7 + line 9.
Add the entries in line 1 0 for Debtor 1 and Debtor 2 or non -filing spouse .10.
$____ _______
+ $____ ________ _ = $__ _____ __ ____
11.State all other regular contributions to the expenses that you list in Schedule J.
Include contributions from an unmarried partner, members of your household, your dependents, your roommates, and
other friends or relatives .
Do not include any amounts already included in lines 2 -10 or amounts that are not available to pay ex penses listed in Schedule J.
Specify: _______________________________________________________________________________ 11 .+ $__ __ ____ _____
12. Add the amount in the last column of line 10 to the amount in line 11. The result is the combined monthly i ncome.
Write that amount on the Summary of Schedules and Statistical Summary of Certain Liabilities and Related Data, if it applies 12. $__ _____ __ ____
Combined
monthly income
13. Do you expect an increase or decrease within the year after you file this fo rm?
No.
Yes. Explain:
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