Chapter 7 Statement of Currently Monthly Income Form 122A-1

Produced by Attorney Mariah Jennings-Rampsi for MassLegalHelp
Created October 2016

The Statement of Currently Monthly Income asks about your income. To file Chapter 7 bankruptcy, your income must be low and you cannot have too much property. This form lets the bankruptcy court know that you qualify.

Get Chapter 7 Statement of Your Current Monthly Income form from the US Bankruptcy Court website.

Save the form on your computer.

In the top box put your name and your spouse’s if you are both filing.

Skip the box that asks for the District.

Put “Mass.” in the box that asks for your state.

The clerk will give you the Case No. when you file your Bankruptcy Petition.

The top box of most Bankruptcy forms.

Most of the form is easy to fill out. Some parts are not so easy to understand. It is important to understand the question before you answer it.

Part 1

Only list income from the past six months. For example, if you got a tax refund seven months ago, do not list it here.

If you know your yearly income, divide that by 12. This is your average monthly income from your job.

Use this calculator to do the math.

Only put in income you actually get. If you did not get child support, alimony or workers compensation, do not put it in.

Complete Column B for your spouse even if he or she is not filing for bankruptcy.

Line 4 If anyone outside your household regularly pays some of your  household expenses, enter the amount here. For example, if your mother pays for your child’s music lessons, or your roommate splits the electricity bill with you put those amounts on this line. Put in the monthly amount.

Do not put the following types of income on this form:

  • Food Stamps,
  • Payments from your spouse, if you are separated from your spouse but you are filing bankruptcy together.

Line 8. Only put Social Security Benefits on the left side.

Part 2

Line 12b. Multiply the “Total Current Monthly Income” you put on Line 11 by 12.  This is your income for a whole year.  

  • The amount on Line 12b is called “Annualized Current Monthly Income.”  This number may not be the same as your actual income for the past year.  It is just based on the special calculations for this form.  Do not change Line 12b to match actual income reported on your W-2s or tax returns.

Line 13. Put “MA” in the state of residence box and enter the number of people in your household.  Then find your household size on the chart below:

Household Size:

State Median Income:













Add $8,100 for each additional person.

  • Find the “State Median Income” for your household size.  Put that amount on Line 13. 
  • Look at the income on Line 13. 
  • Is your income below the State Median Income for your household size?
    • Yes
      1. On Line 14a, check the box.
      2. Go back to the top of page 1 and check the box that says “there is no presumption of abuse.”
      3. In Part 3 sign and date the form. Use today’s date.  It does not need to be the date you actually file your bankruptcy.
    • No: 
      1. Re-check to be sure you put in all your income correctly. 
      2. If your income is more than the State Median Income for your household size, your income may be too high to get a Chapter 7 Bankruptcy discharge.  You can still file a Chapter 7 Bankruptcy, but the Court may tell you that you have to change it to a Chapter 13


        Is your debt not primarily consumer or have you provided certain military or homeland defense services? You have an exemption to the presumption of abuse. Talk to an attorney because you may need to complete a form we do not discuss: Statement of Exemption from Presumption of Abuse Under §707(b)(2)

      3. Line 14b. Check the box.
      4. Go back to the top of page 1 and check the box that says “there is a presumption of abuse.”
      5. In Part 3 sign and date the form. Use today’s date.  It does not need to be the date you actually file your bankruptcy.
      6. Fill out Chapter 7 Means Test Calculation​ form122A-2 to give the Court more information about your financial situation. We do not have instructions for filling out Form 122A-2. If you need help with the form, talk to a lawyer.

Filing without a lawyer

  • Bankruptcy is complicated. Filing without a lawyer is risky.
  • You can lose property and money. You can go to jail if you do not tell the truth.

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