B 22C (Official Form 22C) (Chapter 13) (12/10)
2
Unemployment compensation. Enter the amount in the appropriate column(s) of Line 8.
However, if you contend that unemployment compensation received by you or your spouse
was a benefit under the Social Security Act, do not list the amount of such compensation in
8
Column A or B, but instead state the amount in the space below:
Unemployment compensation claimed to
be a benefit under the Social Security Act Debtor $ ________
Spouse $ _________
$
$
Income from all other sources. Specify source and amount. If necessary, list additional
sources on a separate page. Total and enter on Line 9. Do not include alimony or separate
maintenance payments paid by your spouse, but include all other payments of alimony or
separate maintenance. Do not include any benefits received under the Social Security Act or
payments received as a victim of a war crime, crime against humanity, or as a victim of
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international or domestic terrorism.
a.
$
b.
$
$
$
Subtotal. Add Lines 2 thru 9 in Column A, and, if Column B is completed, add Lines 2
10
through 9 in Column B. Enter the total(s).
$
$
Total. If Column B has been completed, add Line 10, Column A to Line 10, Column B, and
11
enter the total. If Column B has not been completed, enter the amount from Line 10, Column
A.
$
Part II. CALCULATION OF § 1325(b)(4) COMMITMENT PERIOD
12
Enter the amount from Line 11.
$
Marital adjustment. If you are married, but are not filing jointly with your spouse, AND if you contend that
calculation of the commitment period under § 1325(b)(4) does not require inclusion of the income of your
spouse, enter on Line 13 the amount of the income listed in Line 10, Column B that was NOT paid on a
regular basis for the household expenses of you or your dependents and specify, in the lines below, the basis
for excluding this income (such as payment of the spouse’s tax liability or the spouse’s support of persons
other than the debtor or the debtor’s dependents) and the amount of income devoted to each purpose. If
13
necessary, list additional adjustments on a separate page. If the conditions for entering this adjustment do not
apply, enter zero.
a.
$
b.
$
c.
$
Total and enter on Line 13.
$
14
$
Subtract Line 13 from Line 12 and enter the result.
Annualized current monthly income for § 1325(b)(4). Multiply the amount from Line 14 by the number 12
15
and enter the result.
$
Applicable median family income. Enter the median family income for applicable state and household size.
(This information is available by family size at
or from the clerk of the bankruptcy
16
court.)
a. Enter debtor’s state of residence: _______________ b. Enter debtor’s household size: __________
$
Application of § 1325(b)(4). Check the applicable box and proceed as directed.
The amount on Line 15 is less than the amount on Line 16. Check the box for “The applicable commitment period is
17
3 years” at the top of page 1 of this statement and continue with this statement.
The amount on Line 15 is not less than the amount on Line 16. Check the box for “The applicable commitment period
is 5 years” at the top of page 1 of this statement and continue with this statement.
Part III. APPLICATION OF § 1325(b)(3) FOR DETERMINING DISPOSABLE INCOME
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Enter the amount from Line 11.
$