Official Form 22c - Statement Of Current Monthly Income And Calculation Of Commitment Period And Disposable Income Page 3

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B 22C (Official Form 22C) (Chapter 13) (12/10)
3
Marital adjustment. If you are married, but are not filing jointly with your spouse, enter on Line 19 the total
of any income listed in Line 10, Column B that was NOT paid on a regular basis for the household expenses
of the debtor or the debtor’s dependents. Specify in the lines below the basis for excluding the Column B
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 necessary, list additional
19
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 19.
$
20
Current monthly income for § 1325(b)(3). Subtract Line 19 from Line 18 and enter the result.
$
Annualized current monthly income for § 1325(b)(3). Multiply the amount from Line 20 by the number 12
21
and enter the result.
$
22
Applicable median family income. Enter the amount from Line 16.
$
Application of § 1325(b)(3). Check the applicable box and proceed as directed.
The amount on Line 21 is more than the amount on Line 22. Check the box for “Disposable income is determined
23
under § 1325(b)(3)” at the top of page 1 of this statement and complete the remaining parts of this statement.
The amount on Line 21 is not more than the amount on Line 22. Check the box for “Disposable income is not
determined under § 1325(b)(3)” at the top of page 1 of this statement and complete Part VII of this statement. Do not
complete Parts IV, V, or VI.
Part IV. CALCULATION OF DEDUCTIONS FROM INCOME
Subpart A: Deductions under Standards of the Internal Revenue Service (IRS)
National Standards: food, apparel and services, housekeeping supplies, personal care, and
miscellaneous. Enter in Line 24A the “Total” amount from IRS National Standards for Allowable Living
Expenses for the applicable number of persons. (This information is available at
or from
24A
the clerk of the bankruptcy court.) The applicable number of persons is the number that would currently be
allowed as exemptions on your federal income tax return, plus the number of any additional dependents
$
whom you support.
National Standards: health care. Enter in Line a1 below the amount from IRS National Standards for Out-
of-Pocket Health Care for persons under 65 years of age, and in Line a2 the IRS National Standards for Out-
of-Pocket Health Care for persons 65 years of age or older. (This information is available at
or from the clerk of the bankruptcy court.) Enter in Line b1 the applicable number of
persons who are under 65 years of age, and enter in Line b2 the applicable number of persons who are 65
years of age or older. (The applicable number of persons in each age category is the number in that category
that would currently be allowed as exemptions on your federal income tax return, plus the number of any
additional dependents whom you support.) Multiply Line a1 by Line b1 to obtain a total amount for persons
under 65, and enter the result in Line c1. Multiply Line a2 by Line b2 to obtain a total amount for persons 65
24B
and older, and enter the result in Line c2. Add Lines c1 and c2 to obtain a total health care amount, and enter
the result in Line 24B.
Persons under 65 years of age
Persons 65 years of age or older
a1.
Allowance per person
a2.
Allowance per person
b1.
Number of persons
b2.
Number of persons
c1.
Subtotal
c2.
Subtotal
$
Local Standards: housing and utilities; non-mortgage expenses. Enter the amount of the IRS Housing and
Utilities Standards; non-mortgage expenses for the applicable county and family size. (This information is
25A
available at
or from the clerk of the bankruptcy court). The applicable family size
consists of the number that would currently be allowed as exemptions on your federal income tax return, plus
the number of any additional dependents whom you support.
$

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