A bankruptcy intake form template you can adapt

This is a working template for a consumer bankruptcy intake packet — the sections, the fields inside each one, and the layout choices that decide whether a client can complete it accurately at home. It covers Chapter 7 and Chapter 13 in one document, because nearly every question is shared and two packets always drift apart.

Adapt it rather than adopting it: district practice and your exemption scheme change what belongs on the page. The organizing rule holds regardless — every field should have a destination on an official form, and every schedule line a field that feeds it. For the reasoning behind each section, see what a client intake form must collect.

Part A — The client and the household

Section 1: Identity

• Full legal name as printed on a government ID, and every other name used in the last 8 years — maiden, married, nicknames
• Full Social Security number or ITIN in a shaded box marked “not filed publicly”; date of birth
• Current and mailing address, county, prior addresses in the last 3 years, phone, email, contact preference
• Marital status; dates of marriage, separation, or divorce; whether the case will be joint

Section 2: Household

• Everyone living in the home: name, relationship, age, and whether they contribute to expenses
• Dependents living elsewhere and the support provided
• Checkboxes for a non-filing spouse, and for anyone disabled or a full-time student

Part B — Money in and money out

Section 3: Employment and income

• Employer name and address, job title, and hire date, in Debtor 1 and Debtor 2 columns
• Pay frequency as checkboxes, gross pay per period, and typical overtime, bonuses, or tips
• Every employer held during the last 6 full calendar months, with start and end dates
• Self-employment receipts and business expenses; rental, retirement, support income; government benefits; outside contributions; expected changes in the next 12 months

Section 4: Monthly expenses

• Rent or mortgage with an escrow checkbox; HOA dues, lot rent, maintenance
• Separate lines for electricity, heating fuel, water and sewer, trash, phone, internet, cable
• Food and household supplies, clothing, personal care; medical costs not covered by insurance
• Vehicle fuel, maintenance, registration, transit; insurance by type; childcare and tuition
• Court-ordered support paid, charitable giving, and payroll deductions that are not taxes

Part C — What the client owns

Section 5: Real property

• Address of each parcel, including timeshares, vacant land, and inherited interests
• How title is held: sole, joint with spouse, joint with another, life estate
• Purchase date and price, estimated value, and the basis for it — assessment, appraisal, or comparable sale
• Every lien — mortgage, HELOC, tax, judgment, mechanics — with balance, payment, and arrears
• Whether the property is occupied, rented out, or vacant

Section 6: Personal property

• Vehicles: year, make, model, mileage, condition, lienholder, balance, payment — plus motorcycles, boats, and trailers
• Checking, savings, brokerage, education, and retirement accounts with balances and any loan against them; cash; cryptocurrency
• Household goods and electronics as one total, with a prompt for anything individually valuable; jewelry, firearms, collectibles, pets
• Cash value life insurance, deposits, expected tax refunds, unpaid wages, money loaned out
• Claims against anyone, inheritances, business assets, and property stored off-site

Part D — What the client owes

Let clients list debts as they experience them — bills and letters — and classify internally. One grid serves all three categories with columns for collateral and for priority status. It also feeds the creditor matrix, so capture full mailing addresses.

Section 7: Secured debts

• Creditor name and mailing address from the most recent statement, plus account number
• What secures the debt: home, vehicle, furniture, equipment
• Balance, monthly payment, interest rate, and total arrears
• Keep, surrender, or undecided as a checkbox, and whether the creditor has repossessed or sued

Section 8: Priority debts

• Federal, state, and local taxes owed, by year and agency
• A yes/no line per year for whether each of the last 4 returns was filed
• Any installment agreement or offer in compromise, with the monthly payment
• Domestic support arrears with recipient and case number

Section 9: Unsecured debts

• Credit and store cards, including any zero-balance card the client still holds
• Medical bills, including accounts already in collections
• Personal, payday, and title loans, and money owed to family or friends
• Student loans: servicer, balance, federal or private, current status
• Deficiency balances, utility arrears, gym contracts, unpaid rent from a prior residence
• Judgments with court and case number, plus every collector currently writing as well as the original creditor

Part E — History, contracts, and eligibility

Section 10: Leases and co-debtors

• Residential lease: landlord, rent, term, and any eviction filed
• Vehicle and equipment leases, storage units, cell phone and service contracts
• Anyone who co-signed for the client, and any debt the client co-signed
• Whether the client has lived in a community property state during the marriage

Section 11: Financial history

• Property sold, transferred, or given away in the last 2 years, including transfers to family
• Payments to a relative or insider in the last year, and unusually large recent payments to one creditor
• Repossessions, foreclosures, property voluntarily returned, and accounts closed in the last year
• Lawsuits and garnishments; payments to a petition preparer or debt settlement company; businesses operated in 4 years

Section 12: Prior filings and eligibility

• Any prior bankruptcy by either spouse in the last 8 years: district, case number, chapter, date, and outcome
• Credit counseling briefing — date and provider; it must fall within the 180 days before filing under §109(h)
• Any pending foreclosure sale, repossession, garnishment, or shutoff, with the date making it urgent

Part F — Chapter 13 add-ons

A short closing section keeps one packet serving both chapters. Print it on its own page so staff add it only for cases heading toward a plan.

• Mortgage arrears to cure, by lender and amount
• Vehicle purchase and loan dates, which drive whether a claim can be modified
• Tax debt and support arrears to be paid through the plan
• Assets the client specifically wants to protect, and why
• Anticipated changes over the plan term, and whether payroll deduction is workable

Layout for a packet clients fill in by hand

Most firms still receive some of this on paper, and the packet has to survive a client with a pen at a kitchen table. The case for keeping paper is made in why handwritten intake forms persist; these are the rules that make it work.

• Generous write-in space. Handwriting is larger than type — full-width lines, or answers run into the margin.
• One column per spouse, in the same position on every page. Inconsistent order is the leading cause of swapped income figures in joint cases.
• Shaded office-use boxes. A tinted strip for initials, verification date, and the schedule line fed, with an instruction to leave it blank.
• Real checkboxes and ruled grids. Squares large enough to hold an X, and repeating data in headed tables, not open space.
• One topic per page, a “does not apply” box, and numbered pages. Blank means skipped, a checked box means none, and “Page 4 of 12” shows what is missing.

Keeping the template in sync

Official Forms are revised on a rolling basis, and the figures inside the means test and exemption schemes adjust on their own cycle — check the current amounts on uscourts.gov rather than printing them into the packet. Put a version number in the footer, review the packet against the current forms on a schedule, and destroy old stock when a new version issues. Pair it with a document checklist: the questionnaire captures what the client knows, the checklist what the file needs to prove it.

This guide is general information for law-firm staff, not legal advice for any particular case.