Intake Forms

Hard copies of the following intake forms are available at the Bankruptcy Court's five divisional clerk's offices, or you can click on the title of the form to download a fillable version of the form.

Form B 21 (Statement of Social Security Number)

Form B 21 is a national form that implements the federal law requiring a debtor to submit a statement under penalty of perjury setting forth the debtor's Social Security number. Creditors in a case, along with the case trustee and United States trustee, will receive the debtor's full Social Security number on their copy of the notice of the meeting of creditors. The copy of that notice, which goes into the court file, will show only the last four digits of the number.

Form B 23 (Debtor's Certification of Completion of Instructional Course Concerning Financial Management)

Form B 23 is a national form that requires individual debtors to complete an instructional course concerning personal financial management as a condition for receiving a discharge. Each individual debtor, including both spouses in a joint case, must file a separate certification and provide the certificate number issued by the personal financial management counselor.

Form B 200 (Required Lists, Schedules, Statements and Fees)

Form B 200 is a national form that provides basic information regarding the steps necessary for the filing of a bankruptcy petition.

Form B 201A (Notice to Individual Consumer Debtor)

Form B 201A is a national form that provides individual consumer debtors the notice required by federal law regarding the purposes of chapter 7, 11, 12, and 13 of the Bankruptcy Code, the costs and benefits under each chapter, the debtor's obligation to notify the court of any changes in address, the types of services available from credit counseling agencies, warnings about filing deadlines, and warnings about the penalties for bankruptcy crimes.

Local Bankruptcy Rule 2016-2 (Compensation of Petition Preparers)

Local Bankruptcy Rule 2016-2 sets a presumptive maximum allowable fee of $125 chargeable by a bankruptcy petition preparer in any case.

Document Filing Requirements

This court-created document sets forth the filing requirements that apply to any person or entity wishing to file a document with this court.

Use of Bankruptcy Petition Preparers

This court-created document provides guidance to any debtor who pays someone other than an attorney to help prepare a bankruptcy petition and schedules.


In addition to the above district-wide forms, the following documents are available at specific divisional clerk's offices, and may also be downloaded. These documents apply solely to the clerk's office that makes them available.

Akron Office:

Missing Documents Notice

This notice alerts pro se debtors who file petitions in the Akron clerk's office about additional documents that the debtor may be required to file.

Notice re Credit Counseling Requirement

This notice provides information on the pre-bankruptcy credit counseling requirement to individuals considering filing a bankruptcy petition in the Akron clerk's office without an attorney.

Notice re Petition Preparer Information

Pro se debtors filing bankruptcy petitions in the Akron clerk's office are to sign and date this notice, relating to the issue of paid bankruptcy petition preparers.

"Stop" Notice

This notice issued by the Akron clerk's office warns debtors about the requirement for credit counseling prior to the filing of a bankruptcy petition, and the possibility of case dismissal if the counseling is not received.

Canton Office:

Debtor Acknowledgment Form

Pro se debtors filing bankruptcy petitions in the Canton clerk's office are to sign and date this form, acknowledging that they have received certain documents.

Notice re Petition Preparer Information

Pro se debtors filing bankruptcy petitions in the Canton clerk's office are to sign and date this notice, relating to the issue of paid bankruptcy petition preparers.

Notice to Debtors and Creditors Not Represented by an Attorney

This notice provides a variety of information to pro se parties filing bankruptcy documents in the Canton clerk's office.

Cleveland Office:

Bankruptcy Case Search Request Form

Pro se filers who need assistance in finding case-related information regarding cases filed in the Cleveland clerk's office should complete this form.

Change of Address Notification Form

Parties who change their address after filing a petition in the Cleveland clerk's office should complete, sign, and date this notification form.

Deficiency Cover Sheet

This cover sheet should be completed and submitted to the Cleveland clerk's office, along with the listed documents.

Legal Aid Contact Notice

Individuals who are considering filing a chapter 7 or chapter 13 bankruptcy petition in the Cleveland clerk's office without an attorney may be eligible for free legal representation. This notice provides information on how to begin this process.

Matrix Sample

Debtors filing bankruptcy petitions are required to submit a matrix listing the names and addresses of their creditors. This document provides a sample of how the matrix is to be drafted.

Notice re Petition Preparer Information

Pro se debtors filing bankruptcy petitions in the Cleveland clerk's office are to sign and date this notice, relating to the issue of paid bankruptcy petition preparers.

Toledo Office:

Amendment Cover Sheet

This cover sheet is required whenever an amendment to a petition, schedule, creditor matrix, or statement of affairs is filed in the Toledo clerk's office.

Photocopy Request Form

Individuals requesting the Toledo clerk's office to make photocopies of documents should complete this form.

Youngstown Office:

Notice to All Debtors Filing Bankruptcy Without an Attorney

This form must be completed, signed, and dated by pro se debtors filing petitions in the Youngstown clerk's office.