Caption
The district of the United States Bankruptcy Court and the case number if known. The committee note says the debtor's name was moved from the caption to the body of the form.
B 121
Your Statement About Your Social Security Numbers
- Agency
- U.S. Courts
- Revision
- 12/15
- Fillable fields
- 27
- Pages
- 1
- Official source
- U.S. Courts form page
- Checked
- October 20, 2026
Form B 121: Your Statement About Your Social Security Numbers
Form B 121, Your Statement About Your Social Security Numbers, is the Official Bankruptcy Form an individual debtor uses to tell the United States Bankruptcy Court about any Social Security or federal Individual Taxpayer Identification numbers they have used. The U.S. Courts list it under Individual Debtors. The current version is dated 12/15, and the U.S. Courts page lists it as effective on December 1, 2015. The page also says Official Bankruptcy Forms are approved by the Judicial Conference and must be used under Bankruptcy Rule 9009.
The one-page form asks for the debtor's name, every Social Security number and ITIN used, and a signature under penalty of perjury. The form says it is not filed as part of the public case file and is submitted separately. It is derived from former Official Form 21.
This page explains the form in plain words and is not legal advice. You can fill it out free in your browser on this page and download the result without an account.
What's on Form B 121
Privacy notice
The opening text says the form is submitted separately, is not included in the court's public electronic records, and is not made available to the public.
Part 1: Tell the Court About Yourself
Line 1 asks for the first, middle and last name of Debtor 1, and of Debtor 2 only if the spouse is filing.
Part 2, line 2: Social Security numbers
All Social Security numbers you have used, with a box to check if you do not have one.
Part 2, line 3: ITINs
All federal Individual Taxpayer Identification Numbers you have used, in boxes that start with a printed 9, with a box to check if you do not have an ITIN.
Part 3: Sign Below
Each debtor declares under penalty of perjury that the information given is true and correct, then signs and dates.
How to fill out Form B 121
- 1
Check your court's procedures
The form says to consult local court procedures for submission requirements.
- 2
Fill in the court and your name
Enter the district, the case number if known, and the full name of Debtor 1 and, only if the spouse is filing, Debtor 2.
- 3
List every Social Security number used
Line 2 asks for all Social Security numbers you have used. If you do not have one, check the box under the digits.
- 4
List every ITIN used
Line 3 asks for all ITINs you have used. If you do not have one, check the box under the digits.
- 5
Sign under penalty of perjury
Each debtor signs and dates Part 3, declaring that the information is true and correct.
- 6
Submit it separately
The form says not to file it as part of the public case file, and to submit it separately so it is not included in the court's public electronic records.
Why fill Form B 121 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the U.S. Courts, not a copy someone retyped
- Works on a phone, tablet or computer
How it is submitted, privacy and warnings
Where it goes
To the United States Bankruptcy Court for the district named at the top, submitted separately and not as part of the public case file. The form says to consult local court procedures for submission requirements.
Privacy
The form says the court will not make it available to the public and will make only the last four digits of your numbers known to the public. The committee note says that, in accordance with Rule 1007(f), it is submitted to the court but not filed on the public docket.
Other filings
The form says you should not include a full Social Security number or Individual Taxpayer Number on any other document filed with the court.
Filing fee
The form does not print a fee.
Penalties
The form says making a false statement, concealing property, or obtaining money or property by fraud in connection with a bankruptcy case can result in fines up to $250,000 or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.
Related forms
B 101
Voluntary Petition for Individuals Filing for Bankruptcy
159 fields, 9 pages
B 107
Statement of Financial Affairs for Individuals Filing for Bankruptcy
535 fields, 12 pages
B 119
Bankruptcy Petition Preparer’s Notice, Declaration and Signature
54 fields, 2 pages
B 106 Declaration
Declaration About an Individual Debtor’s Schedules
15 fields, 1 page
B 108
Statement of Intention for Individuals Filing Under Chapter 7
58 fields, 2 pages
B 103A
Application for Individuals to Pay the Filing Fee in Installments
37 fields, 2 pages
Who uses Form B 121?
The committee note says the form applies only in cases of individual debtors.
Official sources and the blank
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Questions about Form B 121
Is Form B 121 part of the public court file?
No. The form says not to file it as part of the public case file, that it is submitted separately and not included in the court's public electronic records, and that the court will not make it available to the public.
Who can see my full Social Security number?
The form says the court makes only the last four digits known to the public, and the full numbers are available to your creditors, the U.S. Trustee or bankruptcy administrator, and the trustee assigned to your case.
What if I do not have a Social Security number?
Line 2 has a box to check if you do not have a Social Security number, and line 3 asks for any federal Individual Taxpayer Identification Numbers (ITIN) you have used. There is also a box for not having an ITIN.
Should my full number appear on my other bankruptcy forms?
The form says you should not include a full Social Security Number or Individual Taxpayer Number on any other document filed with the court.
How do I submit Form B 121?
The form says to consult local court procedures for submission requirements, and to submit it separately from the public case file.
Does Form B 121 ask for an Employer Identification Number?
No. The committee note says the debtor's Employer Tax-Identification number (EIN) was eliminated from the form.