To apply for an indigency determination, you must complete an application within sixty (60) calendar days from the date the citation was issued and provide copies of the following documents:
Completed Indigency Application
Last years Federal Income Tax Return. If you do not file taxes, then you will need to complete Form 4506-T.
Two months of all bank statements (all pages)
All sources of household income
Per Government Code 68632 (a), a person may be determined indigent if they provide documentation they are receiving public benefits under one or more of the following programs:
Supplemental Security Income (SSI) and State Supplementary Payments (SSP). Documentation required is two of your most recent benefit check stubs or statement and certification from the county’s Social Services office.
California Work Opportunity and Responsibility to Kids Act (CalWORKs). Your Golden State Advantage Card (EBT) is required as documentation.
Supplemental Nutrition Assistance Program (SNAP). Your Golden State Advantage Card (EBT) is required as documentation.
County Relief, General Relief (GR), or General Assistance (GA). Verification from the County Service Office is required for documentation.
Cash Assistance Program for Aged, Blind, and Disabled Legal Immigrants (CAPI). Verification from the County Service Office is required for documentation.
In-Home Supportive Services (IHSS) (Article 7 commencing with Section 12300) of Chapter 3, Part 3, Division 9 of the Welfare and Institutions Code.
Medi-Cal card or eligibility documentation is required for verification.
Alternatively, per Government Code 68632 (b), a person may be determined indigent if their monthly income is 125 percent or less of the current poverty guidelines updated by the US Department of Health and Human Services.
The information you provide will assist the City in deciding whether you qualify to participate in this program.