Smog Check Consumer Assistance Program Application (Page 2 of 4) in pdf

California Department of Consumer Affairs

Bureau of Automotive Repair

Smog Check Consumer Assistance Program

If your vehicle needs emissions-related repairs in order to comply with Smog Check standards, you may be eligible for

up to $500 under one of the following Consumer Assistance Program options:

Repair Assistance

Income Eligible Applicant:

—

Income Eligibility Table*

Your household income is not more than the maximum

Number of

Maximum

amount shown in the “Income Eligibility Table” to the right.

People

ANNUAL Gross

MONTHLY Gross

If you qualify, you must pay the first $20 toward the

in Household**

Household Income

diagnosis and repair of your vehicle. The state will then

$16,613

- OR -

$1,384

contribute up to $500 in emissions-related diagnostic and

- OR -

$22,422

$1,869

repair services to your vehicle at a CAP-approved station.

$28,231

- OR -

$2,353

You will also need to provide a copy of any one of the

following documents to verify your income eligibility.

- OR -

$34,040

$2,837

❖ A copy of your completed federal or state income tax

$39,849

- OR -

$3,321

form (Form 540 or 1040) from the most recent tax year.

- OR -

$45,658

$3,805

- OR -

-OR-

$51,467

$4,289

❖ A copy of a paycheck stub reflecting your year-to-date

$57,276

- OR -

$4,773

For more than 8, add

earnings, hours worked, and hourly wage.

$5,809

$484

the following amount

- OR -

for each individual:

-OR-

The Income Eligibility Table is adjusted each February.

“Household” means all family members or other persons

❖ A copy of an unemployment, veterans benefits, or

who reside together and share common living expenses

disability check issued to you within the past 60 days.

— BE SURE TO INCLUDE YOURSELF!

-OR-

❖ A copy of a bank statement issued to you within the past 60 days reflecting a deposit of Social Security or

Public Assistance.

-OR-

❖ A letter from the issuing agency stating that you receive any one of these benefits:

Supplemental Security Income (SSI); or

Temporary Assistance for Needy Families (TANF); or

State Supplemental Payments (SSP); or

California Work Opportunity and Responsibility to Kids (CalWORKs); or

General Assistance (GA) or General Relief (GR); or

Publicly subsidized medical coverage (Medicare or Medi-Cal).

Repair Assistance

Test-Only Eligible Applicant:

—

Your registration renewal notice indicates that your vehicle is required to have its Smog Check inspection at a

Test-Only station.

If you qualify, you must pay the first $100 toward the diagnosis and repair of your vehicle. The state will then

contribute up to $500 in emissions-related diagnostic and repair services to your vehicle at a CAP-approved station.

If you are both Test-Only Eligible and Income Eligible, apply as an Income Eligible applicant, and you will only have to

pay the first $20 toward the diagnosis and repair of your vehicle.

Page 2 of 4

Smog Check Consumer Assistance Program Application Page 2

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