Smog Check Consumer Assistance Program Application (Page 3 of 4) in pdf

Smog Check Consumer Assistance Program Application Page 3

California Department of Consumer Affairs

Bureau of Automotive Repair

Consumer Assistance Program

Application Instructions

Fill out the application form on page 4.

Check the option box in Section 1 that applies to you.

❖ If you are an Income Eligible applicant, check the “REPAIR ASSISTANCE:

INCOME ELIGIBLE APPLICANT” box and completely fill out Sections 2

through 5.

❖ If you are a Test-Only Eligible applicant, check the “REPAIR ASSISTANCE:

TEST-ONLY ELIGIBLE APPLICANT” box and completely fill out Sections

2 through 4.

Sign and date the application.

Include the following documents with your signed application:

❖ A copy of your current vehicle registration renewal notice from DMV.

❖ Copies of invoices for any emissions-related repairs that may have been per-

formed at a licensed Smog Check station prior to applying to the Consumer

Assistance Program. This information may only be used to credit your required

co-payment and will not be reimbursed to you.

❖ Income Eligible applicants must include any one of the income verification

documents listed on page 2.

Mail your application and required documents to:

Bureau of Automotive Repair

Consumer Assistance Program

10240 Systems Parkway

Sacramento, CA 95827

Wait until your application is reviewed for eligibility and has been approved

before having any repairs done to your vehicle.

You will not be reimbursed for any repairs performed on your vehicle prior to having

your application approved.

If your application is approved...

You will receive an eligibility letter and information about where you can take your

vehicle for repairs. Only repairs that have been authorized to be done at a

CAP-approved station are eligible for the Consumer Assistance Program.

If you have questions regarding this application or need assistance completing it, please call:

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Smog Check Consumer Assistance Program Application Page 3