Consumer Assistance Program Application PDF Details

The Consumer Assistance Program Application, facilitated by the California Department of Consumer Affairs, offers a financial lifeline to vehicle owners grappling with the costs associated with vehicle retirement or emissions-related repairs. This program distinctly sets aside up to $1,500 for eligible individuals opting to retire their vehicle, while others might access $1,000 for the same. On the flip side, the repair assistance facet of the program bestows upon income-qualified vehicle owners up to $1,200 or $500 for addressing emissions-related repairs on vehicles manufactured from 1996 onwards, following a failed biennial Smog Check inspection. Alternatively, those with vehicles dating from 1976 to 1995 could see up to $900 in repair support. With inclusivity in mind, the program extends an invitation for applications in Spanish, ensuring broader community engagement and support. Applicants are urged to thoroughly complete the application to avoid processing delays, underscoring the importance of accuracy and completeness. Moreover, the application weaves in a commitment to inter-agency collaboration for income verification, thereby safeguarding program integrity and ensuring aid reaches those truly in need. This initiative not only underscores a commitment to environmental stewardship but also to economic assistance, directing residents towards more sustainable automotive practices while offering economic relief.

QuestionAnswer
Form NameConsumer Assistance Program Application
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescap program application form, ca cap, ca cap program, consumer assistance program application vehicle retirement

Form Preview Example

CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

Consumer Assistance Program Application

Receive up to $1,500 to Retire Your Vehicle

Para obtener una solicitud en español, llámenos al 800.952.5210.

Please fill out the application completely. Incomplete applications cannot be processed and may be returned.

Program Option (Choose only one)

Vehicle Retirement - Income eligible vehicle owners may receive $1,500 to retire their vehicle. All others may receive $1,000.

Repair Assistance - Income eligible vehicle owners may receive up to $1200 $500 in emissions-related repairs if their model year 1996 or newer vehicle fails a biennial Smog Check inspection. Owners of model year 1976 through 1995 vehicles may receive up to $900 in emission related repairs.

For a complete list of eligibility requirements, please visit www.smogcheckbar.ca.gov.

Registered Owner Information

LAST NAME

MAILING ADDRESS

FIRST NAME

APT. CITY

M.I.

STATE

DRIVER LICENSE OR I.D. #

ZIP

DATE OF BIRTH

DAYTIME PHONE #

Joint Registered Owner Information (if applicable)

LAST NAME

FIRST NAME

M.I.

DRIVER LICENSE OR I.D. #

DATE OF BIRTH

Vehicle Information

VEHICLE YEAR

MAKE

MODEL

VEHICLE IDENTIFICATION # (VIN)

CALIFORNIA LICENSE PLATE #

Income Verification

NUMBER OF PEOPLE (INCLUDING YOURSELF) LIVING IN THE HOUSEHOLD IS:

GROSS HOUSEHOLD INCOME IS: $

 

MONTHLY

YEARLY

 

Signature(s) Required

I acknowledge that the information provided on this application will be used to assess and verify my eligibility for assistance, and upon request, I may be required to provide documentation to the Bureau of Automotive Repair verifying household income. My signature gives consent for this information to be shared with other government agencies. I declare, under penalty of perjury under the laws of the State of California, that to the best of my knowledge, the information on this application is true and correct. I understand that submitting false information may result in a criminal conviction in addition to civil penalties, and that I will not be eligible to receive future assistance in the Consumer Assistance Program (CAP). I further understand and agree that if my vehicle does not meet all program eligibility requirements, it will not be allowed into the CAP.

Registered Owner

 

 

 

Print Name:

 

Signature:

 

Date:

Joint Registered Owner

 

 

 

Print Name:

 

Signature:

 

Date:

 

 

MAIL YOUR COMPLETED APPLICATION TO:

Bureau of Automotive Repair, Consumer Assistance Program, 10949 N. Mather Blvd., Rancho Cordova, CA 95670

Vehicle retirement and repair assistance can only be performed at State approved facilities. CAP will not reimburse consumers for work performed prior to the approval of an application. Financial assistance is based on the availability of funds.

Questions? Please call 866.272.9642 or visit www.smogcheck.cabar.ca.gov.

Pursuant to Section 1798.17 of the Civil Code (Information Practices Act), the Director of the Department of Consumer Affairs is responsible for maintaining the information in this application. Information may be transferred to other governmental agencies if required. Individuals have the right to review the records maintained on them by the agency, unless the records are exempted by Section 1798.40 of the Civil Code.

CAP/APP (04/2020)(07/12)

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consumer assistance program application vehicle retirement spaces to fill out

Indicate the data in Registered Owner, Print Name, Joint Registered Owner, Print Name, Signature, Signature, Date, Date, MAIL YOUR COMPLETED APPLICATION TO, Vehicle retirement and repair, Questions Please call or visit, Pursuant to Section of the Civil, and CAPAPP.

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