California Program Application Details

The Consumer Assistance Program Application is for those who want to apply for a loan from their credit union. The application process takes about 15 minutes and the user needs only provide basic information such as name, date of birth, address, social security number etc. The application will be processed by the lender and approved if they approve it. If denied, you can find out why through the link provided on the website or contact your credit union's customer service team directly.

You will discover information about the type of form you need to fill out in the table. It will tell you how much time you'll need to fill out consumer assistance program application, what parts you will have to fill in, etc.

QuestionAnswer
Form NameConsumer Assistance Program Application
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesconsumer assistance program application vehicle retirement, california program application, california pua, california cap program

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 $500 in emissions-related repairs if their vehicle fails a biennial Smog Check inspection.

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

Registered Owner Information

LAST NAME

 

FIRST NAME

M.I.

DRIVER LICENSE OR I.D. #

DATE OF BIRTH

 

 

 

 

 

 

MAILING ADDRESS

APT.

CITY

STATE

ZIP

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 (INCLUDE 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.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 (07/12)

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