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Home My WebLink About10/16/2002 - STAFF REPORTS (21) DATE: October 16, 2002 TO: City Council FROM: City Clerk ADMINISTRATIVE APPEAL FEE WAIVER RECOMMENDATION: That the Council adopt guidelines to permit waiver of fees for indigent persons regarding Administrative Appeals Board appeal fees. BACKGROUND: On May 16, 1995 the City Council adopted a Comprehensive Fee Schedule Amendment concerning the establishment of fees for Administrative Appeals. At that time information was included to allow the waiver of fees for indigent persons. A subcommittee of the Administrative Appeals Board did recommend the establishment of a waiver based on the criteria set forth by the Courts. The waiver would apply to individuals only, not businesses. The Resolution implementing the fee for appeals was passed, but a motion to establish the guidelines for waiver was omitted from consideration. A case was been filed for consideration to the Administrative Appeals Board. It appears the applicant is unable to financially pay the appeal fee. If the Council desires to adopt the recommended guidelines, the required information could be considered for waiver of the fee. The Council may also wish to consider applying the same guidelines for other appeal fees that are already in place, i.e. "Planning Commission, Board of Appeals, and other Board/Commissions. City Clerk APPROVED---,---"— City Manager Attachments: 1. Minute Order 2. Guidelines M014 INFORMATION SHEET ON WAIVER OF ADMINISTRIVE APPEAL BOARD APPEALS 1. You are receiving financial assistance under one or more of the following programs: • SSI and SSP (Supplemental Security Income and State Supplemental Payments Programs) • CaIWORKs (California Work Opportunity and Responsibility to Kids Act, implementing TANF, Temporary Assistance for Needy Families, Formerly AFDC, Aid to Families with Dependent Children Program) • The Food Stamp Program • County Relief, General Relief(G.R.), or General Assistance (G.A.) If you are claiming eligibility for a waiver of fees and costs because you receive financial assistance under one or more of these programs, and you did not provide your Medi-Cal number or your Social Security number and birthdate, you must produce documentation confirming benefits from a public assistance agency or one of the following documents: PROGRAM VERIFICATION Medi-Cal Card or Notice of Planned Action or SSI/SSP SSI Computer-Generated Printout or Bank Statement Showing SSI Deposit or "Passport to Services" Medi-Cal Card or CaIW ORKs/TANF Notice of Action or (formerly known as AFDC) Income and Eligibility Verification Form or Monthly Reporting Form or Electronic Benefit Transfer Card or "Pass to Services" Notice of Action or Food Stamp Program Food Stamp ID Card or "Passport to Services" Notice of Action or General Relief/General Assistance Copy of Check Stub or County Voucher OR 2. Your total gross monthly household income is less than the following amounts: NUMBER FAMILY NUMBER IN FAMILY IN FAMILY INCOME FAMILY INCOME 1 $ 922.92 6 $ 2, 527.08 2 1, 243.75 7 2, 847.92 3 1, 564.58 8 3,168.75 4 1, 885.42 Each 5 2, 206.25 additional 320.83 OR 3. Your income is not enough to pay for the common necessaries of life for yourself and the people you support and also pay Appeal fees. To apply, fill out the Application for Waiver of Fees, available from the City Clerk's office. If you claim no income,you may be required to file a declaration under penalty of perjury. / �� APPLICATION FOR WAIVER OF APPEAL FEES NAME CASE NUMBER FINANCIAL INFORMATION 8. 0 My pay changes considerably from month to month.[If you 10. c. Cars, other vehicles, and boats (list make,year, fair check this box, each of the amounts reported in item 9 market value (FMV), and loan balance of each): should be your average for the past 12 months.] Property FMV Loan Balance 9. MY MONTHLY INCOME (1) $ $ a. My gross monthly pay is: . . . . . . . . . . . . . $ (2) $ $ b. My payroll deductions are(specify (3) $ $ purpose and amount): d. Real estate (list address, estimated fair market value (1) $ (FMV), and loan balance of each property): (2) $ Property FMV Loan Balance (3) $ (1) $ $ (4) $ (2) $ $ My TOTAL payroll deduction amount is: $ (3) $ $ c. My monthly take-home pay is e. Other personal property—jewelry,furniture,furs,stocks, (a.minus b.): . . . . . . . . . . .. . . . . . . . . . . $ bonds,etc. (list separately): d. Other money I get each month is (specify source and amount;include spousal support, child support,paren- $ tal support support from outside the home, scholar- 11. My monthly expenses not already listed in item 9b above ships, retirement or pensions, social security, disability, are the following: unemployment, military basic allowance for quarters (SAQ), veterans payments, dividends, interest or royalty, a. Rent or house payment&maintenance $ trust income, annuities, net business income,net rental b. Food and household supplies , . . , , , . . . $ income, reimbursement ofjob-related expenses, and net c. Utilities and telephone $ . . . . . . . . . . . . . . . gambling or lottery winnings): d. Clothing , , , , , , , , , , , , , , , , , , , , $ (1) $ e. Laundry and cleaning . . . . . . . . . . . . . . $ (2) $ f. Medical and dental payments . . . . . . . . $ (3) $ g. Insurance (life, health, accident, etc.). $ (4) $ h. School, child care $ The TOTAL amount of other money is: $ i. Child,spousal support(prior marriage) $ (If more space is needed, attach page j. Transportation and auto expenses IabeledAttachment 9d.) (insurance,gas, repair) . . . . . . . . . . . . . $ e. MY TOTAL MONTHLY INCOME IS k. Installment payments(specify purpose and amount): (c.plus d.): . . . . . . . . . . . . . . . . . . . . . . . . $ (1) $ f. Number of persons living in my home: (2) $ Below list all the persons living in your home, including (3) $ your spouse,who depend in whole or in part on you for The TOTAL amount of monthly support,or on whom you depend in whole or in part for support: installment payments is: . . . . . . . . . . . . . $ Gross Monthly I. Amounts deducted due to wage assign- Name Age Relationship Income ments and earnings withholding orders: $ (1) $ m. Other expenses (specify): (2) $ (1) $ (3) $ (2) $ (4) $ (3) $ (5) $ (4) $ The TOTAL amount of other money is: $ (5) $ (If more space is needed, attach page The TOTAL amount of other monthly labeled Attachment9f.) expensesis: . . . . . . . . . . . . . . . . . . . . . . $ g. MY TOTAL GROSS MONTHLY HOUSEHOLD INCOME IS n. MY TOTAL MONTHLY EXPENSES ARE (a.plus d.plus f): . . . . . . . . . . . . . . . . . $ (add a. through m.): . . . . . . . . . . . . . . . . $ 10, 1 own or have an interest in the following property: 12. Other facts that support this application are(describe un- a. Cash $ usual medical needs, expenses for recent family emergen- b. Checking, savings, and credit union accounts (list banks): cies, or other unusual circumstances or expenses to help the (1) $ court understand your budget;if more space is needed, (2) $ attach page labeled Attachment 12): (3) $ (4) $ Warning: You must immediately tell the City Clerk if you become able to pay appeal fees during this action. MINUTE ORDER NO. APPROVING ADMINISTRATIVE APPEALS BOARD WAIVER OF APPEAL FEES FOR INDIGENT PERSONS BASED ON INCOME GUIDELINES APPLIED FOR WAIVER OF COURT FEES AND COSTS. ------------------ I HEREBY CERTIFY that this Minute Order, approving Administrative Appeals Board waiver of appeal fees for indigent persons based on income guidelines applied for waiver of court fees and costs, was adopted by the City Council of the City of Palm Springs, California, in a meeting thereof held on the 161h day of October, 2002. PATRICIA A. SANDERS City Clerk 160