Homepage Fill Out Your Nm Indigent Fund Form
Article Structure

The Nm Indigent Fund form is an essential tool for individuals in New Mexico who find themselves financially unable to bear the costs associated with the installation and maintenance of an ignition interlock device. Established under specific sections of New Mexico law, this program offers financial assistance to those who meet certain criteria, primarily those with DUI convictions or license revocations that mandate the use of such devices. The form outlines the benefits approved applicants can receive, which include funding for device installation and monthly fees, while also clarifying that individuals remain responsible for any additional costs. To qualify for this aid, applicants must demonstrate their indigency through acceptable proof of enrollment in various public assistance programs, such as TANF, SNAP, or SSI. The process includes completing multiple parts of the form, providing necessary documentation, and potentially recertifying for continued assistance. Applicants will later receive notification about their application status, detailing whether their request was accepted or denied. Overall, this form serves as a gateway for eligible individuals to access vital support in meeting legal obligations related to ignition interlock devices.

Nm Indigent Fund Example

State of New Mexico - Department of Transportation

IIDF.Rev 11.07.14 1

Traffic Safety Division (TSD)

 

INSTRUCTIONS FOR APPLICATION

 

IGNITION INTERLOCK INDIGENT DEVICE FUND

 

Under Sec. 66-8-102.3 & 66-2-7.1 NMSA 1978

 

(Effective July 1, 2010)

 

1 - IGNITION INTERLOCK FUND BENEFITS

If indigency is granted and provided that money is available in the Interlock device fund, the NMDOT Traffic Safety Bureau shall pay for one vehicle per offender, up to: $50.00 for the cost of installation; $30.00 monthly for verified active usage of the interlock device, and up to $50.00 for the cost of removal. The offender is responsible for all other charges associated with the installation, servicing and removal of the ignition interlock device. The interlock device fund fee collected by MVD shall not be imposed on an indigent person.

2 - WHO QUALIFIES FOR BENEFITS FROM THE INTERLOCK DEVICE FUND ?

Individuals who are required, pursuant to convictions under Section 66-8-102 NMSA 1978 or adjudications on the basis of 32A-2-3 NMSA 1978 or NM driver's license revocations pursuant to the Provisions of the Implied Consent Act or as a Condition of Parole, to drive interlocked.

1)If you have been convicted in New Mexico for Driving Under the Influence of Intoxicating Liquor or Drugs (DUI) and have been court ordered to a period of interlock.

2)If your driver's license has been revoked by the Motor Vehicle Division because of a DUI arrest and you can not drive legally without an Ignition Interlock.

3)If you have been ordered to drive interlocked as a condition of parole.

3 - HOW DO I QUALIFY FOR AN INDIGENCY DETERMINATION ? (APPLICATION PARTS C AND D)

INDIGENCY DETERMINATION BY TRAFFIC SAFETY DIVISION BEGINNING JULY 1, 2010:

Indigency shall be determined by the Traffic Safety Division based on applicant's proof of enrollment in one or more of the following types of public assistance:

 

PUBLIC ASSISTANCE PROGRAMS:

 

 

TANF -

Temporary Assistance for Needy Families

GA -

General Assistance

SNAP -

Supplemental Nutritional Assistance Program (Food Stamps)

SSI -

Supplemental Security Income

 

Note: SSI is not Social Security Disability

FDPIR - Food Distribution Program on Indian Reservations

PROOF OF ENROLLMENT DOCUMENT:

Notice of Approval or Form # ISDB003 from Income Support Division Notice of Approval or Form # ISDB003 from Income Support Division Notice of Approval or Form # ISDB003 from Income Support Division Benefit Verification Letter from the Social Security Office

TSD (FDPIR) Verification Form from FDPIR office

Applicants must provide the required PROOF OF ENROLLMENT DOCUMENT listed above with application - a print out of Benefit History will not be accepted.

INDIGENCY DETERMINATION BY COURT, PROBATION & PAROLE PRIOR TO JULY 1, 2010:

You may still qualify for benefits if you were previously declared indigent by Court, Probation and Parole prior to 7/1/10 and if it relates to your license revocation. You must provide a copy of the valid indigency order and complete an application.

A valid indigency order must have client's name, be signed and dated by Judge, Probation or Parole and indicate indigency is for Ignition Interlock.

4 - HOW TO APPLY ?

1)Complete application Parts A, B, C or D (whichever applies), & E, and have signature notarized. Also attach relevant documents

2)Submit application to TSD

5 - HOW TO RECERTIFY (SECOND OR SUBSEQUENT APPLICANTS) ?

If you were previously declared indigent by the Traffic Safety Division you may recertify to extend your benefits from the indigent fund.

1)Complete application Parts A, C or D (whichever applies), & E, have signature notarized and attach relevant documents

2)Submit application to TSD

Applicants must provide current proof of enrollment from Public Assistance Program if declared indigent by TSD after 7/1/10.

6 - WHERE DO I SEND MY COMPLETED APPLICATION ?

(Incomplete applications will be returned to applicant. Also, TSD will not accept faxed or emailed applications)

IF MAILING APPLICATION, MAIL TO ▼

Traffic Safety Division Ignition Interlock Fund

P.O. Box 1149

Santa Fe, NM 87504

Questions should be directed to:

Traffic Safety Division

(505) 827-0427 or 1-800-541-7952

IF DROPPING OFF APPLICATION:

The office that serves all areas is located at:

1122 Cerrillos Road (SB1-N)

Santa Fe, NM 87505

7 - HOW WILL I KNOW IF I WAS APPROVED FOR BENEFITS ?

1)TSD will send letter informing applicant of the indigency status.

-If approved, the letter will indicate benefit effective dates. You will be eligible for subsidy benefits during these effective dates.

-If denied, the letter will list the reason(s) for denial. You may reapply if you later meet the statutory requirements.

-If incomplete, the notice will list the reason(s) application is incomplete. If information is obtained resubmit application for reconsideration.

2)If approved, provide a copy of your approval letter to the Ignition Interlock Provider so you can receive eligible benefits.

3)If approved, TSD will notify MVD of your indigency status. As long as you obtain your initial ignition interlock license between the effective dates, MVD will not charge the interlock device fund fee.

Web link to information and applications: http://dot.state.nm.us/ (Then select Traffic Safety under News & Information)

 

 

State of New Mexico - Department of Transportation

TSD USE ONLY

- IIDF.Rev 11.07.14

 

 

 

 

Traffic Safety Division (TSD)

 

Refund: 

 

 

A D I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPLICATION FOR SUBSIDY

 

Apvd By:

 

 

2SEQ#:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IGNITION INTERLOCK INDIGENT DEVICE FUND

From:

 

 

 

 

 

 

 

 

 

 

Under Sec. 66-8-102.3 & 66-2-7.1 NMSA 1978

 

To:

 

 

 

 

 

 

 

 

 

All information provided is protected under Motor Vehicle Code Confidentiality

A D I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applicant signature must be notarized

 

1SEQ#:

 

 

 

 

 

 

 

NMDOT LOGO

 

 

Please print clearly or type / all items must be completed

 

 

 

 

 

 

 

 

 

PART A:

 

 

 

APPLICANT INFORMATION

 

 

 

 

 

 

 

 

 

Applicant Name

 

 

 

 

 

 

 

Date of Birth

 

 

 

Social Security Number

 

 

 

 

 

 

 

 

 

/

/

 

 

-

-

 

 

Applicant Address

 

 

 

 

 

 

 

Driver License Number or NM State Identification Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (if different)

 

 

 

 

 

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

 

 

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

PART B:

IF YOU ARE A FIRST TIME APPLICANT, COMPLETE PARTS B, C or D (whichever applies), & E

 

 

Has your license been revoked by MVD? Yes No

 

 

 

 

Date of Revocation:

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

If you have been convicted of DUI in NM Court enter current conviction information

Date of Conviction:

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

Court / City

 

 

 

 

 

 

 

 

 

 

Court Case Number

 

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

If you were convicted by a NM Court, attach a copy of your Judgement & Sentence from court.

 

 

 

 

 

 

 

 

Have you been ordered as a condition of parole to drive with an interlock? Yes No

Name of Supervising Officer:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you are required to be interlocked as a condition of parole, attach a copy of your Certificate of Parole.

 

 

 

 

 

 

 

PART C:

 

PUBLIC ASSISTANCE PROGRAM INFORMATION (TANF, GA, SNAP, SSI OR FDPIR)

 

 

Name of State or Federal Public Assistance Program applicant is currently enrolled in:

 

Effective Dates of Eligibility

 

 

 

 

 

 

TANF GA

SNAP

SSI (Supplemental Security Income) FDPIR

 

From:

/

/

 

To:

/

/

 

 

Please attach proof of enrollment in one of the qualifying Public Assistance Programs (TANF, GA, SNAP, SSI OR FDPIR).

 

 

 

 

PART D:

IF YOU WERE PREVIOUSLY DETERMINED TO BE INDIGENT BY A NM COURT, PROBATION

 

 

 

 

& PAROLE OR TSD FOR PURPOSES OF INTERLOCK, COMPLETE PARTS C or D, & E

 

 

 

 

 

 

Was I determined to be indigent by TSD after 7/1/10?

Yes No

From Date:

/

/ To Date:

/

/

 

 

 

 

 

 

 

 

 

 

Was I determined to be indigent by Court, Probation & Parole prior to 7/1/10?

 

 

 

 

 

 

 

 

 

Yes No

 

 

 

 

 

 

 

Date on Order:

/

/

 

 

 

 

 

Date Interlock Installed:

/

/

 

Ignition Interlock Provider / City:

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please attach a copy of your Judgement & Sentence if new DUI case.

 

 

 

 

 

 

 

 

 

If determined to be indigent for ignition interlock benefits prior to 7/1/10, attach a copy of your Order Determining Indigency.

 

 

 

 

PART E:

 

 

 

AGREEMENT, SIGNATURE AND NOTARIZATION

 

 

 

 

 

 

 

I understand that false and misleading information in this application can be the basis for denial of this Application.

If this Application is approved, I understand that I must install and maintain the ignition interlock device according to Sec. 66-5-503 NMSA 2003 ignition interlock license requirements and Sec. 66-8-102.3 NMSA 2010 Interlock Device Fund. The Division may consider any deviation to be a breach of the agreement which could result in revocation of assistance from the Interlock Device Fund.

I agree to notify the Division within ten (10) business days of any change to any information in this application.

 

By signing this form, I hereby acknowledge acceptance and understanding of the above statements. Additionally, I certify

NOTARIAL

under penalties of perjury that all information in this Application is true, correct and complete to the best of my knowledge

 

and belief.

 

 

 

SEAL

 

 

 

 

 

 

 

Applicant Signature (Applicant signature must be notarized)

 

Date:

 

The foregoing instrument was acknowledged before me this _______ day of ___________ 20______ by _____________________.

 

 

 

Notary (Please print name)

 

 

 

My Commission Expires: __________________

 

Notary Public Signature

 

Instructions for completing this application and indigent benefits are on the back of this document or on a separate page depending on printing options

Mail application to: Traffic Safety Division Ignition Interlock Fund; PO Box 1149; Santa Fe, NM 87504

Form Characteristics

Fact Name Details
Governing Law 66-8-102.3 & 66-2-7.1 NMSA 1978
Form Purpose The form is used to apply for financial assistance from the Ignition Interlock Indigent Device Fund.
Benefit Limits Applicants may receive up to $50 for installation, $30 monthly for usage, and up to $50 for removal of the device.
Indigency Criteria Eligibility is based on proof of enrollment in public assistance programs such as TANF, GA, SNAP, SSI, or FDPIR.
Application Parts Applicants must complete relevant parts of the form including A, B, C or D, and E, and have their signature notarized.
Application Submission Completed applications must be mailed to the Traffic Safety Division at the specified address; faxed or emailed applications are not accepted.
Recertification Previous recipients may recertify to extend benefits by submitting a new application with current proof of enrollment.
Indigency Notification Applicants will receive a letter informing them of their indigency status and the effective dates of benefits.
Non-Eligibility Charges The interlock device fund fee will not be charged to individuals approved as indigent.
Effective Date of Law The law providing these benefits became effective on July 1, 2010.

Guidelines on Utilizing Nm Indigent Fund

After the application form for the Ignition Interlock Indigent Device Fund is completed, it must be submitted to the Traffic Safety Division (TSD) for review. TSD will determine eligibility based on the information provided. All applications are carefully evaluated, and a decision will be communicated to the applicant via a letter, detailing the approval status, along with any benefits awarded.

  1. Complete Parts A, B, C or D, and E of the application form. Ensure that all items are filled out completely.
  2. Gather required documentation that proves your enrollment in a public assistance program, if applicable. Acceptable documents include a Notice of Approval or Benefit Verification Letter.
  3. Notarize your application. Sign the form in the presence of a notary public to validate your submission.
  4. Mail the completed application to TSD at the address: Traffic Safety Division, Ignition Interlock Fund, P.O. Box 1149, Santa Fe, NM 87504. Alternatively, you may drop it off at their office located at 1122 Cerrillos Road (SB1-N), Santa Fe, NM 87505.
  5. Await notification from TSD regarding your application status, which they will send via letter.

What You Should Know About This Form

What is the New Mexico Indigent Fund for Ignition Interlock Devices?

The New Mexico Indigent Fund provides financial assistance to individuals who are required to use an ignition interlock device due to DUI convictions or related legal situations. This fund helps cover installation costs, monthly service fees, and removal costs, subject to eligibility criteria.

How do I know if I qualify for benefits from the Indigent Fund?

To qualify, you must have been convicted of DUI in New Mexico, had your license revoked due to a DUI arrest, or been ordered to use an ignition interlock device as a condition of parole. You will also need to demonstrate indigency through proof of enrollment in a public assistance program, such as TANF or SNAP.

What types of financial assistance can I receive from the Indigent Fund?

If approved, the fund can cover up to $50 for the installation of the ignition interlock device, $30 monthly for verified use, and up to $50 for the removal of the device. Applicants are responsible for all other costs associated with the device.

How is indigency determined for this application?

Indigency is determined based on proof of enrollment in specific public assistance programs. Acceptable forms of proof include a Notice of Approval or Benefit Verification Letter from the respective agency. Alternatively, if you were declared indigent by a court or parole board prior to July 1, 2010, you may also qualify.

What steps do I need to take to complete the application?

Start by completing the required parts of the application—Parts A, B, C or D (as applicable), and E. Be sure to notarize your signature and attach all relevant documents. Once complete, submit your application to the Traffic Safety Division.

Where can I send my application for the Ignition Interlock Indigent Fund?

Your completed application should be mailed to the Traffic Safety Division's Ignition Interlock Fund at P.O. Box 1149, Santa Fe, NM 87504. Applications cannot be faxed or emailed and will be returned if incomplete.

How will I be notified of my application status?

You will receive a letter from the Traffic Safety Division informing you whether you were approved or denied for benefits. If approved, the letter will include the effective dates for your benefits. If denied, the letter will provide reasons for the denial.

Can I reapply if my application is denied?

Yes, you may reapply for benefits if you later meet the eligibility criteria outlined in the application. Ensure you address any reasons for denial before submitting a new application.

How often do I need to recertify my indigency status?

If you have previously been declared indigent, you may need to recertify your status periodically. This such as when new proof of enrollment in a public assistance program is required, or if any information related to your eligibility changes.

What happens after my application is approved?

Once approved, you will need to provide a copy of the approval letter to your ignition interlock provider to access the benefits. Additionally, the Traffic Safety Division will notify the Motor Vehicle Division about your indigency status, which should exempt you from the interlock device fund fee.

Common mistakes

Filling out the Nm Indigent Fund form can be a straightforward process if done correctly. However, applicants often make common mistakes that can hinder their chances of receiving benefits. One significant error is failing to provide the required proof of enrollment in public assistance programs. The form specifically states that applicants must submit documents like a Notice of Approval or Benefit Verification Letter. A printout of Benefit History is not acceptable, yet many applicants overlook this detail. Without the correct documentation, an application can be deemed incomplete.

Another frequent mistake is the lack of notarization for the applicant's signature. The instructions explicitly state that the signature must be notarized; however, some applicants forget this important step. Notarization is a critical part of validating the application, and submissions without it will be rejected. This oversight can cause unnecessary delays in receiving assistance.

Some individuals also fail to fully complete all required parts of the application. For first-time applicants, it is essential to complete Parts B, C, or D, along with Part E. Incomplete submissions will be returned. Each part collects specific information needed to determine eligibility. Misunderstanding which parts to complete can lead applicants to miss vital sections, thereby affecting their approval status.

Moreover, not providing accurate information regarding past convictions can lead to complications. If the application includes a conviction for Driving Under the Influence, applicants should be sure to attach a copy of the Judgment and Sentence from the relevant court. Many mistakenly assume that this step is optional, but accurate record-keeping is essential for processing the application smoothly.

Finally, applicants often neglect to keep copies of their completed application and supporting documents. Having a personal record of what was submitted can be invaluable in the event of questions or issues with the application. If a letter arrives stating that the application was incomplete, having a copy ensures that applicants can address the specific missing information. This simple step can make the reapplication process much easier.

Documents used along the form

The Ignition Interlock Indigent Device Fund form is part of an important process for individuals seeking assistance with the costs associated with ignition interlock devices. Alongside this form, several other documents and forms may be necessary to fully complete the application process. Understanding these documents can help ensure a smoother application experience.

  • Proof of Enrollment Document: This document is evidence that the applicant is participating in a qualifying public assistance program, such as SNAP or TANF. It is important to provide official documentation as a printout from a benefit history may not be acceptable.
  • Judgment and Sentence Document: If the applicant has been convicted of DUI, this court-issued document details the conviction and penalties imposed. It must be attached if relevant to the interlock requirement.
  • Indigency Order: If the applicant was declared indigent by a court or probation officer before July 1, 2010, a valid copy of the order must accompany the application. This document confirms the individual's financial status at that time.
  • Certificate of Parole: If required to install an ignition interlock device as a condition of parole, the applicant must provide this document. It demonstrates compliance with parole requirements.
  • Benefit Verification Letter: For those receiving SSI benefits, a letter from the Social Security Office serves as proof of enrollment in that program. This letter must be current and official.
  • Traffic Safety Division (TSD) Verification Form: This form may be used to verify the applicant's enrollment in the Food Distribution Program on Indian Reservations (FDPIR). It helps establish eligibility for financial assistance.
  • Application Parts A and E: These parts of the Ignition Interlock Indigent Device Fund application gather essential personal information, including notarization, and confirm the applicant's understanding of responsibilities regarding the interlock device.
  • Benefit History Printout: While this is not accepted as proof of enrollment, it may help applicants keep track of their benefits and understand the documents required for a complete application.
  • Application for Subsidy Letter: An additional cover letter can be submitted with the application to outline any specific circumstances regarding the request for support.

Having these documents ready and organized can streamline the application process for anyone applying for assistance through the Ignition Interlock Indigent Device Fund. Ensure all required documents are complete, accurate, and submitted to avoid delays or rejections.

Similar forms

The New Mexico Indigent Fund form bears similarities to several other documents related to financial assistance and eligibility determinations. Here is a breakdown of those documents, highlighting how they compare to the Indigent Fund form:

  • Food Stamp Application: Like the Indigent Fund form, a Food Stamp Application allows individuals to demonstrate their eligibility for assistance based on income and enrollment in specific programs, such as SNAP. Both documents require proof of enrollment in qualifying programs.
  • Medicaid Application: The Medicaid Application assesses income and household size. It includes sections requesting documentation of qualifications, much like the Indigent Fund's requirement for proof of public assistance. Both forms aim to ensure that those who need help receive it.
  • Temporary Assistance for Needy Families (TANF) Application: This application seeks to determine eligibility for cash assistance. Similar to the Indigent Fund form, it also necessitates proof of enrollment in public assistance programs and assesses the applicant's financial situation.
  • Supplemental Security Income (SSI) Application: Individuals applying for SSI must provide documentation of their financial status and medical conditions. The process of evaluating an applicant's indigency is akin to the verification needed for the Indigent Fund form, where proof of qualification is essential.
  • Public Housing Application: When applying for public housing, applicants must demonstrate their need based on income and family size, mirroring how the Indigent Fund form verifies financial eligibility through required documentation and proof of assistance.
  • Probation Parole Indigency Determination Form: This form determines financial eligibility for individuals under probation or parole. Similar to the Indigent Fund, it examines the applicant's financial circumstances and requires substantiation of their indigent status.

Dos and Don'ts

Things You Should Do:

  • Ensure all sections of the application are completed fully and accurately.
  • Gather necessary documentation, such as proof of enrollment in a public assistance program.
  • Have your signature notarized before submitting the application.
  • Mail your application to the correct address provided by the Traffic Safety Division.
  • Keep a copy of your application and all supporting documents for your records.
  • Contact the Traffic Safety Division if you have any questions about the application process.
  • Submit the application as soon as you have all necessary documents to avoid delays in processing.

Things You Shouldn't Do:

  • Do not leave any fields blank on the application; incomplete applications will be returned.
  • Avoid using fax or email to submit your application; it must be mailed or delivered in person.
  • Do not provide a printout of Benefit History as proof of enrollment; specific documents are required.
  • Do not submit your application without proper notarization as it may lead to denial.
  • Avoid assuming eligibility without checking the specific criteria for indigency.
  • Do not wait until the last minute to apply; processing can take time.
  • Do not ignore any communication from the Traffic Safety Division; respond promptly to avoid penalties.

Misconceptions

Misconceptions can often lead to confusion when applying for assistance under the New Mexico Ignition Interlock Indigent Device Fund. Here are some common misunderstandings clarified:

  • Indigency is automatic if receiving assistance: Just because someone receives public assistance does not mean they automatically qualify for indigent status. They must provide proof of enrollment in one of the specific programs listed in the application.
  • All costs associated with the interlock device are covered: Only certain costs are covered by the fund. Eligible individuals may receive help for installation (up to $50), active usage (up to $30 monthly), and removal costs (up to $50). Other expenses are the applicant's responsibility.
  • It's not necessary to submit additional documentation: Applicants must submit certain documents to support their application. This includes proof of enrollment in a public assistance program or a valid indigency order, depending on their circumstances.
  • All applications are accepted: Incomplete or improperly filled applications will be returned. To avoid delays, applicants should thoroughly complete all necessary sections and provide required documentation.
  • Recertification requires a full new application: While a recertification involves submitting Parts A, C, or D again, it doesn't mean starting from scratch. Applicants simply need to provide current proof of enrollment and relevant documents.
  • Approval will happen immediately: After submission, applicants will receive a letter from the Traffic Safety Division regarding their indigency status. This process can take time, so patience is important.
  • The fund covers multiple vehicles: The fund only covers one vehicle per offender. Any additional vehicle needs must be managed by the applicant independently.

Understanding these key aspects can help streamline the application process and improve the chances of receiving the necessary support from the Indigent Fund.

Key takeaways

Understanding the Nm Indigent Fund form is essential for eligible individuals seeking financial assistance for ignition interlock device installation and maintenance. Here are key takeaways:

  • Indigency benefits can cover installation costs up to $50.00, a monthly fee of $30.00 for active usage, and removal costs up to $50.00.
  • Eligibility requires proof of an indigent status, typically demonstrated through public assistance program enrollment or a court determination.
  • A notarized application must include specific parts (A, B, C or D, and E) along with supporting documentation. Incomplete applications will be returned.
  • Upon submission, applicants will receive notification of their indigent status, including approval or reasons for denial, if applicable.
  • To maintain benefits, individuals must reapply or recertify periodically, proving continued eligibility under the established criteria.