Form 1307 "Driver Financial Assessment Application - Ignition Interlock Device Program" - South Carolina

What Is Form 1307?

This is a legal form that was released by the South Carolina Department of Probation, Parole and Pardon Services - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the South Carolina Department of Probation, Parole and Pardon Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 1307 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Probation, Parole and Pardon Services.

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Download Form 1307 "Driver Financial Assessment Application - Ignition Interlock Device Program" - South Carolina

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FINANCIAL ASSESSMENT INSTRUCTIONS
Applications for financial assistance that do not comply with these instructions will not be considered.
Applicants must provide all information as requested of them by this application. Do not submit original documents, only
copies, as the information submitted with the application will not be returned. Provide all documents that prove your wages,
income from any source, and your expenses for the last ninety days.
NOTE: Financial assistance will be granted, denied, or continued at the sole discretion of the South Carolina Department
of Probation, Parole and Pardon Services. The Department relies on the applicant to provide full and accurate financial
information. The Department reserves the right to deny or cancel financial assistance if the information provided by the
applicant is false, inaccurate, or misstated.
th
Applications are reviewed on a monthly basis. Those applications received after the 5
of the month will be reviewed the
following month.
APPLICANT INFORMATION SECTION
Applicant’s Name (Last, First, MI): Enter driver’s name.
Applicant’s DL Number: Enter driver’s license number.
Social Security Number: Enter the last four (4) digits of driver’s Social Security Number.
Date of Birth: Enter driver’s birth date.
Address: Enter driver’s mailing address. Check if address is the permanent or temporary address for driver.
Number of Dependents Claimed for Tax Purposes: Enter the number of individuals driver can claim on federal
tax return.
Primary Contact: Enter the best telephone number to contact driver.
DEPENDENTS SECTION
List Other People in Household: Enter name, age and relationship of all dependents listed on driver’s federal tax
return.
EMPLOYMENT STATUS SECTION
Check the appropriate response. If employed, provide all information requested in the “Employed” section only and
proceed to the “Monthly Income” section. Examples of verifying documents include a recent pay stub or a company
or employer letter. If unemployed, provide all information requested in the “Unemployed” section and proceed to
the “Monthly Income” section. Examples of verifying documents include benefits statements/check stubs for
unemployment benefits, employer letters, disability verifications or signed drivers’ statements. If self-employed,
provide all information requested in the “Self-Employed” section only and proceed to the “Monthly Income” section.
Examples of verifying documents include business account books, bank statements or any documents showing
income related to the self-employment.
MONTHLY INCOME SECTION (Do not leave any spaces blank. Place a zero in the appropriate space if the driver has no
income or expenses.)
Applicants must identify the source of all income. Enter all wages as appropriate to include the applicant and the
applicant’s spouse. The following documents can be used as verification: payment stubs, bank statements, court
records, letters from a benefit office that state a monthly benefit amount, etc. (“Rental Property” refers to income
received from rental property that is owned by the driver.) If unemployed, you must explain how your monthly
expenses stated in Section (5) of the application form are being satisfied.
MONTHLY EXPENSES SECTION
Enter all monthly expenses as requested. Provide as much documentary proof of expenses as possible, such as
expense receipts, payment books, utility and other bills. Expenses incurred due to court-ordered support payments
or judgments for debts should be identified and proof of the orders or judgments provided.
ADDITIONAL BENEFITS SECTION
Check the appropriate response. Provide proof of additional benefits, such as documents from benefit offices that
state the amount of benefits you are receiving.
FINANCIAL ASSESSMENT INSTRUCTIONS
Applications for financial assistance that do not comply with these instructions will not be considered.
Applicants must provide all information as requested of them by this application. Do not submit original documents, only
copies, as the information submitted with the application will not be returned. Provide all documents that prove your wages,
income from any source, and your expenses for the last ninety days.
NOTE: Financial assistance will be granted, denied, or continued at the sole discretion of the South Carolina Department
of Probation, Parole and Pardon Services. The Department relies on the applicant to provide full and accurate financial
information. The Department reserves the right to deny or cancel financial assistance if the information provided by the
applicant is false, inaccurate, or misstated.
th
Applications are reviewed on a monthly basis. Those applications received after the 5
of the month will be reviewed the
following month.
APPLICANT INFORMATION SECTION
Applicant’s Name (Last, First, MI): Enter driver’s name.
Applicant’s DL Number: Enter driver’s license number.
Social Security Number: Enter the last four (4) digits of driver’s Social Security Number.
Date of Birth: Enter driver’s birth date.
Address: Enter driver’s mailing address. Check if address is the permanent or temporary address for driver.
Number of Dependents Claimed for Tax Purposes: Enter the number of individuals driver can claim on federal
tax return.
Primary Contact: Enter the best telephone number to contact driver.
DEPENDENTS SECTION
List Other People in Household: Enter name, age and relationship of all dependents listed on driver’s federal tax
return.
EMPLOYMENT STATUS SECTION
Check the appropriate response. If employed, provide all information requested in the “Employed” section only and
proceed to the “Monthly Income” section. Examples of verifying documents include a recent pay stub or a company
or employer letter. If unemployed, provide all information requested in the “Unemployed” section and proceed to
the “Monthly Income” section. Examples of verifying documents include benefits statements/check stubs for
unemployment benefits, employer letters, disability verifications or signed drivers’ statements. If self-employed,
provide all information requested in the “Self-Employed” section only and proceed to the “Monthly Income” section.
Examples of verifying documents include business account books, bank statements or any documents showing
income related to the self-employment.
MONTHLY INCOME SECTION (Do not leave any spaces blank. Place a zero in the appropriate space if the driver has no
income or expenses.)
Applicants must identify the source of all income. Enter all wages as appropriate to include the applicant and the
applicant’s spouse. The following documents can be used as verification: payment stubs, bank statements, court
records, letters from a benefit office that state a monthly benefit amount, etc. (“Rental Property” refers to income
received from rental property that is owned by the driver.) If unemployed, you must explain how your monthly
expenses stated in Section (5) of the application form are being satisfied.
MONTHLY EXPENSES SECTION
Enter all monthly expenses as requested. Provide as much documentary proof of expenses as possible, such as
expense receipts, payment books, utility and other bills. Expenses incurred due to court-ordered support payments
or judgments for debts should be identified and proof of the orders or judgments provided.
ADDITIONAL BENEFITS SECTION
Check the appropriate response. Provide proof of additional benefits, such as documents from benefit offices that
state the amount of benefits you are receiving.
*CONFIDENTIAL*
South Carolina Department of Probation, Parole & Pardon Services
Ignition Interlock Device Program
DRIVER FINANCIAL ASSESSMENT APPLICATION
DATE OF APPLICATION: ___________________
1. APPLICANT INFORMATION -- PLEASE PRINT CLEARLY.
Applicant’s Name (Last, First, MI)
Applicant’s DL#
Last 4 Digits of SSN
Date of Birth
☐Temporary Address
Street Address
Permanent Address
City
State
County
ZIP Code
Number of Dependents Claimed for Tax Purposes
Primary Contact - Phone
(
)
2. DEPENDENTS – List name, age and relationship of all dependents listed on your federal
tax return.
Name
Age
Relationship
Name
Age
Relationship
3. EMPLOYMENT STATUS – Indicate Employment Status Below
☐Employed: Current Employer
Street Address, City, State
Position
☐Unemployed:
☐ If you applied for unemployment benefits, provide the date of your application:
________________
☐ If you did not apply for unemployment benefits, please explain why you did not do so:
☐Self- Employed: Please describe how you are self-employed.
4. MONTHLY INCOME – The Department will not process your application without proof of
income
. Submit documentary proof of ALL monthly income for the last ninety (90) days. Provide
copies only of paycheck stubs, W-2s, bank statements, or any other proof of income. If you are
married, you must include your spouse’s income information for each category listed below.
Combined Monthly Income
Monthly Income Sources
(If married, include your spouse’s income for each category)
$
Monthly Net Wages or Salary
$
Social Security Payments
$
Disability Payments
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Form 1307
$
Unemployment Benefits
$
Spousal / Child Support
$
Income from Rental Properties
$
Investment Income
$
Other:
Total Monthly Income $
UNEMPLOYMENT: If you are unemployed, explain how you take care of the monthly expenses that you list in
Section (5):
5. MONTHLY EXPENSES – List your monthly expenses for the last ninety (90) days. You
must provide copies only of documentary proof for each expense listed or the expense will
not be considered.
$
Rent/Mortgage
$
Electric/Gas
$
Water/Sewer
$
Telephone
$
Court-Ordered Child Support
$
Court-Ordered Alimony
$
Recurring Medical Expenses
Total Monthly Expenses $
6. ADDITIONAL BENEFITS – Check the box that best describes any benefits you are
receiving. Submit copies only of documentary proof of any benefits you receive.
☐Temporary Assistance or Needy Families
☐General Assistance
☐Poverty-related veteran’s benefits
☐Food Stamps
☐Supplemental Security Income
☐Medicaid
7. SIGNATURE
.
With my signature below I certify that the financial information I have provided in this application is true and accurate
Applicant Signature
Date
Application and all supporting documentation must
be mailed to:
For Department Use Only
☐Approved
☐Denied
SCDPPPS
Date: ___________
IID Indigent Fund
P.O. Box 207
Columbia, SC 29202
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Form 1307
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