Form i 912 2012-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1, providing your personal information. Fill in your family name, given name, middle initial, date of birth, and marital status. If applying for a minor child, include their details as well.
3. In Section 2, if applicable, complete the table for dependents by entering their names, A-numbers, and whether they are included in the fee waiver request.
4. Move to Section 3 to indicate the basis for your request. Check any relevant boxes that apply to your situation regarding means-tested benefits or financial hardship.
5. In Section 4, provide details about any means-tested benefits you or household members receive. Include the agency awarding the benefit and whether it is currently being received.
6. Section 5 requires you to detail your household income. Enter monthly wages and any additional support received.
7. Describe your financial hardship in Section 6. Provide specifics about costs incurred or loss of income.
8. Finally, complete Section 7 by signing and dating the form. Ensure all required signatures are included before submission.

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