Hardship Application

Program Overview

ADR Hardship Relief

Must be currently enrolled in Utility Billing Relief Program or Clear Path Relief Program, or have a household income less than or equal to 300% of the Federal Poverty Guidelines based on the 30 days prior to application.
Get interest, costs, and fees waived by paying 50% of the fine amount or enrolling and successfully completing a payment plan.
Restitution is excluded and must be paid in full or included in a payment plan.
Payment plans require a minimum down payment of $25 and can extend up to 60 months.

PLEASE NOTE: ADR does not include parking, red light, or speed violations. If you are seeking debt relief for these types of violations, this requires a different application from ADR. Instead, please apply for the Clear Path Relief Program, which provides low-income motorists with relief for vehicle-related debt, by clicking here.

Eligibility

An individual qualifies as a hardship participant if:

Currently enrolled in the City’s Utility Billing Relief Program; or
Currently enrolled in the City’s Clear Path Relief Program; or
Household income less than or equal to 300% of the Federal Poverty Level based on the 30 days prior to application.

Do you qualify as a hardship participant? *

Yes

To determine if you have eligible debt, you can request and administrative hearings debt check. It is your responsibility to make sure that all eligible debt is included as part of your debt relief. After the relief period hast expired, no adjustments will be made as a result of your failure to pay in full or enter into a payment plan for all your eligible debt.

Do you have the docket or ticket number for all of your outstanding administrative hearings debt? *

Yes

In order to be eligible for the ADR Hardship Relief Program, you must qualify as a hardship participant. To pay or check your balance, please visit EZ-Pay. To enroll in a payment plan or for other questions, please call 312-742-3317.

To determine if you have eligible debt, you can request an administrative hearings debt check. It is your responsibility to make sure that all eligible debt is included as part of your debt relief. After the relief period has expired, no adjustments will be made as a result of your failure to pay in full or enter into a payment plan for all your eligible debt.

Are you requesting a debt check for an individual or a business? *

Individual

Business

Applicant/Business Information

Business Name *

City License Number

First Name *

Last Name *

Email Address *

Email Address Confirmation *

Phone Number *

Proof of ID *

Issued By *

ID # *

Upload Proof of ID *

Choose File

Current Address

Address *

Unit

City *

State *

Zip Code *

Other Name(s)

If you were/are known by or use a name other than the name listed above (e.g., maiden name), please provide that name(s) below.

First Name

Last Name

Prior Addresses

You must include all prior addresses below to ensure you receive the maximum benefit of this program. It is your responsibility to make sure that all eligible debt is included as part of your debt relief. No adjustments will be made as a result of your failure to provide complete information in this application.

Check if you have never resided at any location other than your current address

Address

Unit

City

State

Zip Code

Known AH Dockets

If you know your docket number(s), please provide this information below. Your docket number can be located on the complaint or court order issued at the Department of Administrative Hearings (e.g. 12DS00006M). This information will be used to compile your debt check results.

Please enter one docket number per row in the box below. (You have 2000 characters remaining)

Hardship Eligibility

Are you a member of a household that is currently enrolled in Utility Billing Relief Program? *

Yes

Customer Code *

Premise Code *

Proof of Residency *

Choose File

Form of ID *

I understand that my ADR application will be denied if the uploaded documentation does not match the address of the UBR account. *

Are you currently enrolled in the Clear Path Relief Program? *

Yes

Submission ID for CPR *

Household Income

You must complete this section for every person who has lived in the home in the past 30 days, regardless of age or residency status.

For each person, you must include:

Social Security Number or Individual Taxpayer Identification Number, if one has been issued
Income and benefits received within the last 30 calendar days.
Income received for a minor (i.e. child support or SSI) should be reported by the Parent/Guardian.

For more information on how to calculate income, please click here. Income is subject to verification; therefore records should be maintained for 12 months from this date.

First Name *

Last Name *

Gender *

Ethnicity *

Date of Birth *

Proof of Identification *

SSN or ITIN *

Form of ID

Upload Identification

Choose File

You must report all income received from [range]. To upload multiple files, use the Ctrl key when choosing the files. Amounts reported are subject to audit. Intentionally omitting or providing false information, or materially altering documents shall result in disqualification from the program and a demand for repayment of any benefits received.

Do you have income from <30-days before today> to to report?

Yes

Type of Income *

Pay Cycle *

Have you held this job for more than 30 days *

Yes

Income *

Add document *

Choose File

Description *

By selecting no income, I attest that this person has received no income or cash benefits within the last 30 days.

Total Income for last 30 days

Attestation Letter

Choose File

Attestation Letter Submission Date

Attestation Signature

Preparer Information

Relationship to Applicant *

First Name *

Last Name *

Email Address *

Phone Number *

Address

City

State

Zip Code

Summary

Hardship Agreement

By entering my digital signature below, I certify that I understand and agree to the following terms and conditions:

I understand that in order to qualify for the Administrative Debt Relief Program (ADR), I must be a cited party on the final order associated with the outstanding debt.
I understand that it is my responsibility to provide accurate and complete information on my debt check application and that if the City is unable to locate outstanding debt due to my failure to do so that this debt will not be eligible to receive the benefits (e.g., debt waiver) provided by ADR.
I understand that under no circumstances does the failure to include a debt in the debt check results constitute a waiver or release of any debt due and owing to the City.
I understand that in no event shall any relief granted under ADR entitle me to a refund for any amounts paid prior to the implementation of the applicable relief period.
I understand that if I participate in ADR and have a debt relief payment plan that I must abide by its terms and conditions and that if such payment plan goes into default status that I will no longer be eligible to participate or receive the benefits of ADR.
I understand that if I participate in ADR and have a debt relief payment plan in good standing, that I will be exempt from enforcement action on that debt.
I understand that if I miss a payment on my debt relief payment plan, I will have up to 120 days from the date of the missed payment to re-enroll in a plan.
I understand if I miss three payments on my debt relief payment plan that I will be in default status, cannot re-enroll again, will no longer be eligible to receive the benefits of ADR and my outstanding debt will be eligible for enforcement action.
I understand that restitution is excluded from ADR benefits and must be paid in full or as part of the debt relief payment plan.
If this certification is being submitted by a preparer instead of the applicant, the preparer of this application certifies that the applicant understands the terms and conditions on this page and grants permission to the preparer to attest to these terms and conditions on their behalf.
If the preparer is submitting this certification on behalf of a business, the preparer certifies that they are an authorized representative of such business and have the legal authority to submit this debt check request and receive the results on the business's behalf.
After an application is approved, no additional judgments entered after such date shall be eligible for relief.
An applicant may only be granted relief for one application under ADR

Applicant Signature

All information submitted with my debt check application for ADR is true and correct to the best of my knowledge. I understand that intentionally omitting a material fact relevant to this request or providing a false statement of material fact may result in the forfeiting of any ADR benefits, as appropriate.

Hardship Agreement

By entering my digital signature below, I certify that I understand and agree to the following terms and conditions:

I understand that in order to qualify for the Administrative Debt Relief Program (ADR), I must be a cited party on the final order associated with the outstanding debt, and I must either reside at an address that currently participates in the Utility Billing Relief Program (UBR), or be currently enrolled in the Clear Path Relief Program (CPR), or have a household income of less than 300% of the Federal Poverty Guidelines.
I understand that if I move from the address that is enrolled in UBR or my household income changes while enrolled in CPR or ADR, I must notify the City within 14 calendar days, and my eligibility for the program will be re-evaluated.
I understand that it is my responsibility to provide accurate and complete information on my ADR application and that if the City is unable to locate outstanding debt due to my failure to do so that this debt will not be eligible to receive the benefits (e.g., debt waiver) provided by ADR.
I understand that under no circumstances does the failure to include a debt in the debt check results constitute a waiver or release of any debt due and owing to the City.
I understand that in no event shall any relief granted under ADR entitle me to a refund for any amounts paid prior to the implementation of the applicable relief period.
I understand that if I am enrolled in ADR and have a debt relief payment plan that I must abide by its terms and conditions and that if such payment plan goes into default status that I will no longer be eligible to participate or receive the benefits of ADR.
I understand that if I am enrolled in ADR and have a debt relief payment plan in good standing, that I will be exempt from enforcement action on that debt.
I understand that if I miss a payment on my debt relief payment plan, I will have up to 120 days from the date of the missed payment to re-enroll in a plan.
I understand if I miss three payments on my debt relief payment plan that I will be in default status, cannot re-enroll again, will no longer be eligible to receive the benefits of ADR and my outstanding debt will be eligible for enforcement action.
I understand that restitution is excluded from ADR benefits and must be paid in full or as part of the debt relief payment plan.
After an application is approved, no additional judgments entered after such date shall be eligible for relief.
An applicant may only be granted relief for one application under ADR .
If this certification is being submitted by a preparer instead of the applicant, the preparer of this application certifies that the applicant understands the terms and conditions on this page and grants permission to the preparer to attest to these terms and conditions on their behalf.

Applicant Signature

All information submitted with my application for ADR is true and correct to the best of my knowledge. I understand that intentionally omitting a material fact relevant to my ADR application, providing a false statement of material fact in my ADR application, or materially altering documents submitted to show my income eligibility for ADR, may result in the denial of my application for ADR or my removal from ADR and the forfeiting of any ADR benefits, as appropriate. Such action may also prevent me from re-enrolling in ADR and may subject me to other applicable penalties as provided by law.

Applicant's Signature

Please type Applicant's Name:

Title

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AH DEBT RELIEF PROGRAM

Hardship Application

Program Overview

Eligibility

Applicant/Business Information

Current Address

Other Name(s)

Prior Addresses

Known AH Dockets

Hardship Eligibility

Household Income

Preparer Information

Summary

Hardship Agreement

Applicant Signature

Hardship Agreement

Applicant Signature