Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form)

Federal judicial district where the case is filed. The PDF dropdown lists all 94 districts; the wizard matches typed entries to the dropdown's exact strings. Wrong district = case dismissed for lack of venue.

• Filers type the state name only (e.g., 'California'). The form needs a specific district like 'Eastern District of California'.
• Filers pick the wrong district (e.g., they live in San Diego but type 'Northern District of California' which covers San Francisco). Use 28 U.S.C. 1391 to pick the venue: where the defendant resides, where the events happened, or where any defendant is subject to personal jurisdiction.

The party bringing the case (you). Must match the caption of your complaint exactly.

• Filers list a nickname or shortened version that differs from the caption of the complaint. Match exactly so the clerk's docket pull works.
• Pro se filers in joint suits (spouses, siblings) list only one name. List every plaintiff who is requesting fee waiver, or have each file a separate AO 240.

The party being sued. List the first defendant; if multiple, write 'et al.' after the name (per FRCP caption convention).

• Filers cram every defendant into one line. Use the first defendant's name plus 'et al.'; the full list lives in the complaint, not the AO 240 caption.
• Filers list a fictional 'John Doe' style placeholder that does not match the complaint. The caption on the IFP must match the caption on the complaint, including any Doe defendants.

Civil action number. Blank for new cases (clerk assigns at filing). For pending cases (mid-case IFP filing), copy from the docket.

• Filers invent a case number when none has been assigned. Leave it blank for new filings; the clerk stamps the assigned number on the form when the complaint is filed.
• Mid-case filers copy the magistrate's referral number instead of the district court case number. The case number on the docket sheet header is the right one.

Item 1 routing. AO 240 (Short Form) is for non-incarcerated filers. Incarcerated filers should use AO 239 (Long Form) and attach the 6-month inmate trust account statement.

• Incarcerated filers complete AO 240 (Short Form) when they should be using AO 239 (Long Form). The two forms have different evidentiary requirements; using the wrong one almost guarantees a denial or a Notice to Cure.
• Filers in pretrial detention or immigration custody check 'No' because they are not 'serving a sentence'. The form treats anyone confined in a correctional facility as incarcerated for purposes of the AO 240 vs AO 239 split.

Facility name and address where the incarcerated filer is being held. Required only if is_incarcerated = yes.

• Filers list only the city or only the BOP register number. Provide the full facility name plus mailing address so the U.S. Marshal can serve, and the court can mail orders.
• Filers omit the facility when transferred mid-case. Update with the current facility; an outdated address means the filer never receives the court's order.

Item 2 employer info. Acceptable: 'Unemployed', 'Self-employed', 'Not employed', or a real employer's name and address.

• Filers leave it blank because they are unemployed. Type 'Unemployed' explicitly so the answer is on the form.
• Filer leaves blank when unemployed; type 'Unemployed' or 'Not employed'.
• Filer types only employer name without an address; include both.

Pre-tax pay per the pay period below. Blank or '0' if unemployed.

• Filers enter take-home pay here and then repeat the same number in take_home_pay. Gross pay is before deductions; take-home pay is after. The judge expects a difference.
• Filers leave both pay fields blank when self-employed but do not write 'Self-employed' in employer_name_address. Either declare an employer with $0 gross or declare self-employment status; do not leave the panel ambiguous.

After-tax pay per the pay period below.

• Filers report YTD numbers here when the form asks for per-period pay. Read the pay-period selector and report what the paystub shows for that period.
• Filers exclude wage garnishments. Take-home pay is what actually reaches the filer; if support or tax garnishments reduce it, report the net after those reductions.

Weekly, bi-weekly, monthly, annual, or no pay. The judge multiplies by the period to estimate annual income.

• Filers conflate bi-weekly (every two weeks, 26 paychecks/year) with semi-monthly (twice a month, 24 paychecks/year). The math is different; pick what the paystub actually says.
• Filers select 'monthly' but enter a weekly amount in gross_pay. The period and the amount must agree, or the judge over- or under-estimates annual income by 4x.

Item 3.a checkbox. Yes if you have any self-employment income in the past 12 months.

• Filers check 'No' for occasional gig work (DoorDash, Uber, freelance). Any 1099 income in the past 12 months is self-employment income for AO 240 purposes.
• Filers leave the box blank when the answer is 'No'. Affirmatively check 'No'; a blank box reads as an unanswered question and may slow the IFP review.

Item 3.b checkbox. Yes if you have rent, interest, or dividend income.

• Filers check 'No' for trivial bank-account interest (under $10/year). The form asks about any such income; a $5 interest payment still triggers Yes.
• Filers exclude rent received from a roommate or family member. Cash rent received counts here, even if there is no formal lease.

Item 3.c checkbox. Yes if you receive pension, annuity, or life insurance payments.

• Filers exclude Social Security retirement (SSA) here because they think SSA only counts under disability. SSA retirement is a pension-type payment for AO 240 purposes; check Yes.
• Filers exclude annuity disbursements from a former spouse's retirement (QDRO payments). Those count too.

Item 3.d checkbox. Yes if you receive disability or worker's comp payments. INCLUDES SSDI, VA disability, and state worker's comp.

• Filers check 'No' for SSI thinking only SSDI counts. SSI also goes here; both are means-tested federal benefits.
• Filers list disability income but never describe it in other_income_detail. The narrative is what the judge actually reads; without it, the checkbox alone is incomplete.

Item 3.e checkbox. Yes if you receive gifts or inheritances. Include money from family, even if irregular.

• Filers exclude regular money from a parent or sibling because 'it's just family'. Recurring family support is reportable; the judge views it as available income for fee-payment purposes.
• Filers report a one-time inheritance only when probate closes. If the filer received a distribution in the past 12 months, report it here even if probate is ongoing.

Item 3.f checkbox. Catch-all for any other income source not covered above.

• Filers leave this 'No' but report unemployment compensation, alimony, or food stamps elsewhere. Those go here, with the source named in other_income_detail.
• Filers double-count by checking both this and a more specific category for the same dollar. Pick the most specific category; use 'other' only when nothing else fits.

Free-text description of every 'Yes' answer above. Required when any of items 3.a-3.f are Yes.

• Filers write 'See above' or 'Various sources'. The judge needs concrete numbers; vague answers get the IFP denied with a Notice to Cure.
• Filers list source but no amount. Always pair source with monthly or annual dollar figures so the judge can do the means analysis.

Total cash + checking + savings. The judge uses this with monthly expenses to assess whether the $405 fee is feasible. Lying here is perjury under 28 U.S.C. 1746; the court can verify with bank records.

• Filers report only their checking balance and forget savings, money-market, or PayPal/Venmo balances. Total all liquid accounts.
• Filers omit a joint account because 'half is my spouse's'. Report the full balance and clarify the joint-ownership share in dependents or property_owned; the judge knows how to read it.

Property of value: cars, real estate, stocks, bonds, jewelry, art, items held in another's name on your behalf. Skip ordinary household items. 'None' if no significant property.

• Filers list the car they need to drive to work and worry the judge will deny IFP because of it. Necessary transportation is normal; report it honestly with realistic value.
• Filers omit a 401(k) or IRA because they 'cannot touch it'. List retirement accounts with current value; the judge weighs liquidity separately.

Itemized monthly expenses: rent, utilities, transportation, loan payments. The judge compares against income.

• Filers report rent only and forget utilities, food, transportation, insurance, medical co-pays. Itemize each category; the judge weighs income against total cost-of-living, not rent alone.
• Filers report aspirational expenses (gym memberships, streaming services) as the same priority as rent. Stick to actual recurring expenses; the judge has heard the inflation argument before.

Dependents you financially support. Use initials for children under 18 (per the form's privacy norm; FRCP 5.2 also requires redacted minor names in pleadings).

• Filers list a minor child's full name, violating FRCP 5.2(a)(3). Use initials only (e.g., 'J.S., age 7').
• Filers omit dependents who do not live with them but for whom the filer pays support. Court-ordered child support obligations belong here even if the child lives with the other parent.

Debts and financial obligations: credit cards, medical bills, student loans, child support arrears, court fines.

• Filers list only minimum monthly payments and skip the principal balance. Both matter; report total balance plus monthly payment.
• Filers omit student loans on income-driven $0 payment plans. The total balance is still a debt obligation even if the current monthly payment is zero.

Wet-ink signature under penalty of perjury (28 U.S.C. 1746). Federal courts require a real signature on paper filings. Some districts accept '/s/ John Smith' on e-filed PDFs.

• Filers type their name in cursive font as a 'digital signature'. Pro se paper filers must sign in ink; a typed name in italics is not a signature for paper filings.
• Filers sign before completing the form. The signature certifies that everything above is true; sign last, after every other field is filled.

Date of signature. Sign and date the same day you file.

• Filers post-date or back-date the signature. Use the date the form is actually signed; mismatch with the file-stamp creates an evidentiary issue.
• Filers sign one date, file weeks later, and the financial picture changes. If income or assets shift between signing and filing, re-sign with a current date.

Printed name on the line below the signature.

• Filers leave this blank because they signed above and assume the clerk will read the cursive. Print legibly so the docket entry uses the correct spelling.
• Filers print a different name than they signed (nickname vs legal name). Match the plaintiff caption.