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Social Equity Individual Applicant (SEIA) Eligibility Verification Request Form
Social Equity Individual Applicant (SEIA) Eligibility Verification Request Form
The SEIA Eligibility Verification request submission window closes on July 25, 2022 at 4:00 P.M. Pacific Time (PT)
Social Equity Individual Applicant Eligibility Verification Request (2022)
Language
  • English (US)
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    Disclaimer: I understand that completing this request form shall in no way constitute a legal or binding determination that I can be verified as a Social Equity Individual Applicant under the Los Angeles Municipal Code. I also understand that I can be verified as a Social Equity Individual Applicant only after submitting adequate documentation of the required criteria and that DCR has the sole discretion to determine whether I am a verified Social Equity Individual Applicant. I further understand that DCR's determination is final and not appealable. As with other records and/or information submitted to DCR, information submitted through this request form may be publicly disclosed in response to a California Public Records Act request (Government Code section 6250, et seq.), as permitted by the Information Practices Act (Civil Code section 1798, et seq.), to another government agency as required by state or federal law, and/or in response to a court or administrative order, a subpoena, or a search warrant.
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    Please enter your information here. Requesters must have an ACA Reference ID. ACA Reference ID numbers are assigned when an account is registered on the DCR Licensing Portal and can be found under the "My Account" or "Account Management". Please enter your ACA Reference ID below.
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    California Cannabis Arrest or Conviction

    "California Cannabis Arrest or Conviction" means an arrest or conviction in California for any crime under the laws of the State of California or the United States relating to the sale, possession, use, manufacture, or cultivation of Cannabis that occurred prior to November 8, 2016.

    An arrest, prosecution or conviction for a violation of Proposition D, as codified in former Article 5.1 of Chapter IV of the Los Angeles Municipal Code, is not a California Arrest or Cannabis Conviction.

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    A California Cannabis Arrest or Conviction means an arrest or conviction in California for any crime under the laws of the State of California or the United States relating to the sale, possession, use, manufacture, or cultivation of cannabis that occurred prior to November 8, 2016. An arrest, prosecution or conviction for a violation of Proposition D is not a California Cannabis Arrest or Conviction.
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    If you have more than one California Cannabis Arrest or Conviction, you may provide details for multiple requests below:
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    If you select "YES", you may provide details on the next page:
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    If you have more than one California Cannabis Arrest or Conviction, you may provide details for multiple requests below:
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    If you select "YES", you may provide details on the next page:
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    If you have more than one California Cannabis Arrest or Conviction, you may provide details for multiple requests below:
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    DCR accepts certified copies of court records and/or other government records that reflect the Requester's California cannabis arrest/conviction prior to November 8, 2016.
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    One or more government records and/or documents may be uploaded as evidence; if the legal name listed on the government records and/or documents differs from the legal name associated with your ACA Reference ID, you must provide supporting documentation to demonstrate the relationship between the two legal names e.g. birth certificate, marriage certificate, or other government document relating the to legal names.
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    This concludes the California Cannabis Arrest and/or Conviction section.

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    Income

    "Low-Income" means both of the following definitions are met: (1) the Social Equity Individual Applicant meets the low-income thresholds established in the annual U.S. Department of Housing and Urban Development (HUD) income limits based upon the Area Median Income (AMI) for Los Angeles County based on household size; and (2) the Social Equity Individual Applicant does not have Assets in excess of four times the Low-Income thresholds based on household size.

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    “Household Size” means the number of individuals* that meet any of the following criteria: 1) Spouses or domestic partners; 2) All household members who are under 18 years of age, as claimed on the most recent income tax return; 3) Pregnant applicants may be counted as two household members with verifiable medical documentation; and, 4) Temporarily absent household members, listed on the Requester's most recent tax return, who intend to live in the residence upon return may be considered. *Individuals not listed on the Requester's most recent tax return, such as elderly relatives, live-in assistants, and foster children will not be counted toward household size.
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    https://www.huduser.gov/portal/datasets/il/il2020/2020summary.odn?year=2020&states=%24states%24&data=2020&inputname=METRO31080MM4480*Los+Angeles-Long+Beach-Glendale%2C+CA+HUD+Metro+FMR+Area&stname=%24stname%24&statefp=99&selection_type=hmfa
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    Low-income thresholds established in the 2020 and 2021 annual U.S. Department of Housing and Urban Development (HUD) income limits based upon the Area Median Income (AMI) for Los Angeles County based on household size.
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    Requesters that are married and file taxes separately must provide documentation for the Requester and the Requester's spouse. DCR will only accept complete copies (must include all pages and schedules) of the following categories of documents to verify income: • Requester's Federal tax returns for the calendar year 2020 and/or 2021 (complete filed copies only); • The spouse of the Requester's Federal tax returns for the calendar year 2020 and/or 2021 (if married filing separately); • IRS Verification of Non-filing, which is proof from the IRS that you did not file a return for the 2020 or 2021 tax year. Use the IRS Form 4506-T to order a Verification of Non-filing transcript or Form 1040-series transcripts free of charge. For more information, please visit www.irs.gov/form4506t.
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    DCR will accept
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    Max. file size: 50.0MB
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    Assets

    "Asset" means net assets at, or below, four times the Low-Income thresholds based on Household Size. Examples of liquid accounts that shall be disclosed include but are not limited to, saving accounts, checking accounts, certificates of deposit, money market accounts, stocks, trusts, and gifts. Qualified retirement accounts and an applicant's primary residence shall be excluded for purposes of the calculation, but other forms of real estate shall be included. Such retirement accounts are limited to accounts that are intended for retirement and that would incur a penalty if withdrawn before a specified retirement age per each account.

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    The Asset Attestation Form (SEP-6003-FORM) can be found by clicking on the image below. .
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    Drag and drop files here
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    Max. file size: 10.6MB
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    This concludes the Income and Assets section.

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    Disproportionately Impacted Area (DIA)

    "Disproportionately Impacted Area" means Police Reporting Districts as established in the Expanded Social Equity Analysis, or as established using the same methodology and criteria in a similar analysis provided by an Applicant for an area outside of the City.

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    You can find Disproportionately Impacted Areas by looking at the DCR Licensing Map on DCR's website and clicking the "Social Equity Program" layer, which displays the Police Reporting Districts in pink zones. The DCR Licensing Map can be accessed by clicking on the image below or by navigating to: https://cannabis.lacity.org/licensing/licensing-information/licensing-map
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    Example: if you lived in a DIA for five years, moved away for two years, and moved back for an additional five years, then that would count as ten cumulative years.
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    If you select "YES", you may provide details on the next page:
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    If you select "YES", you may provide details on the next page:
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    DCR will accept the following categories of documents to verify your residency. A sufficient number of documents must be uploaded to evidence the entire 10 year period. • Federal or State tax returns for the calendar year; • Property deeds, mortgage documents or residential lease agreements; • Financial records reflecting lease or mortgage payments that are dated and contain an Applicant’s name and address; • Records reflecting government housing or other assistance that are dated and contain an Applicant’s name and address; • Utility bills, car registration, employment records, insurance documents or government-issued documents that are dated and contain an Applicant’s name and address; and, • Certified education records from a school, including transcripts or enrollment documents, which might reflect an Applicant’s residence.
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    Drag and drop files here
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    Max. file size: 50.0MB
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    This concludes the residency in a Disproportionately Impacted Area section.

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    If you have finished this form and do not need to return later, please hit "Submit and/or Continue Later" on this page, then complete the Captcha and click "Submit Form" on the following page. The information and documents uploaded to this form will be reviewed after July 25, 2022 at 4:00 P.M. Pacific Time (PT) to determine if you meet the requirements to be verified as a Social Equity Individual Applicant.

    If you need to return to this form at a later time, you may do so until July 25, 2022 at 4:00 P.M. Pacific Time (PT) by hitting "Submit and/or Continue Later" on the following page. Once submitted, you may return to the form to edit prior responses or add additional information or documents until July 25 at 4:00 P.M. Pacific Time (PT).

    On July 25, 2022 at 4:00 P.M. Pacific Time (PT), access to this form will be disabled and the verification window will be closed. The information and documents uploaded to this form at that time cannot be further amended, changed or updated. 

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