The Commission on Virginia Alcohol Safety Action Program
Your Doorway to Safe & Sober Driving

Terms & Conditions

Improving Highway Safety Through The Reduction in Incidence of Driving Impaired

It is very important that you pay special attention to these directions before completing the form below. This form is only to be completed if you have been declared indigent for ignition interlock fees by the court. If you are subject to a DMV administrative interlock requirement, you are not eligible for unaffordability. Please make sure you complete this form completely as incompleted forms, or requests that do not meet the eligibility requirements for review, will not be processed.

Once you have filled out the form completely, click the "submit" button and your e-mail browser will be activated containing the contents of your completed form in the body of your e-mail. Please make sure you attach all relevant documents to include salary and expense verification along with proof of your declaration of interlock indigent status by the court. You must include a bank statement that includes the past 60 days of activity. Once completed, send your e-mail. The Commission office will review your request and provide you with a response. If you would rather fill out a hard copy of the form, please contact your local ASAP for a financial form. Upon completion, please give the completed form to your ASAP case manager who will send the information directly to the state-office for review.