Eligibility Determination for Indigent Defense Services

Eligibility Determination for Indigent Defense Services

9-403. Eligibility determination for indigent defense services.

[Section 31-15-7 NMSA 1978. For use in the District Court, Magistrate Court and Metropolitan Court]

STATE OF NEW MEXICO

COUNTY OF

COURT

KEY

[STATE OF NEW MEXICO]

[COUNTY OF ]

v. No.

, Defendant

ELIGIBILITY DETERMINATION FOR INDIGENT DEFENSE SERVICES

Name: DOB: Age:

AKA: Sex: SSN:

Address: Phone:

Charges:

Lives alone: Lives with:

Spouse Children Parent Friend Other

Marital status: Single Married Divorced Separated Widowed

Number of dependents in household:

Defendant is in jail. Defendant is not in jail.

PRESUMPTIVE ELIGIBILITY:

I currently DO NOT receive public assistance.

I currently receive the following type of public assistance in County:

DEPARTMENT OF HEALTH CASE MANAGEMENT SERVICES (DHMS) $

TANF/GA $ Food Stamps $ Medicaid $

Public Housing $ SSI/SSDI $

VA Disability

Unable to complete application because of possible Mental Health/Developmental Issue of applicant.

NET INCOME: SELF / SPOUSE

Employer's Name

Employer's Phone

Pay Period (weekly, every second week, twice monthly, monthly)

Net take home pay (salary wages minus deductions required by law) $ $

Other income sources (please specify) $ $

SCREENING USE ONLY

TOTAL ANNUAL INCOME $ + = A

ASSETS:

CASH ON HAND $ $

BANK ACCOUNTS $ $

REAL ESTATE (equity) $ $

MOTOR VEHICLES (equity) $ $

OTHER PERSONAL PROPERTY (equity):

(describe and set forth equity)

$ $

$ $

SCREENING USE ONLY

TOTAL ASSETS $ + = B

EXCEPTIONAL EXPENSES (total exceptional expenses of dependents):

MEDICAL EXPENSES (not covered by insurance) $

MEDICAL INSURANCE PAYMENTS (receipts required) $

COURT-ORDER SUPPORT PAYMENTS/ALIMONY $

CHILD-CARE PAYMENTS (e.g. day care) $

OTHER (describe) $

$

SCREENING USE ONLY

TOTAL EXCEPTIONAL EXPENSES $ = C

I UNDERSTAND THAT IF IT IS DETERMINED THAT I AM NOT INDIGENT, I MAY APPEAL TO THE COURT WITHIN TEN (10) DAYS AFTER THE DATE I AM ADVISED OF THIS DECISION.

I wish to appeal.

I do not wish to appeal.

STATE OF NEW MEXICO

COUNTY OF

This statement is made under oath. I hereby state that the above information regarding my financial condition is correct to the best of my knowledge. I hereby authorize the screening agent, district defender and the court to obtain information from financial institutions, employers, relatives, the federal internal revenue service and other state agencies.

State of

County of

Signed and sworn to (or affirmed) before me on (date) by (name of applicant).

Notary

(Seal, if any) My commission expires:

SCREENING USE ONLY

COLUMN "A" (net income) plus COLUMN "B" (assets) minus COLUMN "C" (exceptional expenses) equals AVAILABLE FUNDS:

The applicant is indigent.

The applicant is not indigent.

The applicant [has] [has not] paid the $10.00 application fee.

Receipt number:

Based on the above answers and information, I find that the applicant [is] [is not] indigent.

(Complete the following only if the court has determined that the applicant is unable to pay the $10.00 application fee).

_____ I find that the applicant is unable to pay the $10.00 indigency application fee, due to the following reason and I therefore waive the payment of the $10.00 application fee.

GUIDELINES FOR DETERMINING ELIGIBILITY

Pursuant to Section 31-15-7 NMSA 1978, the following guidelines are established for determination of indigency and eligibility for public defender services.

I. APPLICATION FEE

A person shall pay a non-refundable application fee for each case in the amount set in Section 35-15-12 NMSA 1978 at the time the person applies with the public defender for representation. The interviewer will determine if the financial circumstances of the applicant are such that the fee would pose an exceptional hardship, and will recommend to the District office Administrator or Eligibility Supervisor if the fee should be waived. The interviewer will document on the application the reason for the fee waiver.

II. PRESUMPTION OF INDIGENCY

An applicant is presumed indigent if the applicant is a current recipient of state or federally administered public assistance programs for the indigent: temporary assistance for needy families (TANF), general assistance (GA), supplemental security income (SSI), social security disability income (SSDI), Veteran’s disability benefits (VA) if the benefit is the sole source of income, food stamps, medicaid, public assisted housing or Department of Health, Case Management Services (DHMS).

III. FINANCIAL RESOURCES

If the applicant is not presumptively indigent, the screening agent shall examine the financial resources of the applicant with consideration given to net income, assets, and exceptional expenses.

IV. INDIGENCY FORMULA

An applicant is indigent if the applicant's available funds do not exceed one hundred fifty percent (150%) of the current federal poverty guidelines established by the United States Department of Labor.

V. APPEAL

If the applicant is found by the screening agent or the court not to be indigent, the applicant may appeal the decision within ten (10) working days after the date of the decision.

VI. REIMBURSEMENT

Any applicant who is ineligible for free representation but is unable to hire private counsel may sign a contract for public defender representation on a reimbursement basis.

VII. NEW CHARGES

If an applicant has applied for public defender services within six (6) months prior to the filing of new charges or a probation violation, completion of a new eligibility determination form is not necessary, but the applicant shall be required to pay the application fee.