To fill out a poverty affidavit, you download your court’s fee-waiver form, list your income, assets, monthly expenses, dependents, and debts in exact dollar amounts, attach proof of what you’ve reported, and sign the form under penalty of perjury before filing it with the clerk. The form is a sworn financial disclosure that asks the court to let you proceed without paying filing fees — a status known in federal court as proceeding “in forma pauperis” under 28 U.S.C. § 1915.1Office of the Law Revision Counsel. 28 USC 1915 – Proceedings In Forma Pauperis It isn’t complicated, but accuracy matters. Blank sections, round-number guesses, or missing attachments are the usual reasons courts send applicants back or set a hearing.
Get the Right Form First
The form depends on which court your case is in. For a federal district court, you want the Application to Proceed in District Court Without Prepaying Fees or Costs — Form AO 240 is the short version, AO 239 the long one. Both are on the U.S. Courts website under “Forms.”2United States Courts. Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form) Many district courts post the same form on their own sites with a local cover sheet.
State courts use different names for the same document: poverty affidavit, affidavit of indigency, statement of inability to pay, or application for determination of civil indigent status. Go to the website of the court where you plan to file, or ask the clerk’s office. If you can’t find the form online, the clerk is required to give you one at no charge.
Check Whether You Qualify Before You Start
Federal judges have broad discretion. Under § 1915, you qualify if your affidavit shows you can’t pay the court’s fees — there is no fixed income number in the statute.1Office of the Law Revision Counsel. 28 USC 1915 – Proceedings In Forma Pauperis
State courts tend to be more formulaic. Many tie eligibility to a percentage of the Federal Poverty Guidelines published by the U.S. Department of Health and Human Services. The threshold varies: some states use 125 percent, others 150 percent, some as high as 200 percent.3U.S. Department of Health and Human Services. 2025 Poverty Guidelines – 48 Contiguous States For 2025, the guideline for a single person in the 48 contiguous states is $15,650 per year; for a household of four it is $32,150. Check your own court’s threshold before assuming you qualify or don’t.
You may qualify automatically if you receive certain means-tested benefits. The common ones are:
- Supplemental Security Income (SSI)
- Supplemental Nutrition Assistance Program (SNAP)
- Temporary Assistance for Needy Families (TANF)
If one of these applies to you, bring your benefit verification letter or a recent benefits statement. Courts treat enrollment as strong evidence of financial need, and in many places the inquiry stops there.
Gather Your Documents Before You Sit Down With the Form
Pulling paperwork together first is what makes the form fast to complete and hard to challenge. You want the numbers in front of you so you aren’t estimating.
- Your most recent one or two pay stubs showing gross and net earnings.
- Benefit award letters or recent statements for SSI, SNAP, TANF, unemployment, or disability.
- The most recent statement for every checking, savings, or money market account in your name.
- Your most recent federal tax return, especially if you are self-employed or have income that won’t appear on a pay stub.
- Recent bills for rent, utilities, medical debt, and other major recurring expenses.
Attaching documentation isn’t always strictly required, but it speeds approval and reduces the chance the court sets a hearing to question your finances.
How to Answer Each Section
The federal short form is a reliable guide to what state forms also ask.4United States Courts. Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form) – AO 240 The questions sort into the same categories regardless of jurisdiction, and the way you answer them is what the judge will actually read.
Employment and Wages
List your employer’s name and address, your gross pay, and your take-home pay for the current pay period. Use the exact figure from your pay stub. If your take-home is $1,247.63 every two weeks, write $1,247.63. Rounded numbers look like guesses, and judges notice.
Other Income
Report any money received in the past 12 months from self-employment, rental income, interest or dividends, pensions, disability or workers’ compensation, gifts, inheritances, or any other source. The form asks about “any other sources” because applicants routinely forget child support they receive, occasional gig work, or cash gifts from family. List everything, even small or irregular amounts. Having to explain omitted income later is far worse than disclosing a modest sum upfront.
Cash and Bank Accounts
Report the total you currently hold in cash, checking, and savings. Liquid assets get the closest scrutiny. If your savings balance alone would cover the filing fee, the court is unlikely to waive it regardless of your income.
Property and Valuables
List any automobile, real estate, stocks, bonds, jewelry, or other items of value, including anything held in someone else’s name. Don’t overthink valuation. A used car is worth roughly what you could sell it for today, not what you paid. For a home, the number that matters is your equity: market value minus what you still owe on the mortgage. Courts generally do not count the home you live in against you, but significant equity in a second property can weigh against a waiver.
Monthly Expenses
Include everything recurring: rent or mortgage, utilities, groceries, insurance premiums, childcare, transportation, medical costs, and minimum debt payments. The purpose is to show how much of your income is already committed. If your monthly expenses meet or exceed your monthly income, that strongly supports your request.
Dependents and Debts
Name everyone who depends on you for support (initials are standard for minors), state your relationship to each person, and say how much you contribute. Then list your debts and who you owe. The court is assembling a complete picture of what comes in, what goes out, and what you have left over.
Sign It Correctly
Your signature carries legal weight. A poverty affidavit is a sworn statement, and knowingly providing false information exposes you to perjury charges and possible dismissal of your case. Read the declaration language above the signature line; it typically states that everything in the form is true under penalty of perjury.
Whether you need a notary depends on where you file. Federal courts generally accept an unsworn declaration signed under penalty of perjury, with no notary required, under 28 U.S.C. § 1746.5Office of the Law Revision Counsel. 28 USC 1746 – Unsworn Declarations Under Penalty of Perjury Many state courts require notarization. If your form has a notary block at the bottom, you need to sign in front of a notary public. Most courthouses have one on staff, and some waive the notary fee for indigent filers.
File It With the Clerk
Submit the completed affidavit to the clerk of court at the same courthouse where your case is pending or where you intend to file. In most cases you file the poverty affidavit at the same time as your complaint or petition. The clerk holds the case filing without charging the fee while the affidavit is reviewed. If your court uses electronic filing, you can usually upload the affidavit through the same portal; check the court’s website for self-represented filing instructions.
What Happens After You File
The clerk or a judge reviews your affidavit, usually within a few business days, and issues a written order granting or denying the request.6Ohio Legislative Service Commission. Ohio Code 2323.311 – Indigent Litigants Notice typically comes by mail or through the court’s electronic notification system.
If something raises a question — numbers that don’t reconcile, blank sections, expenses that don’t match the income — the court can set a hearing and ask you to explain, often requesting tax returns or bank statements. A hearing doesn’t signal denial. It means the court wants more information.
Once granted, in forma pauperis status generally lasts the duration of the case. The court can revisit it if your finances improve, and you have an obligation to report any significant change.
If the court denies your request, your case isn’t dismissed on the spot. Most courts give you a window, commonly 30 days, to either pay the fee or fix the problem. If the denial order explains what was missing, you can often supplement your application with additional documents and ask the court to reconsider.
What a Fee Waiver Covers and What It Doesn’t
An approved affidavit waives the filing fee, which is the biggest single cost for most litigants. In federal district court, the filing fee is $350 by statute for most civil actions.7Office of the Law Revision Counsel. 28 USC 1914 – District Court Filing and Miscellaneous Fees State filing fees vary, commonly $100 to $400 depending on case type and jurisdiction. The waiver typically also covers service of process through the sheriff or similar court officer.
Several costs are usually not waived:
- Deposition transcript costs charged by the court reporter.
- Expert witness fees.
- Private process server fees if you choose that over the sheriff.
- Photocopying beyond a reasonable initial allowance.
A waiver also isn’t always permanent. If you win at trial, the court may order the losing party to pay your waived fees. Some jurisdictions place a lien on settlements above a certain threshold, so the waived fees come out of the settlement before you receive the balance. If your finances improve during the case and you don’t tell the court, you can be ordered to repay the waived amounts and face sanctions. And if the court later finds the information in your affidavit was inaccurate, it can revoke the waiver and order payment. Treat the affidavit as an ongoing representation of your financial condition, not a one-time snapshot.