Mobility Wallet Pilot Program

As a participant in the Mobility Wallet Pilot Program, I affirm that I am 18 years or older and that the information provided on this application for myself and my household, including the annual household income, is true and correct. I understand that the Mobility Wallet Pilot Program reserves the right to verify my household income, and I will notify the program if I no longer qualify for the benefits.

I acknowledge that neither I nor any household member is participating in the Mobility Wallet Pilot program under a different name. I understand that my first name, last name, address, phone number, email address, birthdate, gender, income bracket and number of household members will be securely stored in the Mobility Wallet Pilot database and only accessed by participating Mobility Wallet Pilot Program agencies.

I agree to the terms and conditions described above. By failing to adhere to the terms and conditions, I or any household member will be disqualified from participating in the Mobility Wallet Pilot Program.

You must live in one of the Los Angeles zip codes deﬁned below to participate in the program:

Program Zip Codes
90007	90016	90062
90008	90018	90089
90011	90037
90015	90043

Household Size and Income

To be elegible for the program, your household size and annual income must meet a defined bracket below:

Household Size =	Annual Income =
1 person	$41,400 or less
2 people	$47,300 or less
3 people	$53,200 or less
4 people	$59,100 or less
5 people	$63,850 or less
6 people	$68,100 or less