📝 Important: Please Complete the Form in Full

To avoid delays or closure of your case file, please ensure that all required fields in the form are completed. Missing information—such as a Social Security number or contact details for the other party—can prevent us from processing your request.

🔒 This form is submitted via a secure server, and your information is protected.

We will use the details you provide to determine if you may be eligible for no-cost services. We usually have eligibility results in two business days.

⏳ Wondering Why Your Case Is Delayed?

The most common reasons for delays include:

• Incomplete form submission
  (e.g., missing Social Security number or contact information for the other party)

• Submission during a weekend or holiday
  Our office, along with the Jefferson City office, is closed on weekends and state/federal holidays. Cases are processed only on business days.

• Pending contract provider assignment
  Your case may be awaiting confirmation from a contract provider for next steps.

If you have questions about your submission, please don’t hesitate to reach out. We appreciate your patience!