State Agency Assistance Request Form

To be able to submit this form, please first enter your address below to verify you are in our district.

First Name *

Last Name *

Address *

City *

Zip Code *

Phone Number

Ext.

Phone Number Type

Do you already have an open case with our office? *

Yes

What state agency do you need assistance with? *

Department of Motor Vehicles (DMV)

Franchise Tax Board (FTB)

Department of Consumer Affairs (DCA)

State Controller's Office (Unclaimed Property)

Other

If you selected other, please specify here.

If other, please specify the agency.

Have you already reached out to the State Agency in an attempt to resolve this issue on your own? *

Yes

If so, when was the last time you were in contact with the State Agency?

Please provide a brief description or any additional information you think we should know regarding your case. *

If you need DMV assistance, please answer the questions below. Otherwise, you are ready to submit.

For DMV: What do you need assistance with?

License Application / Renewal

Real ID

Vehicle Registration

Vehicle Title Transfer

Other

If you selected other, please specify here.

For DMV: What issue(s) are impacting you?

Select all that apply

Financial Constraints

Lack of Information

Missing Forms

Online Portal Access

Other

If you selected other, please specify here.

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