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Marin Access Low-Income Fare Assistance Eligibility Appeal

Use this form to submit a request to appeal your LIFA eligibility determination. 

All requests for an appeal must be received by Marin Access within 30 days of issuance of denial of eligibility. In all cases, the appeal process will be concluded as expeditiously as possible. You have a right to a timely decision. The appeals decision will be final upon mailing of the written determination. When an appeal is received, we will review the request along with all supporting documentation provided and issue a decision in writing. The appellant may elect to have a representative provide documentation or information in their place if additional documentation or information is requested by Marin Access staff.

Should the appeal be successful, and you are determined eligible, eligibility and benefits will be granted starting the date of the appeal decision.

Your Marin Access ID can be found on the letter mailed to you or by request to the Travel Navigator team.

If you have any questions about how to complete this form, contact the Marin Access Travel Navigators at 415.454.0902.

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* 1. First Name:

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* 2. Last Name:

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* 3. Marin Access ID:

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* 4. Please explain why you are appealing your eligibility determination. 

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* 5. Upload additional documentation here.

PDF, DOC, DOCX, JPG, JPEG file types only.
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* 6. Check ALL of the the boxes below to agree to each statement.

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