Use this form for continued Verification of Ignition Interlock Assistance. It must be filled out by the Ignition Interlock Installer upon each calibration. (For use only by Drivers already pre-approved for Ignition Interlock Assistance.)
This document is a Wyoming state form used to apply for financial assistance towards the cost of installing and maintaining an ignition interlock device (IID) for individuals eligible for the Supplemental Nutrition Assistance Program (SNAP). The document includes spaces for the applicant's personal information, including their name, date of birth, address, and Wyoming driver license number. Applicants must certify they are eligible for SNAP benefits. The form also provides instructions on mailing or faxing it to the appropriate WYDOT - Driver Services office, as well as a section for the installer's information and service details.
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