Fillable Revised: December 2020 EquiPass Customer Information Sheet PLEASE

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Revised: December 2020 EquiPass Customer Information Sheet PLEASE

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EquiPass Customer Information Sheet
Revised: December 2020
PLEASE KEEP FOR INFORMATION
You could be eligible for the EquiPass Program if:
You are a resident in the City of Ottawa and you or your family have an income that is below
the listed amount
You have family members who are not eligible for the Community Pass
A child under 18 years of age in a family in receipt of Government Assisted Refugee
Program
You are a privately sponsored refugee or inland claimant
In order for you and your family members to obtain an EquiPass discount, you must fill out an
application, provide required documentation and have your application approved.
You are NOT eligible for the EquiPass if you are:
The primary benefit recipient of Ontario Disability Support Program (ODSP) benefits. You are
eligible for a less expensive Community Pass
Currently a person in receipt of transportation benefits from Community and Social Services,
including but not limited to Ontario Works benefits. If this changes, you may become eligible.
Currently a person in receipt of transportation benefits from the Government Assisted Refugee
Program (RAP). After your first year you may become eligible. All children under 18 years of
age are eligible.
A person 65 years or older. You are eligible for a less expensive Senior 65+ Pass.*
Individuals are only entitled to one fare discount. Seniors who meet the income level entry and
benefit more from the EquiPass discount over the senior discount will be assessed upon
request on a case-by-case basis.
A student who receives a School Board issued bus pass during the school year. The parent or
guardian of the student who is aged 17 years old or younger may apply for the student during
non-school months.
A student who receives a U-Pass. You may apply for EquiPass eligibility during periods when
you do not have full-time status. Approval is contingent upon your annual income.
What do I need to submit with my application?
The following must be included with the completed application and must be included for all members of the
household listed on the application.
Family or Single Applicants:
A photocopy of your 2019 or 2020 Notice of Assessment (NOA) from Canada Revenue Agency.
(Provide copies only - no documents will be returned).
Parents or guardians with dependents 17 years and under must provide a copy of the Canada Child
Benefit (CCB) or Ontario Child Benefit (OCB) statement.
Applicants who have never filed income tax:
If you are aged 18 or 19 or have never filed an Income Tax return, please include:
A copy of your most recent three (3) pay stubs for any and all job(s) held in the last 12 months and / or
any
annual Income Slips (e.g. T4, T4A, or other) you may have received to date
Note: The EquiPass discount in this circumstance is set for one year. To be considered for an
E
quiPass after the first year, you will be required to re-apply and provide a Notice of Assessment
(NOA) after filing your income taxes for that year.
Refugees or Newcomers
If you are recent refugee/newcomer to Canada, but have not filed a tax return:
A copy of your Record of Landing (Citizenship and Immigration Canada (CIC) form IMM 1000) and
Sponsorship agreements or payments, including Refugee Assistance Program cheque stubs, if applicable.
□
□
Revised: December 2020
•
•
•
•
•
•
A copy of your Refugee Status Documentation IMM1442 (Forms IMM1263 and 5292 may
also be considered).
A copy of an Ontario Works (OW) or Ontario Disability Support Program (ODSP) benefit stub
for the current month.
If currently employed, a copy of your most recent three (3) pay stubs for any and all job(s)
held in the last 12 months and / or any annual Income Slips (e.g. T4, T4A, or other) you
may have received to date.
If you are privately sponsored, a letter from your sponsor/sponsoring group is required to
confirm your monthly or annual income.
Note: The EquiPass discount in this circumstance is set for one year. To be considered for
an EquiPass after the first year, you will be required to re-apply and provide a Notice of
Assessment (NOA) after filing your income taxes the following year.
If the above information does not cover your personal situation, please contact us.
If you are unable to provide the documentation above, please contact OC Transpo at EquiPass@ottawa.ca
or 613-741-4390 for more information.
Customers who are Deaf or who have hearing loss can use the relay service
offered by their service provider or call 711 with a TTY to contact OC Transpo
Where do I send my completed application?
Application must be in a sealed envelope, addressed to “OC Transpo – Attn: EquiPass Applications”
By Mail:
OC Transpo
Attn
: EquiPass Applications
925 B
elfast Road
Ottawa, ON K1G 0Z4
By Fax:
613-746-7648
In person:
OC Transpo Customer Service Centres:
Rideau Centre – 3
rd
Floor
Please contact OC Transpo at 613-741-4390
f
or hours of operations.
OR contact OC Transpo at 613-741-4390 for other
options
City of Ottawa Client Service Centres:
City Hall / Laurier (110 Laurier Avenue
W
est)
Ben Franklin Place / Nepean (101
Centrepointe Drive)
Kanata (580 Terry Fox Road)
Orl
éans (255 Centrum Blvd.)
For
your own tracking, please record:
Date Application Sent
Method of Delivery or Location of Drop Off
Mail
Drop Off
Location:
Remember to include copies (as applicable):
Notice of Assessment (NOA)
Canada Child Benefit (CCB) or Ontario Child Benefit (OCB) statement
Most recent three (3) pay statements for all positions held within the last 12 months. Landing
Document/RAP cheque stub/Sponsor Letter
Did
all members of the household 18 years and older sign the application? Yes
□ No □
Revised: December 2020
Frequently Asked Questions:
What is an EquiPass?
The EquiPass is a discounted pass or single-ride fare available to persons whose income is below the Low Income
Cut Off (LICO) set by the Government of Canada.
Can the EquiPass be shared?
No. The EquiPass is no
t transferable. Each member of the family must have their own EquiPass discount set on
their own individual Presto card. Only one EquiPass discount is allowed per person and duplicates will be
c
ancelled.
How do I know if I am eligible for the EquiPass discount?
The family income for the household must be below the low-income level set annually by the Government of
Canada. The chart below is an example of the 2019 LICO levels.
Income Eligibility based on 2019 LICO Rates:
Family size
2019 Annual net
1 person
$21,899
2 persons
$26,653
3 persons
$33,189
4 persons
$41,406
5 persons
$47,148
6 persons
$52,289
7 or more persons
$57,429
I am over 18 but live with my family or parents, am I eligible?
You can apply and be considered. Adult children living at home or other household members 18 and over must
apply separately and are considered separately.
What if we are two families or have non-family members living in the same house?
Family members residing at the same address include parent(s), spouses and any dependents 17 years and
under. If there is another family or relatives residing at the same house, separate applications must be completed.
Single adults over 18 living in the same household must complete their own application.
How do I get my EquiPass discount?
If you are applying for the Presto discount for the first time, a new Presto card with the EquiPass discount will be sent to
you at no charge and you will be required to register the Presto card within 30 days of receipt.
If you are renewing your EquiPass discount, please provide the Presto card number registered in your name, and
the EquiPass discount will be set up for you remotely. If your current Presto card has been lost, you will need to
purchase a new unregistered Presto card for $6 (minimum funds load may be required, depending on location) and
transfer your old card information, including registration, to the new card prior to applying and ensure the new
Presto card number is on your application so that the discount can be set remotely.
How do I load an EquiPass discount that was sent to me remotely?
You must query or use your Presto card within 30 days of being notified that the discount is being loaded. You can
query you card at various locations, including an OC Transpo Ticket Machine, at a Shoppers Drug Mart / Loblaws /
Real Canadian Superstore, at an OC Transpo Customer Service Centre or select City of Ottawa Client Service
Centres, or you can tap your card to pay a fare on any OC Transpo bus or O-Train.
I am a Para Transpo customer, how do I get my EquiPass discount?
When you fill out your application, please ensure that the Para Transpo customer number for each eligible family
member is included. If you use ParaPay, the EquiPass program office will notify Para Transpo and have the EquiPass
discount applied to your account. If you use both Para Transpo and OC Transpo, you will need to follow the directions
above to apply the discount to your Presto card.
I get a pass from my school (U-Pass / School Board pass) – am I still eligibie for EquiPass?
You can apply for the EquiPass for the months when you are not receiving a U-Pass or School Board pass (e.g.
during summer months). Make sure you apply at least 6 to 8 weeks before your school pass expires. If you’re not
sure if you’re going to receive a U-Pass or School Board pass, check with your school first.
Revised: December 2020
How long is my EquiPass discount valid for?
Your EquiPass discount will be valid for around two years based on your birthday. Some applicants with limited
documentation will need to renew after one year when they obtain an income tax Notice of Assessment. Your
EquiPass expiry date will be set out in the approval letter you receive from OC Transpo. You can also view your
expiry date on your account online at prestocard.ca.
Do I need a Presto card?
If you are riding on buses or O-Train, yes. The EquiPass discount is only available on Presto. For Para Transpo
customers, the discount can be also set on your ParaPay account.
Why do I have to register my Presto card?
Because the EquiPass discount is non-transferable, you are the only person who can use your Presto card. So
you must ensure that your Presto card is registered before applying, or, if you get a new card, is registered within
30 days of the discount being set. If your card is not registered and it has an EquiPass discount applied, it may be
cancelled.
How long does it take to get my EquiPass discount?
The application approval process will time is currently a minimum of 30 business days (or approximately six (6)
weeks) once your application is received. Higher volumes may cause longer approval times at certain times of
year (such as in April). For mailed applications, please allow extra delivery time for applications.
I have not received a reply. What do I do?
You can contact equipass@ottawa.ca or 613-741-4390 to check on the status of your application. Customers who
are Deaf or who have hearing loss can use the relay service offered by their service provider or call Bell Relay at
1-800-855-0511 to contact OC Transpo Please do not contact us before 30 business days (or approximately six
(6) weeks) after your application was sent.
☐
☐
☐ ☐
EquiPass Application and Consent Form
October 2020
Name of Primary (Main) Applicant:
Application Reference #: (OC Transpo Use Only)
Street Address:
City / Province:
Unit / Apt #:
Postal Code:
Telephone Number:
Primary:
Alternate: Work
Cell
Mailing Address (if different from above):
Postal Code:
E-mail Address:
E-mail Phone Mail
Household (Family) Composition
All family members (spouse/partner and/or children 17 years and under) must be included on this application along with all required documents.
Income verification will be based on the number of parents and dependent children under 18 in the family.
If more than one family or an adult child resides in the household, a separate application form should be submitted per family or adult child.
Single adults must file a separate application.
If you have more than 6 people in your household (family) please add an additional page and provide all required information for each applicant.
$
☐ – _ _ _ _ _ _ _ _ _ _ _ _
☐
$
☐ – _ _ _ _ _ _ _ _ _ _ _ _
☐
Applicant
#
Name of Household Member
Relation to Primary
Applicant
Date of Birth
(dd/mm/yyyy)
Annual NET income
(line 236 of Notice of
Assessment [NOA])
Supporting Documents
Submitted (NOA or pay
stubs or CCB)
Applying for an EquiPass?
If yes, if you have a registered Presto card, please
provide the card number
1
I am the primary (main)
applicant, and I am over
18 years old
Yes
No
Presto # 312401
2
I am the spouse/common-
law of the primary
applicant
Yes
No
Presto # 312401
☐
☐
$
☐ – _ _ _ _ _ _ _ _ _ _ _ _
☐
3
Child (17 years or under)
Other
Yes
No
Presto # 312401
☐
☐
$
☐ – _ _ _ _ _ _ _ _ _ _ _ _
☐
4
Child (17 years or under)
Other
Yes
No
Presto # 312401
☐
☐
$
☐ – _ _ _ _ _ _ _ _ _ _ _ _
☐
5
Child (17 years or under)
Other
Yes
No
Presto # 312401
☐
☐
$
☐ – _ _ _ _ _ _ _ _ _ _ _
☐
_
6
Child (17 years or under)
Other
Yes
No
Presto # 312401
☐
☐
$
☐ – _ _ _ _ _ _ _ _ _ _ _ _
☐
7
Child (17 years or under)
Other
Yes
No
Presto # 312401
☐
☐
$
☐ _ _ _ _ _ _ _ _ _ _ _ _
☐
–
8
Child (17 years or under)
Other
Yes
No
Presto # 312401
☐
☐
☐
☐
☐
☐
☐
☐
Part 2 – Describe Your Current Situation
1.Is anyone in your household/family new to Canada in the last
18 months?
Yes
No
1 (a). If yes, please provide supporting documents, including but
not limited to Landing Documents, Refugee Assistance Program
(RAP) pay stubs, or other payment statements.
1 (b). If yes, do you currently receive transportation allowance
from the Government of Canada Refugee Assistance Program
(RAP)
Yes
No
Applicant #
2. Is anyone in this application a Para Transpo client?
Yes
No
2 (a). Please provide all applicable Para Transpo client numbers.
Applicant #: Para Transpo ID:
Applicant #: Para Transpo ID:
Applicant #: Para Transpo ID:
Do you need help to communicate with us?
Yes
No
If yes, please provide an alternate contact below.
Alternate Contact Name:
E-mail address: Day Telephone Number:
Relationship to Applicant(s):
Part 3 – Declaration, Consent to Verify Information, and Agreement to EquiPass Program Terms and Conditions
By signing, all applicants age 18 and older acknowledge that the City of Ottawa retains sole discretion to
approve or deny any application and:
1.
Confirm that the information provided on this form and supporting personal financial documents are
true, complete and accurate;
2.
Consent to OC Transpo exchanging personal financial information with the City of Ottawa Community
and Social Services Department, the Ministry of Community and Social Services, the Government of
Canada, the Government of Ontario or any agency, ministry or department of any of the foregoing for
the
sole purpose of determining and verifying eligibility for an EquiPass; and
3.
Agree to the EquiPass Program Terms and Conditions below.
The information collected on this form is necessary for the proper administration of the EquiPass program. The
EquiPass fare category was approved by Council on December 14, 2016 and authorized under Section 8 and
Schedule “C” to the City of Ottawa Transit By-law 2007-268, as amended. Information collected will be used to
determine initial and ongoing eligibility for EquiPass, administer EquiPass services, and enforce EquiPass Terms
and Conditions. All personal financial documents provided in support of this application will be destroyed after the
application is processed. If you have questions about the EquiPass program or the collection/retention of personal
information, please contact the Transit Information Centre at 613-741-4390
or by e-mail at
EquiPass@ottawa.ca .
Customers who are Deaf or who have hearing loss can use the relay service offered by their
s
ervice provider or call 711 with a TTY to contact OC Transpo.
EquiPass Program Terms and Conditions
The EquiPass is for the sole use of the registered user and is not transferable.
The EquiPass user must have in their possession and be prepared to present valid photo
identification
upon request.
EquiPass must be loaded on a PRESTO card registered to the eligible customer(s).
EquiPass Applicants are responsible for ensuring that all members of the household are
aware of these terms and conditions and shall notify the EquiPass program by e-mail at
EquiPass@ottawa.ca
or by phone at 613-741-4390 or in person prior to purchasing an
EquiPass
monthly pass if there is a change in address or change in personal or family
circumstances that may
impact program eligibility including a change in income.
Duplicate applications or pass purchases or failure to register a card will result in
cancellation of additional passes or Presto
cards and may result in revocation of
EquiPass eligibility status.
Failure to comply with these terms and conditions or providing incomplete/inaccurate
information
when applying or renewing an EquiPass may result in loss of eligibility for the
EquiPass program, cancellation of the Presto card(s), and/or a fine under City of Ottawa
Transit By-law 2007-268 as
amended.
Accessible formats and communication supports are available on request.
Applicant # Print Name Signature Date
1
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Revised: December 2020 EquiPass Customer Information Sheet PLEASE

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Completed 8 January 2021

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