AO 240

Application to Proceed in District Court Without Prepaying Fees or Costs (Short Form)

Agency
U.S. Courts
Revision
Rev. 07/10
Fillable fields
28
Pages
2
Official source
U.S. Courts form page
Checked
October 20, 2026
Fill AO 240 online
Page 1 of form AO 240

Form AO 240: Application to Proceed in District Court Without Prepaying Fees or Costs

Form AO 240 is the Short Form of the Application to Proceed in District Court Without Prepaying Fees or Costs, published by the U.S. Courts. It opens with a declaration by a plaintiff or petitioner in a United States district court case that they are unable to pay the costs of the proceedings and are entitled to the relief requested. The answers that follow are given under penalty of perjury.

The form asks where the applicant is held if incarcerated, their job and pay, other income in the past 12 months, cash and bank balances, property, regular monthly expenses, dependents and debts. The U.S. Courts lists it under Fee Waiver Application Forms, effective on July 1, 2010, and the printed form is marked Rev. 07/10.

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Top of page 1 of Form AO 240: Application to Proceed in District Court Without Prepaying Fees or Costs, as printed by COURTS

What's on Form AO 240

Case caption

The district court and district, the plaintiff or petitioner, the defendant or respondent, and the civil action number.

Questions 1 and 2: custody and work

Where the applicant is held, if incarcerated, or the employer's name and address, gross pay, take-home pay and pay period, if not.

Question 3: other income

Yes or no for six sources in the past 12 months: self-employment; rent, interest or dividends; pension, annuity or life insurance; disability or worker's compensation; gifts or inheritances; and any other source. Each yes is described with the amount received and the amount expected.

Questions 4 and 5: money and property

Cash and checking or savings balances, and any automobile, real estate, stock, bond, trust, jewelry, art work or other thing of value, including items held in someone else's name, with approximate values.

Questions 6 to 8: expenses, dependents and debts

Regular monthly expenses such as housing, transportation, utilities and loan payments; each dependent's name, or initials if under 18, with the relationship and the support given; and debts with amounts and to whom they are owed.

Declaration and signature

A declaration under penalty of perjury that the information is true, noting that a false statement may result in a dismissal of the claims, then the date, signature and printed name.

How to fill out Form AO 240

  1. 1

    Fill in the caption

    Enter the district, the plaintiff or petitioner, the defendant or respondent and the civil action number.

  2. 2

    Answer question 1 or 2

    Question 1 is for applicants who are incarcerated and question 2 for those who are not. An incarcerated applicant with a job or account at the institution attaches the certified six-month statements the form describes.

  3. 3

    List other income

    Check yes or no for each of the six income sources in question 3. For each yes, describe the source and the amounts below or on separate pages.

  4. 4

    Describe money, property, expenses and debts

    Give cash and bank balances, things of value with approximate values, monthly expenses, dependents and debts in questions 4 to 8.

  5. 5

    Sign the declaration

    Date the form, sign it and print your name. The answers are given under penalty of perjury.

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Court, fees and attachments

Court

The form is captioned for a United States District Court in a named district, in a case with a civil action number. The form and its U.S. Courts page do not give submission instructions.

Fees and costs

The form asks to proceed without prepaying fees or costs. It does not list fee amounts; the court sets them.

Attachments

Certified institutional account statements for applicants who are incarcerated, and separate pages for describing other income if needed.

Version

The U.S. Courts page lists AO 240 as effective on July 1, 2010. The printed form is marked Rev. 07/10.

Related forms

Who uses Form AO 240?

  • Plaintiffs and petitioners

    The form opens with "I am a plaintiff or petitioner in this case" and a declaration of being unable to pay the costs of the proceedings.

  • Applicants who are incarcerated

    Question 1 asks where the applicant is held. If employed there or holding an account there, the form says to attach a certified statement of the account for the last six months, plus one from any other institution held in during that time.

  • Applicants who are not incarcerated

    Question 2 asks an employed applicant for the employer's name and address, gross pay, take-home pay and the pay period.

  • Anyone comparing the short and long form

    The U.S. Courts forms list has two versions of this application under Fee Waiver Application Forms: AO 240, the Short Form, and AO 239, the Long Form. The AO 240 page does not say when to use which.

The form is written for a plaintiff or petitioner in a federal district court case. Its first questions depend on whether the applicant is incarcerated.

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Questions about Form AO 240

What is the difference between AO 240 and AO 239?

The U.S. Courts forms list has AO 240 as the Short Form and AO 239 as the Long Form of the Application to Proceed in District Court Without Prepaying Fees or Costs, both under Fee Waiver Application Forms. The AO 240 page does not say which one a court expects.

Is Form AO 240 signed under penalty of perjury?

Yes. The form says the answers are given under penalty of perjury, and the declaration says a false statement may result in a dismissal of the claims.

What does an incarcerated applicant attach?

If employed at the institution or holding an account there, the form says to attach a statement certified by the appropriate institutional officer showing all receipts, expenditures and balances for the last six months, plus a similar statement from any other institution where the applicant was held in that time.

How are dependent children listed?

Question 7 asks for the names of everyone who depends on the applicant for support, using initials only for anyone under 18, along with the relationship and how much the applicant contributes.

Does Form AO 240 show the filing fee?

No. The form and its U.S. Courts page do not list fee amounts. The court sets its fees and costs.

Can I add pages to Form AO 240?

Yes. Question 3 says to describe each other income source and amount below or on separate pages.