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PIP Form
[English]
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Case Number
*
Your answer
Court Department
*
Antelope Valley Department A22.
Chatsworth Department F44.
Compton Department 7.
Inglewood Department 1.
Long Beach Department S13.
Norwalk Department W.
Pasadena Department R.
Santa Monica Department S.
Van Nuys Department H.
West Covina Department 2.
Stanley Mosk Department 46
Stanley Mosk Department 66
Stanley Mosk Department 91
Stanley Mosk Department 93
Stanley Mosk Department 97
Other:
Phone
*
Your answer
Email
*
Your answer
FULL Address including ZIP CODE
*
Your answer
Year the building was Built (use google or look on zimas website)
Your answer
How much is your monthly rent? (example: $1,000/mo)
*
Your answer
How many bedrooms?
*
0 bedrooms.
1 bedroom.
2 bedrooms.
3 bedrooms.
4 bedrooms.
5 bedrooms.
Other:
Number of units/apartments on the lot (if its a single family home answer with SFH)
*
Your answer
When did you move in?
*
Your answer
How many adults over 65?
*
No adults over 65
1 adult over 65.
2 adults over 65.
3 adults over 65
4 adults over 65
5 adults over 65
Does anyone in the home have a medical disability?
*
Yes, someone in the home is disabled.
No one with a disability.
Other:
Total Number of adults in the home
*
1 adult.
2 adults.
3 adults.
4 adults.
5 adults
Other:
How many children under the age of 18 in the home?
*
1 child.
2 children.
3 children.
4 children.
5 children
6 children
0 Children.
7+ kids in the home
What is the name of your landlords attorney? (OC/ Opposing Counsel)
Your answer
Name of the notice you first received
*
3 day pay rent or quit / move out.
3 day perform covenants or quit / move out.
3 day quit / move out
10 or 15 day pay rent or quit / move out
30 day notice to pay rent or quit / move out
30 day notice to quit/ vacate
60 day notice to quit/ vacate.
Other:
If the notice is a PAY OR QUIT, what months are they demanding? List all by MONTH/YEAR (ex. June/2023)
Your answer
Who helped you file your answer? (name of agency or self help center)
*
Your answer
Date answer filed?
Your answer
Did an attorney review your answer?
*
Yes an attorney reviewed my answer.
No an attorney did not review my answer.
Have you completed EDN intake?
*
I completed EDN intake online.
I completed EDN intake in person.
I have not completed EDN intake yet.
Ive completed EDN intake in person and online.
Have you signed Limited Scope Agreement with EDN?
*
Yes, I signed the EDN Limited Scope Agreement.
No, I have not signed the EDN Limited Scope Agreement.
Other:
Have you completed a StayHousedLA.org application?
*
Yes Ive applied at SHLA.
No I have not applied at SHLA but will do it as soon as I’m done with this PIP.
Are you in a Stay Housed LA priority zip code?
*
Yes priority zip code.
Not a priority zip code.
What is your goal?
*
I want/need to stay in my home.
I want/need to move out.
I want to move out and I have a place to go.
I want to move out but need more time.
I want to stay / My rental assistance is pending & I can pay my rent moving forward.
Had Step 10 meeting?
*
Yes, I had a Step 10 meeting.
No step 10 meeting yet.
Demanded jury?
*
I demanded a Jury.
I did NOT demand a Jury.
File FW002 or pay $150 jury fee?
*
Filed FW-002 fee waiver.
Paid $150 Jury Fee.
I have not submitted jury fee waiver or paid the $150 fee.
How many court appearances so far?
*
0 appearances.
1 appearance.
2 appearances.
3 appearances.
4 appearances.
5 appearances.
6 appearances.
7 appearances.
8 appearances
9 appearances
10 appearances
Other:
When is your next court appearance ? Please type it in like this:
Next Court Date is 03/02/2025
Your answer
[Discovery] Have you received any of the following packets via overnight mail? (Check all that apply)
*
I have not received discovery
Form Interrogatories (General)
Form Interrogatories (Unlawful Detainer)
Plaintiff's Request for Admissions
Plaintiff's Request for Production of Documents
Plaintiffs Request for Special Interrogatories
Required
[Exchanging of Documents] Have you received any of the following packets via overnight mail? (Meet & Confer)
*
I have not received plaintiff’s Trial Documents
Plaintiff's Statement of the Case
Witness List
Exhibit List
Jury Instructions
Verdict Instructions
Required
List your questions or requests here:
Your answer
Send me a copy of my responses.
Submit
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