Homepage Fill Your Massachusetts Disabled Parking App Form
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Securing accommodations for disabled parking in Massachusetts is a streamlined process, thanks to their comprehensive Application for Disabled Parking Placard/Plate. This form, which must be sent to the Medical Affairs office in Boston, is designed to be filled out with the disabled person’s information, requiring sections A through E to be meticulously completed. It's vital to submit the application within thirty days of a healthcare provider's certification, emphasizing the importance of timely action. Notably, service centers do not handle these applications, highlighting the specific procedural path that must be followed. Applicants and healthcare providers alike play crucial roles, with dual signatures mandating the application’s validity. The form caters to various needs, offering placards and plates for vehicles, including motorcycles, and even provides for disabled veterans through DV plates contingent upon meeting specific criteria. Illegally using or acquiring these placards is subject to severe penalties, underscoring the seriousness with which Massachusetts treats the provision and misuse of disabled parking privileges. Healthcare professionals are tasked with not just endorsing a patient's need but also evaluating their ability to safely operate a vehicle, a responsibility bearing legal and ethical weight. This comprehensive approach ensures that disabled parking accommodations are both accessible to those in genuine need and guarded against misuse, reflecting Massachusetts' commitment to fostering an inclusive and lawful community mobility environment.

Massachusetts Disabled Parking App Sample

Application for Disabled Parking Placard/Plate

Mail to: Medical Affairs, PO Box 55889, Boston, MA 02205-5889857-368-8020mass.gov/rmv

This side of application must be completed in the disabled person’s name.

Please note the information required in this application may affect your driver’s license.

Incomplete application will not be processed and will be returned.

Both disabled person and healthcare provider must sign and date this application. The disabled person’s information must be provided in sections A, B, and C. The healthcare provider must complete sections D and E.

This application must be submitted to Medical Affairs within thirty (30) days of the healthcare provider’s certification.

RMV Service Center locations do not process disability parking applications; dropping off at a service center location may add processing time.

Additional documentation may be required.

A. Disabled Applicant Information – All fields must be completed

Last Name

 

 

First Name

 

 

 

Middle Name

 

Suffix

 

 

 

 

 

 

 

 

 

Date of Birth (MM/DD/YYYY)

Current Massachusetts Learner’s Permit, Driver’s

Gender

 

What is your Social Security Number?

 

 

License # (if applicable) or MA ID

 

M F X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residential Address (Where you

actually reside)

 

 

 

 

 

 

 

Street (including #)

 

Apt. #

City

 

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

Mailing Address

(same as above)

 

 

 

 

 

 

 

Street (including #)

 

Apt. #

City

 

 

 

State

Zip Code

 

 

 

 

 

 

 

 

Email

 

 

 

 

 

Phone Type

Phone #

 

 

 

 

 

 

Cell

Home Work

 

 

 

 

 

 

 

 

 

 

 

 

 

Emergency Contact Information: (optional)

Email

Name

Phone Type

Cell Home Work

Phone #

B. Service Type

Type: Placard

No fee required for a placard. Disabled person is not required to have a vehicle registered in his/her name.

Plate

Only issued to individual who is primary owner with vehicle registered in his/her name. Registration fees apply.

Motorcycle Plate

Only issued to individual who is primary owner with vehicle registered in his/her name. Registration fees apply.

DV Plate

Only issued to individual who: a) is primary owner with vehicle registered in his/her name; b) provide the DV

 

(Disabled Veteran) Plate Letter from the Veteran’s Administration listing service-connected disabilities and total

 

combined rating; c) has qualifying conditions which meet Medical Affairs guidelines and total at least 60% of the

 

service-connected disability.

C. Certification and Signature of Applicant

Rules:

It is illegal to allow someone to use your placard if you are not in the vehicle.

It is illegal for an individual to have more than one placard (temporary or permanent).

It is illegal to provide false information (persons can be prosecuted under Massachusetts Law).

It is illegal to possess or display a counterfeit placard (altered or photocopied).

It is illegal to forge a healthcare provider’s signature.

Acknowledgment:

I have read the rules.

I understand misuse of disabled parking may result in high motor vehicle citation fines ($500, first offense), license suspension terms, and the revocation of my disabled parking privileges.

I certify under the penalty of perjury that all the information provided in this application, including the representation of my medical status/condition, is true and correct to the best of my knowledge.

AUTHORIZATION TO RELEASE MEDICAL RECORDS – I hereby authorize the healthcare provider completing this form to discuss and release any or all medical records pertaining to its content with or to representatives of the RMV.

For applicants for Disabled Veteran plates, I hereby authorize the Veteran’s Administration to release medical information concerning my service connected disability rating(s).

I have reviewed this completed Application Form and swear (affirm), under the penalties of perjury, that the information I have provided is true and complete.

I am aware that false statements are punishable by fine, imprisonment, or both under M.G.L. Chapter 90, Section 24B.

Signature of Disabled Person: ____________________________________________________ Date:__________________________

Applicant’s Name/Patient’s Name

Last 4 Digits of Social Security #

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MAB100_0821

D. Healthcare Provider Information – To be completed by Healthcare provider ONLY

Physician must complete the first question regarding medical qualification to operate a motor vehicle regardless of the patient’s license status or age. Failure to complete all sections will result in delayed processing and a request for more information about this patient.

In my professional opinion and to a reasonable degree of medical certainty:

The reported condition WILL NOT IMPAIR the safe operation of a motor vehicle.

The person applying for this permit is NOT medically qualified to operate a motor vehicle safely.

The medical condition as stated below is of such severity as to require a COMPETENCY ROAD TEST.

This application is completed for individuals who are severely restricted in mobility/ability to walk due to a neurological, orthopedic, arthritic, or other medically debilitating qualifying condition. I acknowledge the RMV grants disabled parking on the basis of necessity and not as a convenience. Disabled parking misuse carries heavy fines and strict license suspension penalties.

Clinical Diagnosis (Required):______________________________________________ (NO ICD CODES ACCEPTED)

Duration of placard to be issued (check one): Temporary Permanent

If temporary, please estimate number of months of disability: __________

Please check ALL that apply:

Unable to walk 200 feet without stopping to rest; list any necessary ambulatory aids: _____________________________

Legally Blind* (Certificate of Blindness may substitute for professional certification). *automatic loss of license

Chronic Lung Disease To such an extent that the applicant’s forced (respiratory) expiratory volume for one second, when measured by spirometry, is less than 1 liter (attach most recent FEV1 Test results):

______ FEV 1 test result

_____ O² saturation with minimal exertion (*automatic loss of license if O² saturation ≤ 88%)

Use of Portable Oxygen?

Yes No

NOTE: Asthma alone is not a qualifying condition. Please describe degree and frequency of impairment (pulmonary function test results are required).

_______________________________________________________________________________________________

Cardiovascular Disease

AHA Functional Classification (check one): I II III IV* (*automatic loss of license)

Loss of Limb or permanent loss of use of a limb (please describe):

E.Healthcare Provider Certification and Signature – All fields must be completed

Provider’s Last Name (please print)

 

 

Provider’s First Name

 

 

 

 

 

 

 

 

Provider’s Address

 

 

 

 

 

 

Street

 

Apt. #

City

 

State

Zip Code

NPI #

 

Board of Registration in Medicine #

 

Phone #

 

 

 

 

 

 

I am a: Medical Doctor

Chiropractor Registered Nurse

Physician Assistant Osteopath Optometrist (legal blindness only)

Podiatrist

 

 

 

 

 

 

I certify under the penalty of perjury that the information I have provided is true and correct to the best of my knowledge.

Provider’s Signature: ___________________________________________________________ Date: _______________________

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MAB100_0821

Form Breakdown

Fact Detail
Application Submission Must be mailed to Medical Affairs at the given address within 30 days of the healthcare provider's certification.
Signatory Requirements Both the disabled person and their healthcare provider must sign and date the application.
Processing Locations RMV Service Center locations do not process disability parking applications. Applications must be mailed.
Documentation Additional documentation may be required beyond the initial application.
Service Types Offered Options include Placard, Plate, Motorcycle Plate, and DV Plate, each with specific eligibility criteria.
Legal Consequences Misuse of disabled parking can result in fines, license suspension, and the revocation of parking privileges.
Governing Law Massachusetts Law Chapter 90, Section 24B outlines the penalties for falsification and misuse regarding the disabled parking application and privileges.

How to Write Massachusetts Disabled Parking App

Filling out the Massachusetts Disabled Parking Application form is a necessary step for individuals seeking disabled parking privileges, whether it's for a placard or plate. This process requires careful attention to detail and complete information from both the applicant and the healthcare provider. By following the steps below, applicants can ensure that their application is submitted accurately and within the required timeframe to the Medical Affairs office.

  1. Start by entering the disabled person's information in sections A, B, and C on the application form. This includes the full name, date of birth, Social Security number, residential and mailing addresses, email, phone numbers, and emergency contact information.
  2. In section B, select the type of service needed: Placard, Plate, Motorcycle Plate, or DV Plate, based on the applicant's specific needs and circumstances.
  3. Review the rules listed under section C, acknowledging the illegalities surrounding misuse of a disabled parking placard or plate, and certifying that all provided information is truthful and agreeing to the authorization to release medical records as required.
  4. Sign and date the application in the designated area at the end of section C.
  5. Have your healthcare provider complete sections D and E. This requires them to provide detailed medical information related to the disability, including the diagnosis, the impact on mobility, and the expected duration of the need for disabled parking. No International Classification of Diseases (ICD) codes are accepted, and specific protocols must be followed if the disability involves visual impairment, chronic lung disease, cardiovascular disease, or loss of limb.
  6. The healthcare provider must check whether the condition impairs the safe operation of a motor vehicle and sign and date the application, confirming the accuracy of the information they have provided.
  7. Ensure that all sections of the application are filled out completely. Incomplete applications will not be processed and will be returned. Both the disabled person and the healthcare provider must sign and date the application.
  8. Submit the application to Medical Affairs at the provided address within thirty (30) days of the healthcare provider's certification. Keep in mind that RMSortV Service Center locations do not process disability parking applications, and submitting it to a service center may result in additional processing time.

After submission, it is important to wait for communication from the Medical Affairs office regarding the status of your application or if additional documentation is required. Processing times can vary, so it is recommended to submit the application as soon as possible after receiving healthcare provider certification.

Discover More on Massachusetts Disabled Parking App

What is the process for applying for a Disabled Parking Placard or Plate in Massachusetts?

To apply for a Disabled Parking Placard or Plate in Massachusetts, the application must be completed with the disabled person’s information in sections A, B, and C, and the healthcare provider must complete sections D and E. Both the applicant and the healthcare provider must sign and date the form. The completed application must then be mailed to Medical Affairs at the address provided, within thirty days of the healthcare provider's certification. Please note that RMV Service Center locations do not process these applications.

Is there a fee for a Disabled Parking Placard in Massachusetts?

No, there is no fee required to obtain a Disabled Parking Placard in Massachusetts. However, registration fees apply for Disabled Parking Plates and Motorcycle Plates.

Can anyone drop off the Disabled Parking Application at an RMV Service Center?

No, RMV Service Center locations do not process disability parking applications. Dropping off the application at a service center location may add processing time. Applications should be mailed to the address provided for Medical Affairs.

What happens if an application is incomplete?

An incomplete application will not be processed and will be returned to the sender. It's important to ensure all sections are filled out accurately and completely, and that both the applicant and the healthcare provider have signed and dated the form.

Who can sign the Disability Parking Application form?

Both the disabled person applying for the placard or plate and their healthcare provider must sign and date the application form. It’s illegal to forge a healthcare provider’s signature.

Is it important to provide an email address and phone number on the application?

Yes, providing contact information such as an email address and phone number is crucial for communication purposes. It allows the Medical Affairs office to reach out if there are any questions or additional documentation is needed.

What are the consequences of misuse of a Disabled Parking Placard in Massachusetts?

Misuse of disabled parking may result in fines of up to $500 for the first offense, as well as potential suspension of the driver's license, and revocation of disabled parking privileges. It's illegal to allow someone to use your placard if you're not in the vehicle, to have more than one placard, or to provide false information on the application.

What medical conditions qualify for a Disabled Parking Placard or Plate?

The application must be for individuals severely restricted in mobility or ability to walk due to neurological, orthopedic, arthritic, or other medically debilitating conditions. Specific conditions listed include being unable to walk 200 feet without stopping to rest, chronic lung disease to a certain degree, cardiovascular disease within certain classifications, legal blindness, or loss of limb or permanent loss of use of a limb.

Can a temporary Disabled Parking Placard be issued?

Yes, the healthcare provider can specify if the placard is needed on a temporary basis by estimating the number of months of disability and checking the appropriate box on the application form.

How does one authorize the release of medical records for the application?

By signing the application, the applicant authorizes their healthcare provider to discuss and release any or all relevant medical records with representatives of the RMV. For Disabled Veteran plates, the applicant also authorizes the Veteran’s Administration to release information concerning their service-connected disability rating(s).

Common mistakes

When filling out the Massachusetts Disabled Parking Application form, applicants sometimes make mistakes that could significantly delay their request or even result in the application being returned. Let's highlight five common errors to avoid:

  1. Not completing the form in the disabled person's name: It's critical that all information provided in sections A, B, and C, is about the disabled person applying for the placard or plate. This may seem obvious, but misunderstandings can occur, especially when someone else is filling out the form on behalf of the applicant.

  2. Leaving fields incomplete: Every field in the application form is required unless stated otherwise. Sometimes people skip parts of the application, like the Social Security Number or the emergency contact information, thinking they are not important. However, incomplete applications will not be processed.

  3. Missing the healthcare provider's signature and incomplete sections D and E: The healthcare provider’s assessment is crucial for the application process. Both the signature and all sections completed by the healthcare provider must be thoroughly checked and filled out. Incomplete or missing healthcare provider information leads to delays or the return of the application.

  4. Not submitting within the required timeframe: The application must be submitted to Medical Affairs within thirty days of the healthcare provider’s certification. Failing to submit within this window can lead to unnecessary delays or the need to restart the application process.

  5. Misunderstanding the type of disabled parking aid needed: The form differentiates between placards and plates, including for motorcycles and DV (Disabled Veteran) plates. Each has specific requirements and implications. Applicants sometimes choose the wrong option due to not understanding the distinctions, which could affect the processing of their application.

To ensure the application process is smooth and successful, attention to detail and a thorough review of the completed form before submission are imperative. Doing so not only helps avoid these common mistakes but also expedites the acquisition of disabled parking aid, providing the applicant the support they need more promptly.

Documents used along the form

Applying for a Disabled Parking Placard or Plate in Massachusetts involves submitting the necessary Application for Disabled Parking Placard/Plate to Medical Affairs. However, it's important to remember that this application might require the support of additional documents to ensure a smooth and comprehensive process. Each supporting document plays a crucial role in establishing eligibility, providing detailed medical information, or meeting procedural requirements.

  • Proof of Residence: A document such as a utility bill, bank statement, or government correspondence that verifies the applicant's Massachusetts residential address.
  • Vehicle Registration: In the case of applying for a Disabled License Plate or DV Plate, the current registration document showing the applicant as the primary owner of the vehicle is necessary.
  • Certificate of Blindness: For individuals applying due to legal blindness, a Certificate of Blindness issued by the Massachusetts Commission for the Blind (MCB) is necessary to substitute for the healthcare provider's certification.
  • FEV1 Test Results: Applicants claiming disability based on chronic lung disease must provide the results of a Forced Expiratory Volume (FEV1) Test to demonstrate the extent of their impairment.
  • Physician’s Detailed Letter: Though the application includes a healthcare provider's certification, a detailed letter from the physician outlining the medical condition, its severity, and its impact on mobility can be vital, especially in complex cases.
  • Disabled Veteran (DV) Plate Letter: For DV Plate applicants, a letter from the Veterans Administration listing service-connected disabilities and the total combined rating is crucial.
  • Driver’s License or State ID: A copy of the applicant's valid Massachusetts Driver’s License or State ID is often required to verify identity and residency within the state.

It's not just about filling out an application; gathering the proper documentation is a critical step in securing Disabled Parking privileges. Attention to detail and ensuring all supportive paperwork accurately reflects the applicant's current situation and needs will contribute to a successful application process. Remember, each document adds clarity and weight to your application, moving you closer to acquiring the parking accommodations necessary for your day-to-day activities.

Similar forms

The Massachusetts Disabled Parking Application form shares similarities with other official documents designed to ensure accessibility and accommodate individuals with disabilities. These documents often require detailed personal and medical information, official signatures, and adherence to legal rules, reflecting a system-wide protocol to facilitate necessary accommodations.

One such document is the Application for Social Security Disability Benefits. Like the Massachusetts Disabled Parking Application, it requires comprehensive personal information, medical history, and the contact details of healthcare providers. Applicants must disclose their condition in detail, similar to how the parking application requires a healthcare provider’s assessment. Both documents underscore the importance of accuracy, warning of legal penalties for providing false information. They play crucial roles in providing necessary accommodations and support, highlighting the intersection of healthcare and legal systems in ensuring equity and accessibility.

Another document that parallels the Massachusetts Disabled Parking Application is the Handicap Parking Permit application seen in other states. Although specific requirements may vary, the foundation remains consistent: detailed personal and medical information must be submitted, along with healthcare provider certifications. Both documents emphasize the legal ramifications of misuse or falsification, showing a unified front across jurisdictions in protecting the rights and ensuring the safety of individuals with disabilities. This similarity underscores a nationwide commitment to accessibility and the importance of a stringent, yet streamlined process for acquiring necessary accommodations.

Lastly, the Federal Disability Report bears resemblance to the Massachusetts Disabled Parking Application, particularly in its requirements for detailed personal and medical information, including a section for healthcare provider certification. Both require the disclosure of conditions affecting mobility or daily activities, aiming to assess the need for special accommodations. The emphasis on legal consequences for false information or misuse of provided accommodations ties these applications together, demonstrating a shared effort to ensure these systems support those genuinely in need.

Dos and Don'ts

When filling out the Massachusetts Disabled Parking Application form, it’s vital to pay attention to detail and understand the do's and don'ts to ensure your application is processed smoothly. Here are some guidelines to follow:

  • Do fill out the application in the disabled person's name. The form requires that all sections be completed accurately to reflect the disabled individual's information.
  • Do not leave any fields blank. Incomplete applications will not be processed and will be returned, delaying the acquisition of your parking placard or plate.
  • Do ensure both the disabled person and the healthcare provider sign and date the application. These signatures are crucial for the validation of the form.
  • Do not submit the application after thirty (30) days of the healthcare provider's certification. Applications must be submitted within this timeframe to be considered valid.
  • Do mail the application directly to Medical Affairs. Dropping it off at a RMV Service Center location may increase processing time since these centers do not process disability parking applications.
  • Do not violate the rules stated in the Certification and Signature of Applicant section. Misuse of a disabled parking placard or providing false information can lead to severe penalties, including fines and license suspension.
  • Do ensure that the healthcare provider completes sections D and E without using ICD codes. Accurate, non-coded descriptions of the disability are required for the application to be processed.
  • Do not forge a healthcare provider’s signature or possess/display a counterfeit placard. Such actions are illegal and punishable under Massachusetts Law.

Following these guidelines can help ensure that your Massachusetts Disabled Parking Application is filled out correctly and processed in a timely manner, thereby avoiding unnecessary delays or legal issues.

Misconceptions

When it comes to applying for a Disabled Parking Placard or Plate in Massachusetts, there are several misconceptions that can easily confuse applicants. Understanding and clearing up these misconceptions can help ensure a smoother application process.

  • Every healthcare provider can sign off on the application: Only specific healthcare providers such as Medical Doctors, Chiropractors, Registered Nurses, Physician Assistants, Osteopaths, Optometrists (for legal blindness only), and Podiatrists are authorized to complete and sign the application.
  • The application can be processed at any RMV Service Center: Unlike other RMV forms, disability parking applications cannot be processed at RMV Service Center locations. They must be mailed to the Medical Affairs PO Box provided on the form, and attempting to drop off the application at a service center could result in additional processing time.
  • There is no deadline for submission: The application must be submitted to Medical Affairs within thirty (30) days of the healthcare provider’s certification. Waiting too long to submit the application could lead to the need for re-certification, causing delays.
  • Any physician's assessment is acceptable: The application specifically requires the healthcare provider to state, to a reasonable degree of medical certainty, if the applicant's reported condition will not impair the safe operation of a motor vehicle. This isn't a general medical assessment but a specific affirmation regarding the individual's ability to drive safely.
  • Applicants can have multiple placards: Massachusetts law states it is illegal for an individual to have more than one placard, whether temporary or permanent. This measure is to prevent abuse of disabled parking privileges.
  • ICD codes can be listed in the clinical diagnosis section: Contrary to some applicants' belief, ICD codes are not accepted in the Clinical Diagnosis section. The diagnosis must be described without using these codes.
  • There is a fee for obtaining a placard: There is no fee required to obtain a placard, which might be surprising considering many government-issued licenses and permits come with a fee.
  • A vehicle must be registered in the applicant's name to qualify: This is only necessary if applying for a disabled license plate. Disabled parking placards do not require the disabled person to have a vehicle registered in their name.
  • Asthma qualifies an applicant automatically: Asthma alone, unless it severely restricts mobility or meets specific criteria mentioned on the form (like requiring the use of portable oxygen), is not considered a qualifying condition for disabled parking privileges.

Clearing up these misconceptions not only simplifies the application process but also helps ensure that those who truly need these parking accommodations can obtain them in accordance with state guidelines.

Key takeaways

When filling out and submitting the Massachusetts Disabled Parking Application form, it's important to keep several key points in mind to ensure the process goes smoothly:

  • The application must be fully completed in the disabled person's name to be processed—missing information can result in the application being returned.
  • The form requires signatures and dates from both the disabled person and their healthcare provider, confirming the accuracy and truthfulness of the information provided.
  • Sections A, B, and C must be filled out with the disabled applicant's information, while the healthcare provider must complete sections D and E.
  • This application needs to be submitted to Medical Affairs within thirty days of the healthcare provider’s certification to be considered valid.
  • Remember, RMV Service Centers do not process disability parking applications; therefore, submitting the form at a service center could add to the processing time.
  • Additional documentation may be requested following the submission of the application.
  • There are strict penalties for misuse of disabled parking privileges, including significant fines and potential suspension of the placard or plate. It's crucial to understand and adhere to these rules.
  • The application warns against several illegal actions, such as providing false information, possessing a counterfeit placard, and forging a healthcare provider's signature, all of which carry severe consequences.

By ensuring all sections are accurately completed and submitted in a timely manner, applicants can facilitate a smoother review process. It's also critical to understand the responsibilities and legal implications associated with obtaining a disabled parking placard or plate in Massachusetts.

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