The Massachusetts Disabled Parking Application form is a crucial document for residents seeking disabled parking placards or plates in Massachusetts. It outlines the process and the necessary information that both the applicant and their healthcare provider must provide, emphasizing the importance of accuracy and completeness to avoid processing delays. To ensure your rights to disabled parking are recognized, click the button below to fill out the Massachusetts Disabled Parking Application form.
Securing a Disabled Parking Placard or Plate in Massachusetts is a procedure that necessitates meticulous attention to detail, guided by the Application for Disabled Parking Placard/Plate. Issued by the state's Medical Affairs branch, the comprehensive document demands accurate completion by both the applicant and a certified healthcare provider. For those navigating the nuances of this process, it's crucial to understand the form's stipulations: applications must be sent to Medical Affairs, and cannot be processed at RMV Service Center locations, underlining the importance of mailing them to the specified address in Boston. The form not only requires personal and disability-specific information from the applicant but also a professional medical certification regarding the individual’s ability to safely operate a vehicle, if applicable. Various types of parking accommodations are offered, including placards and plates, each with its unique set of criteria and intended for different kinds of vehicular ownership. Moreover, the document outlines legal mandates against misuse, emphasizing penalties for providing false information or unauthorized use of disabled parking privileges. Importantly, healthcare providers are tasked with a critical role, presented with sections devoted to their insights on the applicant's medical condition, further underscoring the form's dual purpose of adjudicating eligibility while preventing fraudulent claims. This application, thus, serves as a vital tool in ensuring that Massachusetts’s disabled parking resources are allocated fairly and responsibly, reflecting a concerted effort to accommodate individuals with disabilities while upholding the integrity of the system.
Application for Disabled Parking Placard/Plate
Mail to: Medical Affairs, PO Box 55889, Boston, MA 02205-5889 ● 857-368-8020 ● mass.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)
Email
Phone Type
Phone #
Cell
Home Work
Emergency Contact Information: (optional)
Name
Cell Home Work
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
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
NPI #
Board of Registration in Medicine #
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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Filing an Application for a Disabled Parking Placard or Plate in Massachusetts requires careful attention to detail to ensure the request is processed smoothly and without unnecessary delays. As the process is handled exclusively through mail to the Medical Affairs department and given its specific stipulations, including time-bound submission and rigorous documentation requirements, it is critical to follow each step meticulously. This guide aims to navigate you through the necessary steps to fill out the application successfully.
Upon completion and mailing of your application, it will be reviewed by the Medical Affairs department. Remember, applications cannot be processed at RMV Service Center locations. Ensure all documentation is correct and submitted on time to avoid any processing delays. The careful completion of each step is key to securing your disabled parking placard or plate, thereby providing you with the necessary parking accessibility.
Who can apply for a Disabled Parking Placard or Plate in Massachusetts?
Any Massachusetts resident with a documented disability, as certified by a healthcare provider, may apply for a Disabled Parking Placard or Plate. The disability must restrict mobility or impair the safe operation of a vehicle as stated by a healthcare provider.
What is the difference between a Placard and a Plate, and how do I choose which one to apply for?
A placard is a portable sign that can be moved from one vehicle to another and is used by individuals with disabilities when they travel in any vehicle. A plate is a permanent license plate designated for a vehicle registered in the name of the disabled individual. Applicants should choose based on whether they need the flexibility to use multiple vehicles (Placard) or if their transportation needs are met through a single, personally registered vehicle (Plate).
Is there a fee to apply for a Disabled Parking Placard or Plate?
There is no fee required to apply for or obtain a Disabled Parking Placard. However, standard vehicle registration fees apply for Disabled Parking Plates and DV (Disabled Veteran) Plates.
What information is required for the application?
The application must include comprehensive disabled applicant information, a certification of disability by a healthcare provider, and, for DV Plate applicants, a letter from the Veteran’s Administration. All sections (A, B, C, D, and E) of the application form must be completed, including the applicant's personal information, vehicle information (if applicable), and the medical certification of disability.
What is the deadline for submitting the application?
The application must be submitted to the Medical Affairs department within thirty (30) days of the healthcare provider’s certification to ensure the condition is current and accurately assessed.
Where should I mail my completed application?
The completed application should be mailed to Medical Affairs, PO Box 55889, Boston, MA 02205-5889. It is important to note that RMV Service Centers do not process disability parking applications; mailing it directly is necessary.
Can I drop off my application at an RMV Service Center for processing?
No, RMV Service Center locations do not process disability parking applications. Applications mailed directly to Medical Affairs are processed promptly, and dropping off at a service center location may delay the process.
What happens if I misuse the Disabled Parking Placard or Plate?
Misuse of disabled parking privileges, including allowing others to use your placard or plate when you are not present or providing false information during the application, is illegal and subjects you to penalties. These may include motor vehicle citation fines up to $500 for the first offense, potential license suspension, and revocation of disabled parking privileges.
Filling out the Massachusetts Disabled Parking Application form requires attention to detail. Common mistakes can lead to delays or the rejection of the application. Here are eight errors applicants should avoid:
By avoiding these common mistakes, applicants can help ensure their application for a Disabled Parking Placard or Plate in Massachusetts is processed efficiently and without unnecessary delays.
When applying for a Disabled Parking Placard or Plate in Massachusetts, applicants and healthcare providers need to navigate through a comprehensive process that ensures only eligible individuals receive these accommodations. To streamline the application, it is not uncommon for additional forms and documents to be required, serving to validate the information provided on the application and to adhere to regulatory requirements. These documents not only reinforce the legitimacy of the application but also provide a holistic view of the applicant's needs and qualifications.
The ensemble of these documents, complementing the Massachusetts Disabled Parking Application, ensures a thorough and fair assessment of each request for parking accommodations. By providing a detailed and documented justification of their condition, applicants can help the relevant authorities understand their mobility challenges and make informed decisions regarding eligibility. This careful process underscores the importance of maintaining the integrity of accommodations for individuals with disabilities, ensuring that resources are allocated to those with legitimate needs.
The Massachusetts Disabled Parking Application form shares similarities with other essential documents designed to assist individuals with disabilities, each having its distinct set of requirements and sections aimed at evaluating eligibility and necessary accommodations. These documents, while serving different purposes, often maintain a standard of gathering detailed information to ensure the proper support is made available to those who qualify.
The Social Security Disability Benefits Application: The Massachusetts Disabled Parking Application form mirrors the Social Security Disability Benefits Application in several ways. Firstly, both necessitate detailed personal information alongside health conditions verified by medical professionals to determine eligibility. Just as the parking application requires a healthcare provider's certification regarding the applicant's mobility limitations or medical conditions, the Social Security benefits application demands medical evidence and sometimes a detailed account of how one's disabilities affect daily activities. Moreover, both applications emphasize the legality of the information provided, warning against the consequences of falsification.
The ADA Reasonable Accommodation Request Form: Another document sharing similarities with the Massachusetts Disabled Parking Application form is the ADA Reasonable Accommodation Request Form often used by employees to request adjustments or modifications in the workplace due to a disability. Both forms require the demonstration of a medical condition or disability certified by a healthcare provider, detail the specific accommodations or modifications sought (be it parking space or workplace adaptations), and underscore the applicant's rights and responsibilities. Furthermore, they highlight the confidentiality of the disclosed medical information, except as required for processing and verification purposes.
When applying for a Massachusetts Disabled Parking Placard or Plate, it's important to follow the guidelines carefully to ensure your application is processed smoothly and efficiently. Below are seven dos and don'ts that can help guide you through the application process:
Dos:
Don'ts:
By carefully following these guidelines, you can help ensure your application for a Disabled Parking Placard or Plate in Massachusetts is filled out correctly and processed without unnecessary delays.
When it comes to applying for a Massachusetts Disabled Parking Placard or Plate, there's plenty of room for confusion. Clearing up these misconceptions is critical for a smooth application process. Here are ten common misunderstandings and the reality behind each:
Understanding these key points demystifies the process, making it more accessible for those who need it most. It’s essential for applicants and their healthcare providers to carefully review the requirements and submit a complete, timely application to avoid unnecessary delays or rejections.
When applying for a Disabled Parking Placard or Plate in Massachusetts, it's essential to understand and comply with all specified requirements to ensure the application process goes smoothly. Below are seven key takeaways to guide applicants through this process:
This application process is designed to ensure that disabled parking accommodations are provided to those genuinely in need, based on a healthcare provider's assessment and certification. By carefully following these guidelines, applicants can facilitate a smooth process in acquiring a disability parking placard or plate.
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