Blank Massachusetts Disabled Parking App Form

Here are some key takeaways for filling out and using the Massachusetts Disabled Parking App form:

• Complete the Application Accurately: Ensure all sections are filled out correctly, especially the disabled person’s information in sections A, B, and C, as incomplete applications will be returned.
• Signatures Required: Both the disabled person and the healthcare provider must sign and date the application. This step is crucial for processing.
• Submit on Time: The application must be submitted to Medical Affairs within thirty (30) days of the healthcare provider’s certification to avoid delays.
• Avoid Service Centers: Do not drop off the application at RMV Service Centers, as they do not process disability parking applications. This could add extra processing time.

1. Incomplete Application: Failing to fill out all required fields can lead to delays. Ensure that every section, including personal information and service type, is fully completed.

2. Missing Signatures: Both the disabled person and the healthcare provider must sign and date the application. Omitting signatures will result in processing delays.

3. Incorrect Submission Method: Submitting the application to a RMV Service Center will not be accepted. Always mail it directly to Medical Affairs as instructed.

4. Ignoring Time Limits: The application must be submitted within thirty (30) days of the healthcare provider’s certification. Late submissions can lead to rejection.

5. Providing False Information: Any false statements can lead to legal consequences. Ensure that all information, especially medical details, is accurate and truthful.

When filling out the Massachusetts Disabled Parking Application form, keep the following guidelines in mind:

• Do complete all sections of the application in the disabled person's name.
• Don't submit an incomplete application; it will be returned.
• Do ensure both the disabled person and the healthcare provider sign and date the application.
• Don't forget to submit the application to Medical Affairs within thirty (30) days of certification.
• Do provide accurate and truthful information to avoid legal consequences.
• Don't drop off the application at an RMV Service Center, as they do not process these applications.
• Do include any additional documentation that may be required.
• Don't allow someone else to use your placard if you are not in the vehicle.
• Do keep a copy of the completed application for your records.

What is the purpose of the Massachusetts Disabled Parking App form?

The Massachusetts Disabled Parking App form is designed for individuals with disabilities who need a parking placard or plate. This form allows eligible applicants to request a special parking permit that provides access to designated parking spaces. The application must be filled out in the name of the disabled person and requires certification from a healthcare provider to confirm the applicant's medical condition.

How do I complete the application?

To complete the application, you need to provide detailed personal information in sections A, B, and C. This includes your name, date of birth, address, and Social Security number. The healthcare provider must fill out sections D and E, which include their certification of your medical condition. Ensure that all fields are completed, as an incomplete application will be returned. Both the disabled person and the healthcare provider must sign and date the application before submission.

Where do I send the completed application?

Once you have completed the application, mail it to Medical Affairs at PO Box 55889, Boston, MA 02205-5889. It is important to send the application directly to this address, as RMV Service Center locations do not process disability parking applications. Dropping it off at a service center may delay processing time.

What happens if my application is incomplete?

If your application is incomplete, it will not be processed and will be returned to you. It is crucial to ensure that all required sections are filled out accurately. Double-check that both the disabled person’s and the healthcare provider’s signatures are included, as missing signatures can lead to delays.

Are there any fees associated with the disabled parking placard or plate?

No fee is required for a disabled parking placard. However, if you are applying for a disabled parking plate or a motorcycle plate, registration fees will apply. The plate can only be issued to individuals who are the primary owner of the vehicle registered in their name.

What are the consequences of misusing a disabled parking permit?

Misusing a disabled parking permit can lead to significant penalties, including hefty fines, license suspension, and revocation of parking privileges. It is illegal to allow someone else to use your placard if you are not present in the vehicle, and providing false information can result in prosecution under Massachusetts law. Understanding and adhering to the rules is essential to avoid these serious consequences.

Instructions on How to Fill Out Massachusetts Disabled Parking App

After gathering the necessary information, you can begin filling out the Massachusetts Disabled Parking Application form. It is important to ensure that all sections are completed accurately. Both the disabled person and the healthcare provider must sign the application to avoid any delays. Follow the steps below to complete the form correctly.

1. Section A: Disabled Applicant Information
   • Provide the disabled person’s last name, first name, middle name, and suffix.
   • Enter the date of birth in the format MM/DD/YYYY.
   • If applicable, include the current Massachusetts Learner’s Permit, Driver’s License #, or MA ID.
   • Select the gender: Male, Female, or Non-binary.
   • Fill in the Social Security Number.
   • Provide the residential address, including street number, apartment number, city, state, and zip code.
   • If different, fill in the mailing address or check the box if it is the same as the residential address.
   • Enter an email address and phone number, selecting the type of phone (cell, home, or work).
   • Optionally, provide emergency contact information, including name, phone number, and type.
2. Section B: Service Type
   • Select the type of service needed: Placard, Plate, Motorcycle Plate, or DV Plate.
3. Section C: Certification and Signature of Applicant
   • Read and acknowledge the rules regarding the use of disabled parking.
   • Sign and date the application, confirming the accuracy of the information provided.
4. Section D: Healthcare Provider Information
   • The healthcare provider must answer questions regarding the medical qualification of the applicant to operate a motor vehicle.
   • Provide a clinical diagnosis and indicate the duration of the placard (temporary or permanent).
   • Check all applicable conditions that affect mobility or ability to walk.
5. Section E: Healthcare Provider Certification and Signature
   • The healthcare provider must complete all fields, including their name, address, NPI number, and board registration number.
   • Select the provider’s profession and sign the application, certifying the accuracy of the information.

Once the form is fully completed and signed by both parties, it should be mailed to Medical Affairs at the address provided on the form. Make sure to submit it within thirty days of the healthcare provider’s certification to avoid any processing delays.