The Metro Access Application form serves as a crucial gateway for people with disabilities to obtain MetroAccess Door-to-Door Paratransit Service, enabling a more accessible and independent travel experience within the Washington, DC metropolitan area. By requiring both self-reported information and a healthcare provider's assessment, the form meticulously evaluates the applicability of the service to each individual's needs. For those seeking to enhance their mobility and access to the city, completing this application is the first step. To begin filling out your form, click the button below.
Individuals with disabilities who find regular public transportation challenging now have a comprehensive solution through MetroAccess. This crucial service, provided through the Metro Transit Accessibility Center, offers a door-to-door, shared ride paratransit service designed specifically for those whose disabilities prevent them from using the regular Metrobus and Metrorail services. With eligibility grounded in the criteria set by the Americans with Disabilities Act (ADA), applicants must engage in a thorough application process that includes both written documentation and an in-person assessment. This process ensures that those who truly need specialized transportation can access it. The service area is extensive, covering multiple counties and cities across the Washington, DC metropolitan area, highlighting the service's commitment to accessibility. Completing the application involves a collaborative effort between the applicant and a healthcare provider to provide comprehensive details on the applicant's mobility and healthcare needs. Additionally, understanding the range of accessible transportation options available is part of the process, encapsulating the program's dedication to informed and accessible travel for everyone. The application also addresses practical concerns, such as mobility aids and service animals, ensuring that all aspects of an individual's needs are considered. By facilitating essential mobility, MetroAccess plays an integral role in enhancing the quality of life for people with disabilities within the community.
Application for
MetroAccess Door-to-Door Paratransit Service
For People with Disabilities
DO NOT MAIL OR FAX APPLICATION
Transit Accessibility Center
6005th Street, NW Washington, DC 20001
(Between Chinatown/Gallery Place and Judiciary Square Metro Stations)
(202)962-2700 & select option #5 TTY (202) 962-2033
All Assessments are by Appointment Only
Thank you for yourd oninterMetro’sst in Mdeterminationtro services offoryourpeopleeligibilitywith disabilities. The following services
(A)Reduced Fare Program for People with Disabilities – Eligible people with disabilities
travel on accessible Metrobus and Metrorail for half the regular (rush hour) fare at all times. This
program is available for people with disabilities who use the accessible Metrobus and Metrorailare available base:
system as their primary travel option. For more information on the Reduced Fare program or to
obtain an application please visit our website atunder the section titled “How
dohttp://wwwI get a Metro.wmataDisability.com/accessibility/metroaccessID Card?”_eligibility.cfm
or call (202) 962-2700 and select option 1 from the phone
(B)MetroAccess – Door-to-door, shared ride public paratransit service for people with disabilities who are unable to use regular accessible Metrobus and Metrorail public transportation
for some or all of their public transportation due to a disability. The Americans with Disabilities Act (ADA) outlines specific criteria to determine eligibility for paratransit service and an application anmenu.
in-person assessment is required. MetroAccess operates throughout the metropolitan area where there is regularnd PrincebusGeorge’sand/or railCountyservinceMaryland;. Service isArlingtonprovidedCounty,in Washington,Fairfax County,DC; MontgomeryCity of County a
Alexandria, City of Fairfax, and City of Falls Church in Virginia.
To apply for this service you and your healthcare provider must complete this application. Please read and follow the instructions on page 2.
Instructions
Application revision date: March 2017
Page 1 OF 9
Step 1: Read the entire application and complete Part A.
Step 2: Read Accessible Transportation Options for People with Disabilities and Senior Citizens in
the Washington, DC Metropolitan Area, included with this application packet or also available at http://www.wmata.com/accessibility/doc/Accessible_Transportation_Options.pdf
Step 3: Take the entire application to a healthcare provider holding active licensure or credentials in certifythe areatheofapplication:your disabilityPhysician,to completePhysician’sPart BAssistant,. One of the following health care providers must
Certified Nurse Practitioner, Optometrist
(visual disabilities only), Podiatrist (disabilities of the foot and ankle only) or, Licensed Clinical Psychologist (Psychiatric disabilities only). It is your responsibility to ensure the original signed and completed application is received by the Metro Transit Accessibility Center on the day of your appointment.
Step 4: Upon completion of the application, call 202-962-2700 and select option 5, ( TTY 202-962-2033) to conduct a pre-assessment interview. At that time, a determination will be made as to the type of
appointment and/or assessment that will be required, and an appointment will be made for you. officePleasewithinhave 60yourdayscompletedof the dateapplicationof the healthcareat handprovider’swhen yousignaturecall. Also. Applicatiensure you contact the
ons more than 60
days old will not be accepted. You will be instructed to bring your completed original application with you to the appointment. Do not mail or fax the application. NOTE: We require 24 hours notice if you need to cancel your appointment, except in case of a verified emergency. If you miss or cancel 2 appointments you will be required to complete a new application and be required to wait 120 days to reapply.
Copies, faxes, and scans will not be accepted. Applications with missing information will not be accepted and will be returned to the applicant without processing. Applications that are mailed will be returned to the applicant with instructions to contact the Transit Accessibility Center.
Step 5: Metro will determine your eligibility based on how your disability impacts your functional abilities to use the accessible Metrobus and Metrorail public transportation system. Financial need is not a criterion for MetroAccess eligibility. All assessments take place at the Metro Transit Accessibility Center. If you use a mobility aid, please bring it with you to the assessment. If transportation is needed, advise the Metro Transit Accessibility Center representative at the time of your telephone interview.
If you have questions or need additional information, please contact the Metro Transit Accessibility Center at 202-962-2700 and select option 5, TTY 202-962-2033 or e-mail eligibility@wmata.com. Please do not bring children to the appointment unless the child is the applicant. Please note that the minimum age to apply for the service is 5 years old. The office is open Monday, Wednesday
-Friday from 8:00 AM - 4:00 PM, and Tuesday, 8:00 AM to 2:30 PM. Hours are subject to change without notice so Please call in advance. Phone lines open at 8:30 on all days.
Page 2 OF 9
I am a current MetroAccess customer. MetroAccess ID Card # ________________________
I am a current Reduced Fare customer. Reduced Fare ID Card # ____________________
I have access to the internet and/or have an email account.
Part A: APPLICANT INFORMATION AND RELEASE (Copies, faxes or scans will not be accepted)
Last Name______________________________ First Name______________________________ Middle Initial ________
Street Address:
Apartment #:
City, State, Zip:
County or City:
Gender: Male Female Date of Birth: ____/______/________ E-mail:_________________________________
Primary phone number: ( ) _______________________________ Home Cell Phone Work
Secondary phone number: ( ) _____________________________ Home Cell Phone Work
In case of an emergency, who should be notified?
Name:
Relationship:
Mobility Devices: Do you require the use of a mobility device when traveling? No Yes
Check all that apply: Man
al Wheelchair
Support C
e Portable Oxygen
Power Wheelchair
800 pounds when occupied
CrutchesWalkerorScooterWhiteupCane(forto 48” xvisually30” andimpaired)no more than Other: _____________________________
Do you use a service animal?
No Yes
Sometimes If yes, please describe the type of
animal and what service(s) the animal was trained to perform:
I certify that all information contained in part A of this application were completed by me or my appointed representative and are true.
Original Signature of Applicant: __________________________________________ Date:_________________________
(Under 18, Signature of Parent or Guardian)
Page 3 OF 9
AUTHORIZATION TO HELP ME APPLY FOR METROACCESS SERVICES
Please complete the authorization below if you are providing legal authority to another party to complete this application and act as your agent in the processing of this application.
** This form is only to be used when an applicant is not able to otherwise give consent for
Applicant’sassist ce andNameinformation sharing.
Applicant’s Address______________________________________________________
_____________________________________________________
I would like to apply for MetroAccess door to door paratransit service.
I am appointing _____________________________to help me apply for MetroAccess service. For this
purpose only, he or she has the authority to act on my behalf, including scheduling appointments, completing paperwork, and providing information about me to WMATA (Metro), so long as it relates to my application for MetroAccess service. Metro may release any information it has about me upon request, to this person, including health care information, so long as it relates to my application for services. For this purpose only, my agent may request, receive, and review any information, oral or written, regarding my physical or mental health, including but not limited to, medical and hospital records and other protected health information, and consent to disclosure of this information.
For all purposes related to this document, my agent is my personal representative under the Health Insurance Portability and Accountability Act (HIPAA) and is entitled to request, receive, and review protected health information: any information, oral or written, regarding my physical or mental health, including but not limited to medical and hospital records, and other protected health information. My agent may also consent to disclosure of this information.
Page 4 OF 9
This agreement expires: (Select one from options below.)
_____ At the end of my appointment on __________________; or
_____ At the end of my MetroAccess certification process; or
_____ At the end of my MetroAccess certification and any applicable appeal process.
In any event, this agreement would expire no later than one year from when it is signed. I can cancel this agreement at any time by telling the person and calling Metro to inform them that this authorization is no longer valid.
Signature
Date
Printed Name
I, ________________________________________________, agree to help ______________________________ with
(Agent’s Name)
(Applicant’s Name)
his/her application for MetroAccess services. Either I, or another person from my organization, will come with the applicant to their eligibility appointment and assist him/her.
Page 5 OF 9
Part B: HEALTH CARE PROVIDER CERTIFICATION
holding active licensure or credentials in the area of the applicant’s disability orA healthcarethe applicant’sproviderprimary care provider as outlined on page 2 must complete Part B.
Your patient has requested eligibility for MetroAccess services. MetroAccess is a door to door,
uniquely qualified to clarify his or her functional
the applicant’s healthcare provider you are
shared ride paratransit service for people whose disability(ies) prevent them from riding the fixed
route accessible system, all or part of the time. As
icant’s functional abilities we
that you the healthcare provider not the applicant
abilities and l mitations to ride the M
tro
’s require
accessible bus and rail system. In order to determine this appl
travel independently onhow the applicant’s
complete and certify all of the following
sections. Please detail
disability(ies) impact their ability to board, navigate and
the accessible fixed route system. Please be as specific as possible
Applicant’s HIPAA Authorization:
I _________________________________authorize the healthcare provider completing this application to
release to the Washington Metropolitan Area Transit Authority (Metro) any protected health information about my disability in order to verify my eligibility for Metro Services for People with Disabilities. I also authorize the release of further information should it be needed for this application for a period of 60 days from the date of my signature on part A of this application.
____________________________________________________________ (Applicant’s name) is being referred for a brief
functional assessment to determine eligibility for Metro services for people with disabilities.
1.Name of Health Care Provider: (Please print)____________________________________________________
2.Phone: ( ) _______________________
3.License Number/State Issued: ___________________________
4.Street Address & Suite #: ________________________________________________________________________________
5.City, State, Zip: ____________________________________________________________________________________________
6.Specialization: ____________________________________________________________________________________________
7.Written Diagnosis (es) and ICD-9CM and/or DSM Code(s): ______________________________________
__________________________________________________________________________________________________________________
8.HYPERTENSION: Eligibility for service is determined by a functional assessment, which is
conducted by a certified/licensed therapist with the Transit Accessibility Center. Applicants may be required to walk/travel up to 1/2 mile. In order to ensure the safety ofe applicant’sthe applicant,restinga bloodB/P is pressure (B/P) reading is taken prior to starting the assessment. If th
Page 6 OF 9
160/100 or higher, the assessment will be suspended pending certification by the health care provider that the applicant can complete the assessment. If you are currently treating the applicant for hypertension and certify that he/she is cleared to complete the functional assessment, we may proceed without referring the applicant back to you for evaluation and certification.
9.Are you currently treating this applicant for Hypertension? No Yes
10.Applicant can complete the assessment as described above if B/P does not go above a reading of: ______________________
11.If applicant has a seizure disorder or epilepsy have they had a tonic-clonic seizure within the past 4 months?
No Yes N/A
12.Does the applicant require a Personal Care Attendant (PCA) when traveling on public transportation?
13. Does the applicant require any of the following mobility aids listed in question 14?
14.Check all that apply: Manual Wheelchair Support Cane Portable Oxygen
Power Wheelchair or Scooter CrutchesWalkerWhite Cane (visually impaired) Other: __________________
15. What is the expected duration of the disability? (Please initial appropriate box)
_____Short-Term: Conditions that last at least 90 days, but are likely to improve within one year.
____Long-Term: Conditions with absolutely little expectation of improvement
16. Does this applicant’s disability(ies) prevent him/her from independently using the accessible Metrobus and Metrorail system?
No Yes the disability or health condition impact the applicant’s ability to travel If yes, HOW does
independently from one location to another on the accessible Metrobus and Metrorail system?
Page 7 OF 9
17.If this applicant is currently on medication(s), will the side effects of this significantly reduce or hinder his/her ability to independently ride the accessible Metrobus and Metrorail system?
applicant’sIf you selectedabilityyestoforusethisthequestion,accessiblepleasefixedexplainroute bushowandtherailsidesystem:eff cts would hinder this
Based on the applicant’sENVIRONMENTALdisability(ies),ISSUESpleaseTHATtell usAFFECTif followingTHEenvironmentalAPPLICANT factors affect his/her ability to ride Metro’s accessible bus and rail system.
18.Would extremes in temperature affect this applicant’s ability to ride the accessible Metrobus or Metrorail?
If yes, please explain the effect and the extent of the limitation(s)
19. Would ice and/or snow affect this applicant’s ability to ride accessible Metrobus or Metrorail system?
If yes please explain the effect and the extent of the limitation(s)
20. Would poor air quality affect this applicant’s ability to ride Metrobus or Metrorail? Yes No If yes please explain the effect and the extent of the limitation(s). NOTE: If applicant suffers from Asthma, please indicate if the applicant has been on systemic medication for the immediate past 6 months OR has been required to use fast acting inhalers for three or more episodes per week for the immediate past six months
Page 8 OF 9
21.In your medical opinion what other factors related to the applicant’s disability(ies) affect his/her ability to ride the accessible Metrobus or Metrorail?
HEALTH CARE PROVIDER SIGNATURE PAGE
I certify that I have completed the questions in Part B and that the information provided is correct.
Original Signature of Physician/Healthcare Provider: ______________________________________________
(Note: Must be original hand signature, not signature stamp)
Printed Name_________________________________________________________Date: _____________________
False certification may be reported to the licensing agency under District of Columbia Code Annotated,
Section 2-3305.15, Code of Virginia 54. 1-2915, or Maryland Health Occupations Code Annotated 14-404 or appropriate code for state of license. Metro reservesn, (2) makethe rightthe finalto: (1)determinationv ify the validityon anofapplicant’sthe licenseeligibilityof the health care provider providing the certificatio
for MetroThes rvicesADA requiresfor peopleMetrowith disabilities,to provideanotificationd (3) retainofa copyan applicant’sof this applicationeligibility. status within 21 NOTE:
days of submitting a completed application. If, for any reason, it takes longer than that to process the determination, the applicant will be eligible to use MetroAccess until Metro completes the eligibility process. This is called "presumptive eligibility." If 21 days have passed since Metro received the completed application the applicant will be automatically granted eligibility for MetroAccess until the review process is completed.
Page 9 OF 9
Applying for MetroAccess Door-to-Door Paratransit Service involves a detailed process that seeks to determine an applicant's eligibility for transportation assistance due to disability. The application process is comprehensive, requiring information both from the applicant and a healthcare provider. First, the entire application must be read and completed carefully. Then, a healthcare professional with knowledge of the applicant's disability will need to fill out part of the form. Once the form is completed, a pre-assessment interview will be conducted over the phone to schedule an in-person assessment. It's important to follow these steps closely to ensure that the application process moves smoothly and efficiently.
After the steps are completed, the Metro team at the Transit Accessibility Center will assess your eligibility for the MetroAccess service by examining how your disability impacts your ability to use the public transportation system. Remember, this service is aimed at supporting individuals whose disabilities prevent them from using standard Metrobus and Metrorail services. It's important to keep the details of your appointment and any necessary documentation organized and accessible throughout this process.
MetroAccess is a door-to-door, shared-ride public paratransit service. It's designed for people with disabilities who are unable to use regular accessible Metrobus and Metrorail public transportation for some or all of their trips due to a disability. This service operates throughout the metropolitan area, including specific counties in Maryland, Virginia, and Washington, DC, adhering to the Americans with Disabilities Act (ADA) criteria for eligibility. An application and an in-person assessment are required to determine eligibility for this service.
To apply for MetroAccess services, follow these steps:
Part B of the application must be completed by a licensed healthcare provider knowledgeable about your disability. This can be a Physician, Physician’s Assistant, Certified Nurse Practitioner, Optometrist (for visual disabilities), Podiatrist (for foot and ankle disabilities), or a Licensed Clinical Psychologist (for psychiatric disabilities).
If you miss or cancel your assessment appointment, you must notify the Transit Accessibility Center at least 24 hours in advance, except in verified emergencies. If you miss or cancel two appointments without proper notice, you will be required to submit a new application and wait an additional 120 days before reapplying.
Applications that are more than 60 days old from the date of the healthcare provider’s signature will not be accepted. You will have to obtain a new signature from your healthcare provider and submit a new application if more than 60 days have elapsed.
No, do not mail or fax your application. Applications must be submitted in person at the Transit Accessibility Center to ensure they are complete and to schedule your in-person assessment. Applications sent via mail or fax will be returned with instructions to contact the center.
Yes, please do not bring children to your assessment appointment unless the child is the applicant. This policy helps ensure a focus on the assessment process. If you require assistance or support during your assessment, let the Transit Accessibility Center know ahead of time so accommodations can be made.
You should bring any mobility aids that you regularly use, such as manual wheelchairs, crutches, scooters, or support canes. If you have a service animal, please bring them along with you. Also, remember to carry the original signed application form with you.
For more information or if you have additional questions, you can contact the Transit Accessibility Center by phone at (202) 962-2700, option 5, or by TTY at (202) 962-2033. You can also email questions to eligibility@wmata.com. The office is open on weekdays, with specific hours listed in the application packet, but it's always a good idea to call ahead to confirm.
Failing to read the entire application and instructions carefully before starting, leading to misunderstandings about the application process.
Not completing Part A of the application, which is crucial for providing applicant information and consent.
Overlooking the need to take the application to a licensed healthcare provider to complete Part B, which assesses the applicant's disability and need for the service.
Missing the deadline to submit the application within 60 days of the healthcare provider's signature, resulting in the application being invalidated.
Attempting to mail or fax the application, despite instructions explicitly stating these methods are not accepted.
Forgetting to schedule or missing the pre-assessment interview call, which is an essential part of the application process.
Not bringing necessary mobility aids to the assessment, which could lead to an incomplete evaluation of needs.
Bringing children to the appointment when it's clearly stated they should only accompany if the child is the applicant.
Ignoring the policy that requires 24 hours notice to cancel an appointment except in verified emergencies, risking the need to restart the application process.
Common mistakes made during the application process for MetroAccess services include not thoroughly reading the application instructions, missing critical deadlines, and failure to comply with specific submission methods. Applicants should also pay attention to the requirements for the pre-assessment interview and the assessment itself, such as bringing mobility aids and not bringing children unless they are applicants. Observing these guidelines ensures a smoother application process.
Applying for MetroAccess Door-to-Door Paratransit Service involves more than just filling out the primary application form. Applicants often need to gather and submit several additional forms and documents to support their application. Understanding what these documents are and why they are important can make the application process smoother and more efficient. Below is a list of other forms and documents that are typically used along with the Metro Access Application form.
Collectively, these forms and documents build a comprehensive profile of the applicant, ensuring that MetroAccess services are provided fairly and to those who truly need them. Securing and submitting the proper documentation can seem daunting at first, but it’s a crucial step in gaining access to vital transportation services for people with disabilities. Being thorough and accurate with this information helps streamline the application process, leading to a smoother and quicker path to receiving services.
Disability Parking Permit Application: Just like the Metro Access Application, the Disability Parking Permit Application requires detailed information about the applicant's condition, as certified by a healthcare professional. They both serve individuals with disabilities, though in different aspects of accessibility.
Passport Application Form: The Metro Access Application shares similarities with a Passport Application in the way it gathers personal details, proof of identity, and requires an original signature. They both are gateways to services provided by entities - one for international travel by the Department of State, and the other for local mobility services.
Medicaid Application Form: Medicaid Applications and the Metro Access Application both require disclosure of personal details, and may necessitate medical certification to verify the eligibility criteria. These forms are designed to aid in obtaining essential services, with a focus on serving people based on need.
College Admission Application: While serving vastly different purposes, both the Metro Access Application and a College Admission Application request a compilation of personal information, potential references, and sometimes require interviews or assessments to determine eligibility or fit.
Job Application Form: Similarly, to apply for a job, applicants must provide personal information, contact details, and qualifications – akin to the Metro Access Application’s collection of personal data, contact numbers, and details regarding the applicant’s mobility needs and qualifications for the service.
Voter Registration Form: Both the Metro Access Application and Voter Registration forms serve to register the applicant for participation in societal privileges—voting in public elections or accessing specialized public transit services, respectively. They collect basic personal identification info but are used for different types of community engagement.
Special Dietary Needs Form for Schools: Schools often require a form to be filled out for students with special dietary needs, similar to how the Metro Access Application identifies individuals with specific mobility needs. Both require formal documentation and are focused on meeting the specific needs of the individual within a public service context.
Filling out the Metro Access Application form is crucial for securing door-to-door paratransit service for people with disabilities. It's vital to do it correctly to ensure a smoother application process. Here are some do's and don'ts to help guide you through the application process.
Do:
Don't:
When applying for MetroAccess, a door-to-door paratransit service designed for people with disabilities, it's common for applicants or their caregivers to encounter misconceptions about the process. Understanding these misconceptions can help streamline applications, making them more efficient and less stressful.
Misconception #1: The application can be mailed or faxed. One major misunderstanding is that the MetroAccess application can be mailed or faxed for processing. However, the form explicitly states not to mail or fax the application. Instead, the completed application, along with any required documentation, must be brought to the Transit Accessibility Center in Washington, DC. This ensures that all applications are processed efficiently and securely, adhering to the guidelines set forth by MetroAccess.
Misconception #2: Any healthcare provider can complete the application. It's a common mistake to think any healthcare provider can fill out the application. In reality, only licensed or credentialed health care providers in certain specialties are authorized. These include Physicians, Physician’s Assistants, Certified Nurse Practitioners, Optometrists for visual disabilities, Podiatrists for disabilities of the foot and ankle, and Licensed Clinical Psychologists for psychiatric disabilities. Understanding this requirement can prevent potential delays in processing the application.
Misconception #3: Financial need determines eligibility. Another common misunderstanding is that financial need plays a role in determining eligibility for MetroAccess services. The application process, however, is solely focused on how an applicant's disability impacts their functional abilities to use the public transportation system. This misconception may deter individuals who are financially stable but genuinely in need of the service from applying, assuming they would not qualify.
Misconception #4: The application process does not require an in-person assessment. Some applicants believe that the process is completed once the application is submitted, without the need for an in-person assessment. However, all applicants must undergo an assessment by appointment only, as stated on the application. This step is crucial for evaluating the extent of an applicant's disability and their need for the service, ensuring those who truly need assistance receive it.
Overall, understanding these misconceptions and the actual requirements can help applicants and their families navigate through the application process more smoothly. It highlights the importance of thoroughly reading and following the instructions provided by MetroAccess to ensure a successful application.
Filling out and using the Metro Access Application form requires attention to detail and an understanding of the process. Here are key points to remember:
It's crucial for applicants and their helpers to understand these guidelines to ensure a smooth and efficient process in applying for MetroAccess services.
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