The MV-145A form serves as a critical application for individuals seeking to acquire a person with a disability parking placard in Pennsylvania. This no-fee form, accessible through the Pennsylvania Department of Motor Vehicles, outlines specific requirements for eligibility and accommodates various needs, including original requests, renewals, replacements, and changes in address or name. To streamline access to parking privileges that cater to disabilities, it’s vital to fill out the MV-145A form accurately. Ensure your application is complete by clicking the button below.
Navigating the application process for a Person with Disability Parking Placard in Pennsylvania requires an understanding of the MV-145A form, a comprehensive document that serves a vital role for individuals seeking these critical accommodations. Available through the Pennsylvania Department of Motor Vehicles, this no-fee application attends to several needs, including original requests for permanent and temporary placards, renewals for permanent placards, replacements, and adjustments to personal information such as name and address changes. Importantly, it covers applicants including severely disabled veterans, reflecting a consideration for a broad spectrum of disabilities. Each section of the form is meticulously designed to ensure the applicant's eligibility is properly assessed, guiding the user through a series of straightforward instructions. To qualify, applicants must fall under specific disability categories, each associated with a "Reason Code" that matches certain mobility impairments or health conditions. Verification by health care providers or, in certain instances, certification by police officers or the U.S. Department of Veterans Affairs, underscores the form's stringent adherence to proper authority and compliance standards. Issuance of the placard promises enhanced accessibility and mobility for individuals, offering a significant positive impact on their daily lives. The form functions not just as an application but as an essential resource for understanding one’s rights and the state’s provisions for disability accommodations, making it crucial for applicants or their representatives to comprehend its contents and requirements thoroughly.
MV-145A (7-21)
www.dmv.pa.gov
PERSON WITH DISABILITY PARKING PLACARD APPLICATION NO FEE REQUIRED
SEE REVERSE SIDE FOR INSTRUCTIONS AND ELIGIBILITY REQUIREMENTS
FOR DEPARTMENT USE ONLY
Bureau of Motor Vehicles • P.O. Box 68268 • Harrisburg, PA 17106-8268
q ORIGINAL REQUEST - qPermanent Placard
CHECK ( 4) APPROPRIATE BLOCKS BELOW
qSeverely Disabled Veteran qTemporary Placard
q RENEWAL REQUEST - (For Permanent Placards Only)
q REPLACEMENT REQUEST - qPLACARD
qID CARD qDefaced qLost q Stolen q Never Received PREVIOUS PLACARD # __________________
q CHANGE OF ADDRESS - Complete Sections A and E. NOTE: Notarization is not required.
qCHANGE OF NAME - Complete Sections A and E. Check here to indicate reason for change of name: qMarriage qDivorce qOther: ______________________
APERSON WITH DISABILITY INFORMATION - LIST NAME AND ADDRESS OF PERSON WITH DISABILITY - NOTE: If listing an out-of-state address, you must also complete and attach Form MV-8.
Last Name (or Full Business Name)
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
or Bus. ID#
Street Address
City
State
Zip Code
Email Address
NOTE: If you are the parent or adult charged by law with the natural parent’s rights, duties and responsibilities acting on behalf of a minor child (under 18) in place of the child’s natural parents (person in
loco-parentis), you must complete the information below. In addition, a parent, including an adoptive or foster parent who has custody care or control of the child or adult child or a spouse may sign on
behalf of the child, adult child or spouse (applicant) provided the applicant meets eligibility requirements (1) through (8).
Name of Parent, Person in Loco Parentis or Spouse
Relationship to Applicant
CERTIFICATION FROM A HEALTH CARE PROVIDER LICENSED OR CERTIFIED IN PA OR A CONTIGUOUS STATE (NEW YORK, NEW JERSEY, DELAWARE, MARYLAND, WEST VIRGINIA OR
B
OHIO). THIS SECTION MUST BE COMPLETED IN FULL. HEALTH CARE PROVIDERS MAY ONLY CERTIFY DISABILITIES WITHIN THEIR SCOPE OF PRACTICE. WARNING: Altering or forging a
document issued by the Department, such as a disabled person parking placard, or possessing, using or displaying such a document knowing it to have been altered, forged or counterfeited,
is a misdemeanor of the first degree pursuant to the Vehicle Code, 75 Pa.C.S. Section 7122, punishable by a fine of not more than $10,000 or imprisonment of not more than five years, or both.
I hereby certify that the person with the disability listed above is under my care and has the following condition listed on the reverse side of this
UNCORRECTED
application under “Eligibility Requirements”: _______________
(NOTE: Only those conditions listed on the reverse side of this application qualify
R
20/
List Reason Code # Here
an applicant for a person with disability placard.)
L
NOTE: If reason code #1 is listed above, please indicate the individual's visual acuity by completing the chart to the right:
If reason code #4 is listed above, please indicate the type of device used: ________________________________________________
CORRECTED
Temporary placards are only issued for a period of time not to exceed six months. If the applicant requires additional time after the expiration of
the placard issued, the applicant must be recertified by a health care provider.
Health Care Provider’s Printed Name
Health Care Provider’s Signature
Medical License No.
Office Street Address
Telephone Number
(
)
C
CERTIFICATION BY POLICE OFFICER - Police officer may only certify that the applicant does not have full use of a leg or both legs, or is blind.
NOTE: If Section B above is completed, please skip this Section and go on to Section E.
This is to certify that the person with disability listed above has the condition listed and is entitled to the use and privileges of the person with disability
parking placard.
qis blind, OR does not have full use of a leg or both legs as evidenced by the use of a: qwheelchair
qwalker
qcrutches
q cane/quad cane
q other prescribed device
Officer’s Printed Name
Officer’s Signature
Badge Number
CERTIFICATION FROM U.S. DEPARTMENT OF VETERANS AFFAIRS REGIONAL OFFICE ADMINISTRATOR (PHILADELPHIA OR PITTSBURGH)
DOR SERVICE UNIT IN WHICH THE VETERAN SERVED OR A LEGIBLE PHOTOCOPY OF THE APPLICANT'S LETTER OF PROMULGATION, AWARDS LETTER, SINGLE NOTIFICATION, OR SUMMARY OF BENEFITS LETTER.
qThis is to certify that the veteran listed above with VA number ___________________________, has a 100% service-connected disability or has the following service connected disability reason code number _______, listed on the reverse side of this application under “Eligibility Requirements.” NOTE: If reason code #4 is listed, please indicate the type of device used: __________________________.
Authorized Printed Name and Title: ____________________________________________ Authorized Signature: ____________________________________________
qIn lieu of the U.S. Department of Veterans Affairs Regional Office Administrator certification, I have attached a legible photocopy of my Letter of Promulgation, Awards Letter, Single Notification Letter, or Summary of Benefits Letter that indicates I have a 100% service-connected disability.
E NOTARIZATION AND APPLICANT SIGNATURE - Person with disability, natural parent or other authorized person listed in Section A must sign below.
SUBSCRIBED AND SWORN
I state that I have read and signed this application after its completion, and I swear or
TO BEFORE ME:
MONTH
DAY
YEAR
affirm that the statements made herein are true and correct, and that any statement
made on or pursuant to this application is subject to the penalties of 18 Pa.C.S.
SIGNATURE OF PERSON ADMINISTERING OATH
Section 4903 (a)(2) (relating to false swearing), which shall include punishment of a
fine not exceeding $5,000, or to a term or imprisonment of not more than two years,
S
or both.
T
SIGN IN PRESENCE OF NOTARY
A
Person with Disability Signature
Date
M
THIS APPLICATION MAY BE DUPLICATED
P
INSTRUCTIONS
1.Permanent Placard - Complete Sections A, B or C (NOT BOTH) and E. NOTE: Individuals should list their PA Driver’s License (PA DL) or Photo ID# in the space provided. Businesses should list their Business ID# (Bus. ID) where indicated (i.e. E.I.N.).
2.Severely Disabled Veteran Placard - Complete Sections A, D and E.
3.Temporary Placard - Complete Sections A, B and E. NOTE: Only licensed health care providers* may certify disabilities for temporary placards. Temporary placards may be issued for a period up to six months and may not be extended for an additional period of time. When additional time is needed, a new application must be completed and certified by a health care provider. In addition, please list your previous placard number.
4.Renewal Request - Complete Sections A and E. NOTE: Notarization is not required.
5.Replacement Request - Indicate if applying for a replacement placard or ID card. Please check reason for replacement; Lost, Stolen, Defaced or Never Received. List your previous placard number and complete Sections A and E. NOTE: If product was not received within 90 days, please check the "Never Received" box or if product was not received for over 90 days please check the "Lost" box.
6.Change of Address - Complete Sections A and E. NOTE: Notarization is not required.
7.Change of Name - Complete Sections A and E. Check the block on the front of this application to indicate reason for change of name. NOTE:
Notarization is not required.
*Health Care Provider is defined as a physician, chiropractor, optometrist, podiatrist, physician assistant, or a certified registered nurse practitioner licensed or certified in Pennsylvania or a contiguous state. Health care providers may only certify disabilities within their scope of practice.
Placard Type
Eligibility Requirements
Qualifying Vehicles
Benefits
Person with Disability Placard
“Reason Codes”
Applicant:
(1)is blind.
(2)does not have full use of an arm or both arms.
(3)cannot walk 200 feet without stopping to rest.
(4)cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair or other assistive device.
(5)is restricted by lung disease to such an extent that the person’s forced (respiratory) expiratory volume for one second, when measured by spirometry, is less than one liter or the arterial oxygen tension is less than 60 MM/HG on room air at rest.
(6)uses portable oxygen.
(7)has a cardiac condition to the extent that the person’s functional limitations are classified in severity as Class III or Class IV according to the standards set by the American Heart Association.
(8)is severely limited in their ability to walk due to an arthritic, neurological or orthopedic condition.
NOTE: If you are the parent or adult charged by law with the natural parent’s rights, duties, and responsibilities, acting on behalf of a minor child (under 18) in place of the child’s natural parents (person in loco-parentis), complete the appropriate information on the front side of this application.
In addition, a parent, including an adoptive or foster parent who has custody, care, or control of the child or adult child or a spouse, may sign on behalf of the child, adult child, or spouse (applicant) provided the person with disability meets eligibility requirements (1) through (8).
(1)A passenger vehicle or truck with a registered gross weight of not more than 14,000 lbs.
(2)The placard is required to be displayed when the vehicle is parked in areas designated for use by persons with disability only and must not be displayed when the vehicle is being operated on the highway.
NOTE: Organizations that operate a passenger vehicle to transport persons with disabilities must supply the Department with the following:
a)A notarized statement of how the placard will be used and the type of services that will be provided.
b)The weekly or monthly number of hours that the services are provided.
c)The make of the vehicle(s), including the title number, vehicle identification number and registration plate number. The vehicle(s) must be titled in the name of the organization and must be a passenger vehicle.
d)The number of placards required: (Organizations may not be issued more than eight placards in the organization’s name.)
(1)Parking permitted in spaces designated for disabled persons and for 60 minutes in excess of legal parking period except where local ordinances or police regulations provide for the accommodation
of heavy traffic during morning, afternoon or evening hours.
(2)Upon request of a person with disability, local authorities may erect on the highway as close as possible to the person’s residence a sign(s) indicating that the place is reserved for the person with disability, that no one else may park there unless a person with disability plate or placard is displayed and that any unauthorized person parking there will be subject to a fine.
Severely
Disabled
Veteran
Placard
(1)100% service-connected disability certified by the U.S. Department of Veterans Affairs (Pittsburgh or Philadelphia) or service unit in which the veteran served or as shown on the applicant’s Letter of Promulgation, Awards Letter, Single Notification Letter, or Summary of Benefits Letter.
(2)Same disabilities as listed above for Person with Disability Placard but must be service-
Same as 1 and 2 above for Person with Disability Placard.
Same as above for Person with Disability Placard.
Use of Person with Disability and Severely Disabled Veteran Placards:
. Parking in a designated persons with disability parking space is only permitted with this parking placard when the vehicle is being used for the transportation of the person for which the parking placard was issued.
. Any vehicle lawfully displaying a parking placard will qualify for parking in areas designated only for use by persons with a disability. NOTE: This parking placard can not be used to park where parking is prohibited.
Send completed application to: PennDOT, Bureau of Motor Vehicles, P.O. Box 68268, Harrisburg, PA 17106-8268
Visit us at www.dmv.pa.gov or call us at 717-412-5300. TTY callers — please dial 711 to reach us.
Filling out the MV-145A form, formally known as the Person with Disability Parking Placard Application, is important for acquiring a disability parking placard in Pennsylvania. This no-fee application is your pathway to gaining parking privileges that are essential for many individuals with disabilities. To complete this form accurately and ensure a smooth process, follow these steps.
Remember, ensuring that each section is correctly filled out and submitting all required documentation will help expedite the processing of your application. This placard not only allows parking in designated spaces but also symbolizes the much-needed awareness and consideration for individuals with disabilities. Taking the time to fill out the application carefully is a step towards accessing the benefits and recognitions deserved.
The MV-145A form, known as the Person with Disability Parking Placard Application, is a document issued by the Pennsylvania Department of Motor Vehicles. It's designed for individuals seeking to obtain a parking placard that allows them to park in spaces designated for persons with disabilities. The form caters to various groups, including permanently disabled individuals, temporarily disabled individuals, and severely disabled veterans. It doesn't require a fee and encompasses options for original requests, renewals, replacements, and changes in address or name.
To apply for a placard, you need to complete the MV-145A form. The application process involves:
After completing the necessary sections, send the form to the PennDOT address provided on the application.
Eligibility for a disability parking placard includes but is not limited to individuals who:
Applicants must have their conditions certified by a qualified health care provider to qualify.
If your placard is lost, stolen, defaced, or never received, you should:
Submit the form to the PennDOT for processing of your replacement request. Remember, you don’t need to get the form notarized.
Yes, individuals with permanent disability parking placards can renew their placards by using the MV-145A form. To renew:
Note that renewal requests are for permanent placards only. Temporary placard holders must be recertified by a health care provider for an additional period.
Filling out the MV-145A form for a Person with Disability Parking Placard Application in Pennsylvania seems straightforward, but mistakes can delay the process. Here are five common errors to avoid:
Incorrectly checking the type of request. The form includes options for an original request, renewal, replacement, and change of address or name. It's essential to check the correct box (Original Request, Renewal Request, Replacement Request, Change of Address, Change of Name) to ensure your application is processed correctly.
Not completing certification sections properly. Section B requires certification from a health care provider, while Section C is for police officer certification in specific cases. Skipping these or not having them filled out by the appropriate professionals can lead to denials.
Failing to list a previous placard number when requesting a replacement or renewal. If your placard was lost, stolen, defaced, or you never received it, you must provide your previous placard number.
Omitting personal information such as PA Driver’s License (PA DL) or Photo ID# for individuals, or Business ID# for businesses. This information helps to verify your identity and streamline the application process.
Not checking the correct box for a change of name due to marriage, divorce, or other reasons. This section is also often overlooked, leading to processing delays.
Avoid these common mistakes to ensure your MV-145A form is processed smoothly and efficiently, enabling quicker access to your much-needed Person with Disability Parking Placard.
When submitting the MV-145A form for a Person with Disability Parking Placard in Pennsylvania, various other forms and documents might be required or used in conjunction, depending on the applicant’s circumstances. Here’s a concise outline of these forms:
It’s essential to accurately complete and submit the necessary documentation to ensure timely processing of requests related to the MV-145A form or any other vehicle and driver services in Pennsylvania. Careful attention to the specific requirements of each form, including supporting documentation, will facilitate smoother interactions with the Department of Motor Vehicles.
The MV-145A form is similar to the Application for Disabled Person License Plate. Both forms are used to assist individuals with disabilities in obtaining special parking privileges. The key similarity lies in the certification process, which requires medical verification of the disability.
The Application for a Disabled Veteran License Plate shares similarities with the MV-145A form, particularly in the section dedicated to veterans. Both applications accommodate individuals with disabilities by requiring proof of disability status, albeit the veterans' form focuses on service-connected disabilities.
Renewal Application for Disability Placard and the MV-145A form have a renewal process in common, especially noted in the MV-145A's section on renewal requests for permanent placards. The emphasis is on keeping the information updated and ensuring continued eligibility for the benefit.
The Replacement Application for Disability Placard/Plate mirrors the replacement request section of the MV-145A form. Both necessitate the applicant to indicate the reason for replacement, such as loss, theft, or damage to the original placard or plate.
Change of Address Notification for Disability Placard is akin to the change of address section in the MV-145A form. Accurate and current address information is vital for both forms to ensure the applicant receives the placard or any related correspondence.
Change of Name Application for Disability Placard resembles the change of name section in the MV-145A. Both recognize the significance of reflecting the user's current legal name on all official documents and require verification for name changes due to marriage, divorce, or other reasons.
Application for Organizational Disability Placard shares the idea with the MV-145A form of providing services to groups or individuals with disabilities. This form is specifically designed for organizations that transport disabled persons, necessitating details about vehicle use and the services provided.
The Health Care Provider Certification for Disability Placards is closely related to the section in the MV-145A form that requires a health care provider's certification. Both emphasize the need for medical verification of the disability within the health care provider's scope of practice.
Temporary Disability Placard Application echoes the MV-145A's section for requesting a temporary placard. The primary commonality is the issuance duration and the requirement for a health care provider's recertification for extensions, highlighting the temporary nature of the applicant’s disability.
When filling out the MV-145A form for a Person with Disability Parking Placard application in Pennsylvania, there are several important dos and don'ts to keep in mind to ensure the process is completed accurately and efficiently.
Dos:
Don'ts:
When it comes to the MV-145A form, or the Person with Disability Parking Placard Application in Pennsylvania, there are several misconceptions that can confuse individuals trying to navigate the process of obtaining a parking placard. Clearing up these misconceptions is key to a smooth application process.
Notarization is required: Many people believe notarization is needed for the MV-145A form. However, this is not the case, as the form explicitly states that notarization is not required for the application, renewal, change of address, or name change sections.
There’s a fee involved: Another common misconception is that applicants must pay a fee to obtain a disability parking placard. In reality, the MV-145A application process requires no fee, making it accessible to all qualifying individuals without any cost.
Temporary placards can be easily extended or renewed: Some applicants believe that temporary placards can be extended or renewed by simply requesting more time. However, to extend the duration or obtain a new temporary placard, a new application must be completed and certified by a health care provider.
Any health care provider can certify the application: There's a misconception that any health professional can certify a disability for the placard. The truth is, only specific licensed or certified health care providers in Pennsylvania or a contiguous state—and within their scope of practice—can certify disabilities for this placard.
Veterans automatically qualify: While veterans with disabilities do have provisions under the application process, not all veterans qualify for a placard. Severely disabled veterans must provide specific documentation of a 100% service-connected disability or other qualifying conditions as stated on the form.
The form is complicated and lengthy: The thought that the MV-145A form is excessively complicated and long deters some from applying. In reality, the form is straightforward and requires only relevant information for assessing eligibility and ensuring proper identification.
Organization vehicles don’t qualify: Contrary to this belief, organizations that transport persons with disabilities can apply for placards. Strict guidelines and specific documentation are required, limiting misuse and ensuring these placards serve individuals genuinely in need.
Every condition qualifies for a placard: It's wrongly assumed that any medical condition can lead to eligibility for a disability parking placard. The form clarifies that only specific disabilities, as listed under the "Eligibility Requirements", qualify an applicant for a placard.
Placards are valid in every state: While many states offer reciprocity for disability parking placards, there is a common misunderstanding that a Pennsylvania placard guarantees parking privileges in all states. It’s important for placard holders to check local parking laws when traveling out of state
Understanding the proper procedures, requirements, and eligibility criteria can significantly simplify the process of obtaining a Person with Disability Parking Placard in Pennsylvania.
The MV-145A form is a valuable document for individuals with disabilities in Pennsylvania, enabling them to apply for a parking placard that facilitates more accessible parking options. Here are key takeaways regarding filling out and utilizing the form:
Understanding these key points can make the process of applying for a Person with Disability Parking Placard smoother and ensure that applicants are well-informed about their responsibilities and the benefits provided.
Army New Counseling Form - Used by army leaders, the DA 4856 outlines the discussion points of developmental counseling for service members.
Da 7666 - When completed, the DA 7666 allows for a collaborative approach to the healthcare of military dependents, involving various stakeholders.