The BFS 108 Michigan form is an application for a disability parking placard, allowing eligible individuals to park in designated spaces. This form requires personal information from the applicant and medical certification from a licensed healthcare provider. If you need a disability parking placard, fill out the form by clicking the button below.
The BFS 108 Michigan form serves as a crucial document for individuals seeking a disability parking placard in the state of Michigan. This application is divided into several parts, each designed to gather essential information from both the applicant and their healthcare provider. Part 1 requires the applicant to provide personal details and consent to the release of medical information. In Part 2, a licensed medical professional must assess and confirm the applicant's eligibility based on specific medical criteria, which include conditions that severely limit mobility. If the applicant also qualifies for free parking, Part 3 must be completed, detailing additional criteria that must be met. Organizations applying for placards on behalf of individuals with disabilities can fill out Part 4, ensuring that transportation services are adequately documented. It is vital to note that applications cannot be processed without the necessary signatures and certifications, emphasizing the importance of accuracy and honesty in the information provided. Completed forms can be submitted in person at any Secretary of State branch office or mailed to the designated address, making it accessible for all applicants. Understanding the details of this form is essential for ensuring compliance with state regulations and securing the necessary accommodations for individuals with disabilities.
MICHIGAN DEPARTMENT OF STATE
Disability Parking Placard Application
Directions:
Office Use Only:
Expiration
Date:
Placard
Number:
Applicants please complete and sign Part 1. Your physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant must complete Part 2 and the certification on the bottom of this page. If you also qualify for free parking, your physician, chiropractor, optometrist, nurse practitioner, physician’s assistant, or physical therapist must also complete Part 3. Organizations applying for parking placards to provide transportation services for disabled persons complete Part 4. Completed applications may be presented at any Secretary of State branch office or mailed to the address on the reverse side of this form. (Application cannot be processed without signed release of information and physician’s certification.)
Part 1: Release of Information and Signature
I am applying for a disability parking placard as provided in Public Act 300 of 1949. I authorize the release of the medical information described below to the Michigan Department of State. I certify the information is true and realize by making a false statement on this application I am subject to the penalties described on the reverse side of this form.
PLEASE PRINT OR TYPE INFORMATION REQUESTED
Print Form
Clear Form
Asterisks (*) indicate required fields.
Name (First, Middle, Last)*
Date of Birth*
Michigan Driver’s License or State ID Card #*
Street Address*
County*
Disability Plate Number (if any)*
City, State, Zip*
Daytime Phone Number*
Last Parking Permit Number
(
)
Signature of Disabled Person*
Today’s Date*
Are you a Michigan resident?*
X
YES
NO
Signature of Representative (If presented by representative)*
Representative’s Driver’s License Number*
Part 2: Medical Eligibility Standards and Physician’s Determination
The Michigan Vehicle Code [MCL 257.19a] states that a disabled person be determined by a licensed physician, physician’s assistant, chiropractor, nurse practitioner, physical therapist, or optometrist identifying one or more of the following characteristics which affect your patient’s ability to walk.
Circle all letters that apply*
Right Eye:
Left Eye:
Both Eyes:
Visual field (in degrees):
a) Blindness. Corrected acuity level:
20/
b)An inability to walk more than 200 feet without having to stop and rest. Please provide the diagnosis for this ambulatory disability:
____________________________________________________________________________________________________________________
c)Patient must use a wheelchair, walker, crutch, brace, or other ambulatory aid to walk. Describe:
d)Patient has a lung disease from which the forced expiratory volume for one second, when measured by spirometry, is less than one liter, or from which the arterial oxygen tension is less than 60mm/hg of room air at rest.
e)Patient has a cardiovascular condition which measures between 3 and 4 on the New York Heart Classification Scale, or which renders the patient incapable of meeting a minimum standard for cardiovascular health established by the American Heart Association and approved by the Michigan Department of Health and Human Services.
f)Patient has an arthritic, neurological, or orthopedic condition that severely limits ability to walk. Describe:
g)Patient has persistent reliance upon an oxygen source other than ordinary air.
Physician’s Certification
A parking placard will be issued solely on the physician’s evaluation
Patient’s condition is*:
Permanent
Temporary
If temporary, estimated duration:
months (maximum 6 months)
Physician’s Name*
Medical Specialty*
Office Telephone*
Office Fax*
I certify the person listed above is eligible for a disability placard as provided in Public Act 300 of 1949. I also understand that making a false statement to obtain a disability parking placard is a misdemeanor and may result in fines, imprisonment, or both.
Medical License Number**
Physician’s Signature*
Date*
**If the medical license was issued in a state other than Michigan, the Physician/Physical Therapist must submit a copy of their medical license.
NOTE: If the individual listed above is also eligible for free parking, Part 3 on the reverse side of this application must also be completed.
BFS-108 (10/19/2023)
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Part 3: Free Parking Application and Physician’s Certification
(Complete Parts 1, 2, and 3)
The free parking application is completed only when the applicant qualifies for free parking. To qualify, your patient must be a Michigan licensed driver, have an ambulatory disability described in Part 2, and have one of the following conditions. Economic need is not a consideration.
Circle all letters that apply:
a)The patient cannot insert coins or tokens in a parking meter or cannot accept a ticket from a parking lot machine due to a lack of fine motor control of both hands.
b)The patient cannot reach above their head to a height of 42 inches from the ground, due to a lack of finger, hand, or upper extremity strength or mobility.
c)The patient cannot approach a parking meter due to use of a wheelchair or other ambulatory device.
d)The patient cannot walk more than twenty feet due to an orthopedic, cardiovascular, or lung condition in which the degree of debilitation is so severe that it almost completely impedes the patient’s ability to walk. (A condition requiring applicant to rest after walking twenty feet when not using a wheelchair or other ambulatory device.)
I certify the person listed on the front of this application is also eligible for free parking as provided in state law [MCL 257.675]. I understand that making a false statement to obtain a free parking sticker is a misdemeanor and may result in fines, imprisonment, or both.
Physician’s signature: X
Date
(Physician / Chiropractor / Physician’s Assistant / Optometrist / Nurse Practitioner / Physical Therapist)
Part 4: Organization Request for Disability Parking Placards
Name of Organization
FEIN
County
Telephone Number
Street Address
City, State, Zip
Describe the transportation services your organization provides to persons with disabilities:
Number of disability placards you are requesting:
(No more than one per vehicle used to transport clients.)
I am applying for a disability parking placard as provided in Public Act 300 of 1949 and certify the above information is true.
Signature of Organization Officer
Printed Name of Organization Officer
Organization Officer’s Driver’s License Number
Position (Title) Within Organization
Note: If the organization ceases to provide specialized services to disabled persons, the parking placard must be returned to the Secretary of State for cancellation.
Penalties
Michigan Vehicle Code Section 257.676 prohibits:
•Using a disability parking placard to park in a designated parking space unless the disabled person is driving or being transported.
•Altering, modifying, or selling a disability parking placard or free parking sticker.
•Copying or forging, or using a copied or forged disability parking placard or free parking sticker.
•Making a false statement to obtain a disability parking placard or free parking sticker or committing a deception or fraud on a medical statement attesting to a disability.
•Knowingly using or displaying a disability parking placard that has been canceled by the Secretary of State.
A violation is a misdemeanor and punishable by a fine up to $500 or imprisonment for up to 30 days, or both. A law enforcement officer may immediately confiscate a disability parking placard for improper use.
Return completed applications to any Secretary of State branch office or mail to:
Michigan Department of State
Internal Services Section
PO Box 30764
Lansing, MI 48918
If you have any questions regarding disability parking placards, please call the Department of State Information Center at 1-888-767-6424.
The personally identifiable information collected on this form will be used by MDOS to complete the requested transaction. MDOS limits the amount of personally identifiable information to only that information which is relevant and necessary to complete your transaction. Please be aware that under the Federal Driver’s Privacy Protection Act, 18 U.S.C. 2751, et seq. and the Michigan Driver’s Protection law, MCL 257.208c, your personal information may be provided to third parties without additional prior notice or consent when permitted or required by law. As a public body, MDOS is subject to the Michigan Freedom of Information Act (FOIA), MCL 15.231 et seq., and information such as a name or address may be disclosed in response to a FOIA request pursuant to law.
Authority granted under Public Act 300 of 1949, as amended.
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Filling out the Bfs 108 form is an important step for those seeking a disability parking placard in Michigan. It is crucial to ensure that all required sections are completed accurately to avoid delays in processing. Below are the steps to guide you through the process of filling out this form.
Once the form is completed, you may present it at any Secretary of State branch office or mail it to the address specified on the reverse side of the form. It is essential to retain a copy of the completed application for your records.
The Bfs 108 Michigan form is an application for a disability parking placard. It allows individuals with disabilities to apply for a placard that grants them access to designated parking spaces. The form must be completed by the applicant and certified by a qualified medical professional.
Part 2 must be completed by a licensed physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant. This section assesses the applicant's medical eligibility based on specific criteria related to their ability to walk and other disabilities.
If you qualify for free parking, your medical professional must also complete Part 3 of the application. This section outlines additional criteria that must be met to receive free parking privileges, including specific physical limitations that prevent you from using standard parking meters.
You can submit the completed Bfs 108 form at any Secretary of State branch office in Michigan. Alternatively, you can mail it to the address provided on the reverse side of the form. Ensure that all necessary parts are completed and signed to avoid delays in processing.
Providing false information on the application is considered a misdemeanor. Penalties may include fines, imprisonment, or both. The law strictly prohibits deception in obtaining a disability parking placard or free parking sticker.
Yes, organizations can apply for disability parking placards on behalf of individuals with disabilities. Part 4 of the application must be completed, detailing the transportation services provided to disabled persons. Organizations may request one placard per vehicle used for transportation.
Improper use of a disability parking placard can lead to serious consequences. Violations include using a placard when the disabled person is not present, altering or selling placards, and using a placard that has been canceled. Penalties can include fines up to $500 or imprisonment for up to 30 days, or both.
Incomplete Information: Failing to fill out all required fields can lead to delays. Make sure to include your full name, date of birth, and contact information.
Missing Signatures: Both the applicant and the physician must sign the form. Omitting either signature will result in rejection.
Incorrect Physician Information: Ensure that the physician's name, medical specialty, and license number are accurate. Any discrepancies can cause processing issues.
Not Following Directions: Carefully read the instructions for each part of the form. Skipping steps or not following the order can lead to confusion and errors.
Failing to Attach Required Documents: If applying for free parking, include necessary documentation. This may include proof of a medical waiver if applicable.
Submitting Without Review: Before submitting, review the entire application for accuracy. Small mistakes can lead to significant delays in processing.
The Bfs 108 Michigan form is essential for individuals applying for a disability parking placard in Michigan. However, several other forms and documents often accompany it to ensure a smooth application process. Below is a list of commonly used documents that applicants may need to complete or submit.
Each of these documents plays a vital role in the application process for a disability parking placard. Ensuring that all forms are accurately completed and submitted can significantly enhance the likelihood of a successful application.
The BFS 108 Michigan form shares similarities with the ADA National Network's Disability Parking Permit Application. Both documents require applicants to provide personal information and medical verification of their disability. The ADA application also involves a physician's certification, ensuring that the applicant meets specific criteria related to their mobility limitations. This process underscores the importance of having a medical professional validate the need for special parking accommodations, which helps to maintain the integrity of the program and prevent misuse.
Another comparable document is the Department of Motor Vehicles (DMV) Disabled Person Parking Placard Application. Like the BFS 108, this application mandates that applicants disclose their disability and obtain a physician's signature to confirm their eligibility. Both forms aim to facilitate access to parking for individuals with disabilities, ensuring they can find accessible spaces while minimizing the potential for fraudulent claims. The DMV application, however, may vary in its specific requirements based on state regulations, but the core purpose remains aligned with the BFS 108.
The Social Security Administration (SSA) Disability Benefits Application also parallels the BFS 108 in its focus on medical documentation and eligibility criteria. Applicants seeking disability benefits must provide extensive information about their health conditions, similar to the medical requirements outlined in the BFS 108. Both documents emphasize the need for a healthcare provider's assessment, reinforcing the significance of medical evidence in determining an individual's ability to function in daily life. While the SSA application is geared toward financial assistance, the underlying principles of verifying disability status are consistent.
Additionally, the Veterans Affairs (VA) Disability Compensation Application exhibits similarities with the BFS 108. Both forms require detailed medical evaluations and documentation to support claims of disability. The VA application focuses on veterans seeking compensation for service-related disabilities, while the BFS 108 is aimed at civilians needing parking assistance. Despite their different contexts, both processes highlight the necessity of credible medical assessments in securing benefits for individuals with disabilities.
Finally, the state-specific Medical Certification Form for Handicapped Parking is another document that aligns closely with the BFS 108. This form, used in various states, requires a physician's endorsement to validate the applicant's disability status. The similarities lie in the structured approach to gathering essential information about the applicant's condition and the medical professional's assessment. Both forms aim to ensure that parking privileges are granted only to those who genuinely require them, promoting fairness and accessibility in public spaces.
When filling out the BFS 108 Michigan form, there are important dos and don'ts to keep in mind. Following these guidelines will help ensure your application is processed smoothly.
The BFS 108 Michigan form is essential for individuals seeking a disability parking placard. However, several misconceptions can lead to confusion. Below are four common misconceptions explained.
This is incorrect. A licensed physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant must complete Part 2 of the form to certify the applicant's medical eligibility. Without this certification, the application cannot be processed.
Only individuals with specific medical conditions that affect their ability to walk can apply. The form outlines various conditions, such as blindness or the inability to walk more than 200 feet. Eligibility is determined based on these criteria.
Submission of the application does not guarantee approval. The Michigan Department of State reviews each application based on the physician's certification and the information provided. If the criteria are not met, the application may be denied.
This is false. To qualify for free parking, applicants must meet additional criteria outlined in Part 3 of the form. This includes being a Michigan licensed driver and having specific conditions that prevent them from using parking meters or approaching parking areas.
When filling out and using the Bfs 108 Michigan form for a disability parking placard, consider the following key takeaways: