The Illinois Placard form is an essential document that allows individuals with disabilities to apply for a parking placard, granting them access to designated parking spaces. This form must be completed accurately and includes sections for both the applicant and their medical professional to certify eligibility. To begin the process of obtaining your placard, click the button below to fill out the form.
The Illinois Placard form is an essential document for individuals with disabilities seeking to obtain a parking placard that allows for easier access to parking spaces. This form is designed for both new applicants and those looking to renew their existing placards. If a placard has been lost, stolen, or damaged, a replacement form is available online. The certification process requires the signature of a medical professional, confirming that the applicant meets the criteria for a disability. The form is divided into several parts, each requiring specific information. Applicants must provide personal details, including their Illinois driver’s license number and address, and if they are minors, a parent or guardian must also complete a section. Additionally, medical professionals must verify the applicant's disability and, if applicable, certify eligibility for meter-exempt parking. The form emphasizes the importance of accurate information, as misuse can lead to serious penalties. Completing the Illinois Placard form correctly ensures that individuals with disabilities can access the necessary accommodations to enhance their mobility and independence.
State of Illinois Secretary of State 501 S. 2nd Street Springfield, IL 62756
NNEW APPLICANT
NRENEWAL
*If your valid placard was lost/stolen/damaged,
use replacement form VSD 415,
available online at cyberdriveillinois.com or visit your local Secretary of State facility.
Persons with Disabilities Certification for Parking Placard
*This form is valid for three months from your physician’s signature date for a Temporary Placard and six months for a Permanent Placard.
NOTE TO DISABILITY LICENSE PLATE OWNERS: If you have a disability license plate, you MUST complete the form and renew your placard.
DIRECTIONS: Both sides of this document must be signed and completed fully. All fields are required.
Applicants complete Part 1. If the applicant is a MINOR, then Parent/Guardian(s) MUST also complete Part 2. The applicant’s medical profes- sional MUST complete Part 3. If the applicant is applying for meter-exempt parking, his/her medical professional MUST also complete Part 4.
Part 1: Applicant Information (MUST have a valid Illinois driver’s license and/or ID card)
I hereby certify that I meet the definition of a person with a disability as provided in 625 ILCS 5/1-159.1, and I certify that my physical condition entitles me to the issuance of a Persons with Disabilities Parking Placard. By affixing my signature below, I understand that the parking placard may not be used unless I am the driver or passenger of the vehicle.
*If a military veteran, please provide a copy of your DD214 showing proof of service.
Disability Parking Placard # (if any)
Full Name of Person with Disability (If Minor, complete Part 2 also.)
Male/Female
Date of Birth
Valid Illinois Driver’s License or ID Card # of Applicant
Illinois Address
Apt/Unit #
City
IL
ZIP
Mailing Address if Different from Above
Telephone Number
Email Address
Military Veteran? Yes / No
Signature of Person with Disability
Today’s Date
Part 2: For Parent or Legal Guardian (MUST have a valid Illinois driver’s license and/or ID card)
I hereby certify that the above applicant is a minor and I have primary responsibility for his/her transportation. By affixing my signature below, I understand that the disability placard is issued to the person with disability and may not be used unless I am transporting the disabled person in the vehicle.
Name of Parent or Legal Guardian
Relationship to Person with Disability
Valid Illinois Driver’s License or ID Card #
Signature of Parent or Legal Guardian
Warning: Any misuse of the disability parking placard/plates or making a false application may result in the revocation of the placard, a 12- month suspension or revocation of your driver’s license, and a fine of up to $1,000.
Temporary Disabled Parking Placard Applications — May be taken to any Secretary of State facility or mailed in. Permanent Disabled Parking Placard Applications — MUST be mailed to the following address:
Secretary of State, Persons with Disabilities Placard Unit, 501 S. 2nd Street, Room 541, Springfield, IL 62756.
*If you have a permanent disability placard and would like a Persons with Disabilities License Plate, please visit your local Secretary of State facility to apply. You will need your permanent placard number and current plate number or VIN.
Please complete Page 2 to ensure timely processing.
Printed by authority of the State of Illinois. July 2021 — 1 — VSD 62.28
Part 3: Medical Eligibility Standards and Medical Professional Certification
As the medical professional(s) executing this document and verifying the nature of the applicant’s disability, I understand that making a false representation of a person’s disability for the purposes of obtaining any type of disabled parking placard may result in suspension or revocation of my license and a fine of up to $1,000. As a licensed physician, advanced practiced nurse, optometrist, chiropractor or physician’s assistant, I certify the applicant has a condition that constitutes him/her as a person with disabilities.
Length of Disability: (Check one)
NTemporary Disability; the duration of this disability is ________________________(maximum 6 months)
NPermanent Disability
NMeter-Exempt Disability (Must complete and sign Part 4 also.)
Check all that apply: (MUST check at least one):
NIs restricted by a lung disease to such a degree that the person’s forced (respiratory) expiratory volume (FEV) for 1 second, when measured by spirometry, is less than 1 liter.
NUses a portable oxygen device.
NHas Class III or Class IV cardiac condition according to the standards set by the American Heart Association.
NCannot walk without the use of or assistance from a wheelchair, a walker, a crutch, a brace, a prosthetic device, or another person.
NIs severely limited in the ability to walk due to an arthritic, neurological, oncological, or orthopedic condition.
NCannot walk 200 feet without stopping to rest because of one of the above five conditions.
Check all that apply: (MUST check at least one diagnosis):
N Amputation of extremity(s) _________________________
N Arthritis of the ______________________________________
N Spina Bifida
N Osteoarthritis of the
_________________________________
N Multiple Sclerosis
N Chronic Pain due to
N Quadriplegia/Paraplegia
N Legally Blind with limited mobility
NCerebral Palsy
NOther Diagnosis: _________________________________________________________________________________________
If none of the above conditions apply, list the medical condition that impacts the person’s mobility.
Medical Professional’s Printed Name
Specialty
Office Address
City, State, ZIP
Medical Professional’s Signature
State Professional License Number (NOT NPI#)
Signature of Collaborating/ Supervising Physician (if signed above by resident/assistant)
Supervising State Professional License Number
Part 4: Medical Eligibility for Meter-Exempt Parking
The meter-exempt parking certification must be completed only when the applicant qualifies. To qualify, the applicant MUST have a VALID Illinois driver’s license, have an ambulatory disability described in Part 3, and also have one of the following conditions listed below.
Economic need is not a consideration for meter-exempt parking.
The applicant is eligible for meter-exempt parking as provided by statue due to the following PERMANENT medical condition or disability:
Check all that apply:
NCannot manage, manipulate or insert coins, or obtain tickets in parking meters/ticket machines due to lack of fine motor control of BOTH hands.
NCannot reach above his/her head to a height of 42 inches from the ground due to a lack of finger, hand or upper-extremity strength or mobility.
NCannot approach a parking meter due to his/her use of a wheelchair or other device for mobility.
NCannot walk more than 20 feet due to an orthopedic, neurological, cardiovascular or lung condition in which the degree of debilitation is so severe that it almost completely impedes the ability to walk.
NMissing a hand(s) or arm(s) or has permanently lost the use of a hand or arm.
NPatient is under 18 years of age and incapable of driving.
FOR SECRETARY OF STATE OFFICE USE ONLY
Parking Placard Number: ________________________________
Expiration Date: ______________________________________
Issued By: ___________________________________________
Issue Date: __________________________________________
Filling out the Illinois Placard form is a straightforward process, but it requires careful attention to detail. Make sure you have all necessary information ready before you begin. This includes your personal details, any relevant medical information, and signatures from both you and your medical professional. Follow the steps below to complete the form accurately.
The Illinois Placard form is used to apply for a parking placard designated for persons with disabilities. This placard allows individuals with qualifying disabilities to park in designated spaces that are closer to their destinations. The form can be used for both temporary and permanent placards, depending on the applicant's medical condition.
To complete the form, follow these steps:
If your placard is lost, stolen, or damaged, you must use the replacement form VSD 415. This form is available online at cyberdriveillinois.com or can be obtained at your local Secretary of State facility. It is important to act quickly to avoid any inconvenience when parking.
To be eligible for a parking placard, the applicant must:
Misusing a disability parking placard can lead to serious consequences. This includes revocation of the placard, a 12-month suspension or revocation of your driver’s license, and a fine of up to $1,000. It is essential to use the placard only when the authorized person is present in the vehicle.
Failing to sign both sides of the form. Each section requires a signature to validate the application.
Not providing a valid Illinois driver’s license or ID card number. This is mandatory for both the applicant and the parent or guardian if applicable.
Leaving out required fields. All fields on the form must be completed, including contact information and medical professional details.
Submitting the form without the necessary medical certification. The medical professional must fill out Part 3 and, if applicable, Part 4.
Not indicating the correct type of disability. Applicants must check at least one box in both the disability and diagnosis sections.
Forgetting to specify if the applicant is a minor. If the applicant is under 18, the parent or guardian must complete Part 2.
Neglecting to provide proof of military service when applicable. Veterans must include a copy of their DD214.
Not mailing the application to the correct address for permanent placards. Ensure it is sent to the Secretary of State’s specified unit.
When applying for an Illinois Placard, there are several other forms and documents that may be needed. These documents help ensure that the application process runs smoothly and that all necessary information is provided. Below is a list of some commonly used forms and documents.
Each of these documents plays a crucial role in the application process. Ensuring that all necessary forms are completed and submitted can help avoid delays and facilitate a smoother experience when obtaining an Illinois Placard.
The Illinois Vehicle Registration Application is similar to the Illinois Placard form in that both documents require personal information from the applicant. This includes details such as the applicant's name, address, and date of birth. Both forms also necessitate a valid Illinois driver’s license or ID card number. The Vehicle Registration Application serves to register a vehicle, while the Placard form is specifically for individuals with disabilities seeking parking accommodations. Each document aims to ensure that the appropriate credentials are verified and that the applicant meets the necessary criteria for their respective requests.
The Application for a Disabled Person's License Plate is another document that shares similarities with the Illinois Placard form. Both applications are designed for individuals with disabilities and require medical certification to confirm eligibility. The process for obtaining a disabled license plate is akin to that of acquiring a parking placard, as both require the signature of a medical professional. Additionally, both documents emphasize that the issued credentials must be used solely by the individual with the disability, reinforcing the importance of proper use.
The Temporary Disability Parking Permit Application is also comparable to the Illinois Placard form. Like the Placard application, this document is intended for individuals with temporary disabilities and requires medical verification. Both forms have specific time frames associated with their validity; the Temporary Disability Parking Permit is usually valid for a limited period, similar to the temporary placard option. Applicants must provide the same type of personal and medical information, ensuring that those who truly need assistance receive it.
Finally, the Illinois Medical Certification for Disability Parking is another document related to the Illinois Placard form. This certification is often required as part of the application process for both placards and disabled license plates. It serves to validate the applicant’s disability through the signature of a qualified medical professional. The focus on medical eligibility and the requirement for professional endorsement is a common thread that links this certification to the Placard form, ensuring that only those with legitimate needs are granted access to disability parking privileges.
Filling out the Illinois Placard form can be straightforward if you follow the right guidelines. Here’s a list of things you should and shouldn’t do to ensure a smooth application process.
By adhering to these guidelines, applicants can avoid common pitfalls and streamline their experience with the Illinois Placard form. Remember, accuracy and honesty are key components in this process.
This is incorrect. The form accommodates both temporary and permanent disabilities. Temporary placards are valid for three months, while permanent placards last for six months.
This is a common misunderstanding. The placard may only be used when the individual with the disability is either the driver or a passenger in the vehicle.
In fact, if the applicant is a minor, a parent or legal guardian must complete and sign a specific section of the form to certify their responsibility for transportation.
Applicants must possess a valid Illinois driver’s license or ID card to complete the application process.
This is false. A medical professional must complete a section of the form to certify the applicant's disability. Their signature is required for validation.
To qualify for meter-exempt parking, applicants must have a valid Illinois driver’s license and meet specific medical conditions outlined in the form.
This is not the case. Applicants must complete the renewal process every year, ensuring that all information is up to date and accurate.
Only licensed physicians, advanced practice nurses, optometrists, chiropractors, or physician’s assistants can certify the applicant's disability on the form.
Misuse of the disability parking placard can lead to serious consequences, including revocation of the placard, suspension of your driver’s license, and fines up to $1,000.
When filling out and using the Illinois Placard form, keep these key points in mind: