The MV 145A form is an application used to request a parking placard for individuals with disabilities in Pennsylvania. This form allows eligible individuals to obtain a permanent or temporary placard, which grants them access to designated parking spaces. To ensure a smooth application process, it is essential to follow the instructions carefully and provide the necessary documentation.
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The MV-145A form is a crucial document for individuals seeking a parking placard designed specifically for persons with disabilities in Pennsylvania. This application is available at no cost and serves several important purposes. It allows applicants to request an original placard, renew an existing one, or replace a lost or stolen placard. The form also accommodates changes in address or name, ensuring that the applicant's information remains current. Importantly, the MV-145A requires certification from a licensed health care provider to confirm the applicant's disability status, which is essential for qualifying for the placard. Additionally, the form includes specific sections for severely disabled veterans, recognizing their unique needs. Understanding the eligibility requirements is vital, as the form outlines various qualifying conditions that may grant access to the benefits associated with the placard, such as parking in designated spaces. By following the instructions carefully and providing accurate information, applicants can navigate the process smoothly, ensuring they receive the assistance they need while promoting greater accessibility in their communities.
MV-145A (6-25)
PERSON WITH DISABILITY PARKING PLACARD APPLICATION NO FEE REQUIRED SEE REVERSE SIDE FOR INSTRUCTIONS AND ELIGIBILITY REQUIREMENTS
(The space above is for Department use only)
Bureau of Motor Vehicles • P.O. Box 68268 • Harrisburg, PA 17106-8268
CHECK ( 4) APPROPRIATE BLOCKS BELOW
qORIGINAL REQUEST - q Permanent Placard q Severely Disabled Veteran q Temporary Placard
qRENEWAL REQUEST - (For Permanent Placards Only)
q REPLACEMENT REQUEST - q PLACARD q ID CARD q Defaced q Lost q Stolen q Never Received PREVIOUS PLACARD # ______________________
qCHANGE OF ADDRESS - Complete Sections A and E.
qCHANGE OF NAME - Complete Sections A and E. Check here to indicate reason for change of name: q Marriage q Divorce q Other: ______________________
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.
q is blind, OR does not have full use of a leg or both legs as evidenced by the use of a: q wheelchair
q walker
q crutches
q cane/quad cane
q other prescribed device
Officer’s Printed Name
Officer’s Signature
Badge Number
D
CERTIFICATION FROM U.S. DEPARTMENT OF VETERANS AFFAIRS REGIONAL OFFICE ADMINISTRATOR (PHILADELPHIA OR PITTSBURGH)
OR 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.
q
This 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: ____________________________________________
In 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
UNSWORN DECLARATION AND APPLICANT SIGNATURE - Person with disability, natural parent or other authorized person listed in Section A must sign below.
I/We declare under penalty of perjury under the law of the Commonwealth of Pennsylvania, that the foregoing is true and correct, and that application was made for the above product or that the items as indicated were never received in the mail. Furthermore, I/we state that I/we have read and signed this application after its completion, and I/we swear or 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. Section 4904 (relating to unsworn falsification), which include criminal prosecution and a term of imprisonment, the maximum of which may be one year [18 Pa.C.S. 4904(b)], or up to two years[18 Pa.C.S. 4904(a)]. In addition to any other penalty, a person convicted under this section shall be sentenced to pay a fine of at least $1,000 [18 Pa.C.S. 4904(d)].
Signed on the _____ day of _______________, ___________________ at ________________________________________, _________________________.
(county or other location, and state)
(country)
Printed Name of Person with Disability
Person with Disability/Loco Parentis Signature
THIS APPLICATION MAY BE DUPLICATED
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.
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.
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.
*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.
NOTE: Customers with a permanent placard have the option to renew their placard, request a replacement placard or change the address their placard online at https://www.placard.penndot.pa.gov/PlacardWeb/public/external/placardLogin.xhtml or scan the QR code on the front of this application.
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)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-connected.
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.pa.gov/dmv or call us at 717-412-5300. TTY callers — please dial 711 to reach us.
After completing the MV-145A form, submit it to the Bureau of Motor Vehicles at the address provided. Ensure all required sections are filled out accurately to avoid delays in processing your application.
The MV-145A form is an application for a Person with Disability Parking Placard in Pennsylvania. This form allows eligible individuals to apply for a parking placard that provides special parking privileges. The application is free of charge and can be used for original requests, renewals, or replacements of existing placards.
Eligibility for a disability parking placard includes individuals who meet certain medical criteria. These criteria include being blind, having limited use of limbs, or being unable to walk a certain distance without assistance. Additionally, severely disabled veterans with a 100% service-connected disability are also eligible. A health care provider must certify the disability, ensuring it falls within their scope of practice.
To complete the MV-145A form, follow these steps:
If your disability parking placard is lost or stolen, you can request a replacement by completing the MV-145A form again. Be sure to check the box indicating that you are applying for a replacement due to a lost or stolen placard. Provide any previous placard number if available, and submit the completed form to PennDOT.
The disability parking placard must be displayed in a vehicle used for the transportation of the person for whom the placard was issued. It is important to note that the placard cannot be used to park in areas where parking is prohibited. However, it does allow for parking in designated spaces for persons with disabilities, providing important accessibility benefits.
Incomplete Sections: Failing to fill out all required sections can delay your application. Make sure every relevant section is completed fully.
Incorrect Signature: The application must be signed by the person with a disability or an authorized representative. Missing or incorrect signatures can lead to rejection.
Wrong Type of Placard: Selecting the wrong type of placard (permanent, temporary, or severely disabled veteran) can result in complications. Choose carefully based on your situation.
Omitting Previous Placard Number: If you are applying for a replacement, failing to include your previous placard number can cause delays. Always check to ensure this information is included.
Missing Health Care Provider Certification: This section must be completed by a licensed health care provider. Not providing this certification can lead to application denial.
Incorrect Eligibility Codes: Ensure you use the correct reason codes when indicating your eligibility. Using incorrect codes can result in disqualification.
Not Providing Contact Information: Omitting your phone number or email can hinder communication regarding your application status. Always include your contact details.
Not Checking for Notarization Requirements: While notarization is not required for most requests, it is essential to confirm whether it is necessary for your specific application type.
Failure to Review Instructions: Skipping the instructions on the back of the form can lead to mistakes. Always read the guidelines carefully before filling out the application.
Submitting Without a Copy: Not keeping a copy of your completed application can be a mistake. Always make a copy for your records before submitting.
The MV-145A form is a key document for applying for a person with disability parking placard in Pennsylvania. Along with this form, several other documents may be required or helpful in the application process. Here’s a concise list of those additional forms and documents.
These documents help ensure that the application process is smooth and that the applicant meets all necessary requirements for obtaining a disability parking placard. Always check the latest guidelines from the DMV to ensure you have the most up-to-date information and forms.
The MV-145A form shares similarities with the MV-145 form, which is the application for a person with a disability parking plate. Both forms serve to facilitate parking privileges for individuals with disabilities, allowing them to access designated parking spaces. The MV-145 requires similar personal information, including the applicant’s name, address, and details about their disability. Just like the MV-145A, the MV-145 also necessitates certification from a healthcare provider to confirm the applicant's eligibility based on specific criteria related to their disability.
Another document comparable to the MV-145A is the MV-8 form, which is used for individuals with disabilities who reside out of state. This form complements the MV-145A by ensuring that applicants from outside Pennsylvania can still apply for disability parking privileges. The MV-8 requires the same personal and disability-related information, emphasizing the importance of proper documentation to validate eligibility. Both forms highlight the need for a healthcare provider's certification, ensuring that the process is thorough and fair for all applicants.
The MV-145A also resembles the MV-350 form, which is a request for a special registration plate for a disabled veteran. This form, like the MV-145A, is designed to provide parking benefits to individuals with disabilities, specifically those who have served in the military. Both documents require the submission of personal information and medical certification to confirm the applicant's eligibility. The MV-350 focuses on veterans, while the MV-145A is broader, encompassing all individuals with disabilities, thus highlighting the commitment to support those in need.
Finally, the MV-65 form, which is a request for a temporary disability parking placard, shares several features with the MV-145A. Both forms allow individuals to apply for parking privileges based on temporary or permanent disabilities. The MV-65 specifically addresses those who may require short-term assistance due to a medical condition, while the MV-145A caters to a wider audience. Each form mandates the inclusion of healthcare provider certification, ensuring that the assessment of disability is conducted with care and accuracy, thereby fostering a supportive environment for all applicants.
Filling out the MV-145A form can seem daunting, but following a few simple guidelines can make the process smoother. Here’s a list of things you should and shouldn’t do when completing this important application for a person with a disability parking placard.
By keeping these tips in mind, you can confidently navigate the MV-145A form and ensure that your application is processed without unnecessary delays. Good luck!
The MV-145A form is essential for individuals seeking a parking placard for disabilities. However, several misconceptions surround its use and requirements. Below are six common misconceptions, along with clarifications.
Filling out and using the MV-145A form is crucial for obtaining a disability parking placard in Pennsylvania. Here are four key takeaways to ensure a smooth application process:
Act promptly to avoid unnecessary delays. The application process is straightforward, but attention to detail is key. If you have questions, don’t hesitate to reach out to the DMV for assistance.