The Illinois Placard form is a critical document for residents of Illinois who have disabilities, facilitating their access to designated parking spaces. It ensures that individuals with temporary or permanent mobility impairments can obtain either a Temporary or a Permanent Parking Placard, depending on their specific needs. As outlined by the state's requirements, the form must be fully completed and signed by both the applicant and a certified medical professional to ascertain the nature of the disability. To learn more or to begin the application process for obtaining a disability parking placard in Illinois, click the button below.
In Illinois, the provision of the Persons with Disabilities Certification for Parking Placard form by the Secretary of State's office is a critical step towards ensuring that individuals with disabilities have the necessary accommodations for parking. Located at 501 S. 2nd Street, Springfield, IL 62756, this form encompasses a range of options including applications for new placards, renewals, and replacements for lost, stolen, or damaged placards. This comprehensive document requires detailed information from the applicant, a certification of disability from a medical professional, and, if applicable, details for meter-exempt parking. Distinct parts of the form cater to various needs; for instance, Part 1 collects applicant information which must corroborate with a valid Illinois driver's license and/or ID card, whilst Parts 3 and 4 are strictly for medical professional certification based on medical eligibility standards. The form also warns of severe penalties for misuse or false applications, emphasizing the importance of accuracy in the process. Moreover, it outlines the stances for both temporary and permanent disability placards, specifying that applications for permanent disabled parking placards must be mailed directly to the Secretary of State's Placard Unit. This form is not just a procedural necessity; it embodies the state's commitment to accessibility and support for its residents with disabilities, ensuring that their mobility and independence are facilitated through the proper use of parking placards.
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: __________________________________________
When you need to apply for or renew an Illinois Placard for persons with disabilities, understanding how to fill out the necessary form correctly is crucial to avoid delays. This document is critical for securing a parking placard that assists individuals experiencing disabilities with better accessibility in parking, whether temporarily or permanently. Throughout this explanation, we'll take each part of the form step by step, ensuring clarity and ease during the process. It's important to follow through every section to make certain the application is comprehensive and thus processed without unnecessary hindrance.
After everything is filled out and double-checked for accuracy, your part in the process is complete. Remember, it's important to submit your application within the validity period stated, which is three months from your physician’s signature date for a Temporary Placard and six months for a Permanent Placard. This step ensures that the application is considered within the effective timeline and moves you closer to receiving the necessary placard for your needs.
The Illinois Placard form must be filled out by any individual applying for a new or renewal of a Persons with Disabilities Parking Placard. If the placard has been lost, stolen, or damaged, a different form, VSD 415, should be used. Additionally, disability license plate owners must also complete this form to renew their placard. If the applicant is a minor, a parent or legal guardian must also complete part of the form. Moreover, the applicant’s medical professional is required to certify the disability in Part 3 of the document.
Eligibility for a disabled parking placard in Illinois requires certification by a licensed medical professional that the applicant has a condition that significantly impairs their mobility. Conditions may include but are not limited to severe arthritis, inability to walk 200 feet without stopping to rest, usage of a wheelchair, walker, crutch, brace, prosthetic device, or requiring the assistance of another person for walking. Applicants can also qualify if they have specific cardiac conditions, use a portable oxygen device, or have severely limited lung function.
Temporary Disabled Parking Placards are valid for up to six months from the physician's signature date, and the form specifies that it's valid for three months for a Temporary Placard. However, the actual duration will depend on the medical certification. Permanent Disabled Parking Placards have a longer validity period, details of which can be found on the specific placard issued. Both types of placards might require renewal upon expiration, with permanent placards requiring renewal procedures as specified by Illinois law.
Yes, individuals with a permanent disability placard may opt to apply for a Persons with Disabilities License Plate. To do this, they should visit their local Secretary of State facility. Applicants will need to provide their permanent placard number along with their current license plate number or Vehicle Identification Number (VIN). This option is designed to provide a more permanent solution for those with long-term mobility impairments.
For eligibility for meter-exempt parking, the applicant must have a valid Illinois driver’s license and a permanent disability that significantly impairs mobility. Qualifying conditions specifically for meter-exempt eligibility include inability to manage or manipulate coins or parking tickets due to lack of fine motor control in both hands, inability to reach a parking meter or ticket machine, use of a wheelchair or similar mobility device, or severe mobility restrictions that prevent walking more than 20 feet. Medical certification of these conditions is necessary for meter-exempt qualification.
Any misuse of the disability parking placard, including making false statements on the application or using the placard when the qualified individual is not present, may result in severe penalties. These can include the revocation of the placard, a suspension or revocation of the driver’s license for up to 12 months, and a fine of up to $1,000. The State of Illinois takes the misuse of disability parking placards seriously to ensure those who truly need these accommodations have access.
Applications for Permanent Disabled Parking Placards must be mailed to the Secretary of State, Persons with Disabilities Placard Unit, at the address 501 S. 2nd Street, Room 541, Springfield, IL 62756. This requirement ensures proper processing and verification of eligibility for permanent placards. Temporary placard applications, on the other hand, may be taken to any Secretary of State facility or also mailed in.
Filling out the Illinois Placard form requires attention to detail to ensure accuracy and compliance. Here are seven common mistakes people make when completing this form:
Making these mistakes can greatly impact the processing time and effectiveness of your application. Ensuring completeness, accuracy, and providing all required information and documentation will streamline the process and help avoid unnecessary delays.
When completing or updating information for an Illinois Placard, several other forms and documents might also be required to ensure proper registration and compliance with state regulations. Here are four commonly used forms and documents in conjunction with the Illinois Placard form:
Each of these documents plays a crucial role in ensuring individuals with disabilities or health conditions obtain the necessary placard for their vehicle, facilitating better access to parking and mobility support. Whether for replacement, medical verification, additional licensing, or veteran status confirmation, these forms complement the Illinois Placard process, providing a comprehensive approach to support individuals with disabilities.
The Illinois Placard form is similar to various documents used throughout the healthcare and motor vehicle sectors to verify disabilities and provide accommodations. These similarities can be seen in the detailed information required, the involvement of healthcare professionals, and the stringent verification processes.
Documents within the healthcare sector:
Documents within the motor vehicle sector:
Filling out the Illinois Placard form accurately is essential for individuals with disabilities seeking parking accommodations. To ensure the process goes smoothly, follow these guidelines on what you should and shouldn't do.
When it comes to the Illinois Placard form for parking placards for people with disabilities, there's quite a bit of confusion and several myths that circulate, which can make the process seem more daunting than it actually is. Let's clear up some common misconceptions:
Understanding the real requirements and limitations can help make the application process smoother for those who need it, ensuring that they receive the support and resources available to them under the law.
Filling out and using the Illinois Placard form, which helps individuals with disabilities obtain parking privileges, requires understanding significant details for proper completion and submission. Here are eight key takeaways to ensure accuracy and compliance:
Understanding these points ensures a smoother application process and helps applicants avoid common pitfalls. Always check the current requirements and procedures, as they may change.
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