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The Disabled Toll Permit form plays a crucial role in ensuring accessibility for individuals with significant mobility challenges in Florida. This form allows eligible applicants to access toll facilities without the requirement of payment, thus easing financial burdens associated with travel. To obtain this permit, applicants must complete a detailed application that provides personal information, including name, address, and driver's license numbers. Importantly, the form requires documentation of a severe physical disability from a licensed physician or the Adjudication Office. This certification confirms that the individual has permanent upper limb mobility or dexterity impairments affecting their ability to deposit coins in toll baskets. Applicants must also include proof of vehicle insurance and return the sticker if the vehicle is sold or if the individual is no longer eligible for the permit. Renewals should be submitted well in advance, allowing for a processing time of six to eight weeks. Submission is strictly by mail, with no electronic options available. Clear guidelines and necessary information are provided to help applicants navigate the process easily and effectively.

Disabled Toll Permit Example

Florida Commission for the Transportation Disadvantaged

605 Suwannee Street, MS-49

Tallahassee, Florida 32399-0450

Phone: 1-800-983-2435

Hearing & Speech Impaired Call: 711 Florida Relay System

Website: www.fdot.gov/ctd

DISABLED TOLL PERMIT RENEWAL FORM

Allow six (6) to eight (8) weeks from the time we receive your completed application for processing.

All completed applications must be MAILED -- NO ELECTRONIC DELIVERIES, THIS INCLUDES EMAIL AND FAX.

APPLICANT INFORMATION

FIRST Name

 

MIDDLE Name

LAST Name

 

 

 

 

 

 

Area Code

Phone

Date of Birth [Month, Day, Year]

 

 

 

 

 

 

Address

 

 

 

Apt. #

 

 

 

 

 

 

City

 

State

 

Zip Code

 

 

 

 

 

ORANGE DISABLED TOLL PERMIT NUMBER

 

 

 

 

Orange Permit #

 

 

 

 

 

 

 

 

 

 

APPLICANT DRIVERS LICENSE INFORMATION

 

 

 

 

Florida License #

 

Other State _____ License #

 

 

 

 

 

APPLICANT VEHICLE INFORMATION

 

 

 

 

Vehicle Year

 

Vehicle Make

 

 

Model

 

 

 

 

VIN #

 

Permanent License Plate #

 

 

 

 

 

Vehicle Registered To

 

 

 

 

Proof of Insurance is REQUIRED - ATTACH A COPY OF YOUR VEHICLE INSURANCE CARD with the APPLICATION

If the vehicle for which this permit was issued is sold, traded or otherwise disposed, I shall be responsible for removing the decal and returning it the Florida Commission for the Transportation Disadvantaged at the above address for a REPLACMENT. If the individual for which this permit was issued is no longer eligible or is deceased, the permit will become null and void and shall be returned to the Florida Commission for the Transportation Disadvantaged at the above address.

I certify that all information I have provided on this application is accurate and I meet the qualifications for a toll permit, as defined in the Beverly Chapman Act, Section 338.155 F.S., on the reverse side. I have provided a disa ility state e t fro either a li e sed physi ia ’s or the Adjudication Office that I do have severe and permanent upper limb mobility or dexterity impairments that substantially impair my ability to deposit coins into coin baskets. I also ertify that I have a valid driver’s li e se a d operate the specially equipped vehicle

listed on this application.

I understand that providing false information to obtain this permit and/or failure to abide by the policies indicated above will result in revocation of all Tolls Permits and Non-Revenue SunPass Transponders and/or possible legal action by the Florida Department of Transportation or appropriate authority.

___________________________________________________________

____________________

Signature of Applicant

Date

PHYSICIAN’S/ADJUDICATION OFFICER’S CERTIFICATION

This is to certify that ___________________________________________________ is SEVERELY physically disabled AND has PERMANENT

Applica t’s Na e [PLEASE PRINT]

UPPER LIMB mobility or dexterity impairments, which SUBSTANIALLY IMPAIRS the a ed i dividual’s ABILITY TO DEPOSIT COINS IN TOLL BASKETS, as described in Chapter 338.155, Florida Statutes, see Beverly Chapman Act on reverse side of application.

Signed this ___________ day of _________________________, ___________, by _______________________________________________

Physicia ’s/Adjudicatio Officer’s Na e [PLEASE PRINT]

A licensed physician under Chapter 458 or 459, Florida Statutes, or by the Adjudication Office of the Veterans Administration.

_________________________________________________________

 

 

_______________________

Signature of Physician/Adjudication Officer

 

 

 

 

 

Date

 

PHYSICIAN’S/ADJUDICATION OFFICER’S INFORMATION

 

 

 

 

 

Name [Last, First, Middle Initial]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical License Number

 

 

State

 

Area Code

Phone#

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

 

Zip Code

 

 

 

 

 

 

 

 

OFFICIAL USE FOR FLORIDA COMMISSION FOR THE TRANSPORTATION DISADVANTAGED

License______________________

Tag/VIN # ___________________

Physician___________________

Eligible/Rejected____________________

Staff

Date

Staff

Date

Staff

 

Date

Staff

Date

 

 

 

 

 

 

 

 

 

 

Permit # _____________ is hereby authorized for use by the Applicant Named above Certified by ____________________________________________

Florida Commission for the Transportation Disadvantaged

TollPermitRenewalForm20161010

Revised 10/10/2016

Florida Commission for the Transportation Disadvantaged

605 Suwannee Street, MS-49

Tallahassee, Florida 32399-0450

Phone: 1-800-983-2435

Hearing & Speech Impaired Call: 711 Florida Relay System

Website: www.fdot.gov/ctd

"Beverly Chapman Act"

(P.L. 88-252)

Section 338.155, F.S.

Payment of toll on toll facilities required; exemptions.

(1)No persons are permitted to use any toll facility without payment of tolls, except employees of the agency operating the toll project when using the toll facility on official state business, state military personnel while on official military business, handicapped persons as provided in this section, persons exempt from toll payment by the authorizing resolution for bonds issued to finance the facility, and persons exempt on a temporary basis where use of such toll facility is required as a detour route. Any law enforcement officer operating a marked official vehicle is exempt from toll payment when on official law enforcement business. Any person operating a fire vehicle when on official business or a rescue vehicle when on official business is exempt from toll payment. The secretary, or the secretary's designee, may suspend the payment of tolls on a toll facility when necessary to assist in emergency evacuation. The failure to pay a prescribed toll constitutes a noncriminal traffic infraction, punishable as a moving violation pursuant to s. 318.18. The department is authorized to adopt rules relating to guaranteed toll accounts.

(2)Any person driving an automobile or other vehicle belonging to the Department of Military Affairs used for transporting military personnel, stores, and property, when properly identified, shall, together with any such conveyance and military personnel and property of the state in his or her charge, be allowed to pass free through all tollgates and over all toll bridges and ferries in this state.

(3) Any handicapped person who has a valid driver's license, who operates a vehicle specially equipped for use by the handicapped, and who is certified by a physician licensed under chapter 458 or chapter 459 or by comparable licensing in another state or by the Adjudication Office of the United States Department of Veterans Affairs or its predecessor as being severely physically disabled and having permanent upper limb mobility or dexterity impairments which substantially impair the person's ability to deposit coins in toll baskets, shall be allowed to pass free through all tollgates and over all toll bridges and ferries in this state. A person who meets the requirements of this subsection shall, upon application, be issued a vehicle window sticker by the Department of Transportation.

(4)A copy of this section shall be posted at each toll bridge and on each ferry.

(5)The Department of Transportation shall provide envelopes for voluntary payments of tolls by those persons exempted from the payment of tolls pursuant to this section. The department shall accept any voluntary payments made by exempt persons.

(6)Personal identifying information provided to, acquired by, or in the possession of the Department of Transportation, a county, or an expressway authority for the purpose of using a credit card, charge card, or check for the prepayment of electronic toll facilities charges to the department, a county, or an expressway authority is exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution.

TollPermitRenewalForm20161010

Revised 10/10/2016

Form Characteristics

Fact Name Details
Governing Law This form is governed by the Beverly Chapman Act, specifically Section 338.155 of the Florida Statutes.
Application Processing Time Applicants should allow six to eight weeks for processing from the time their completed application is received.
Submission Method All completed applications must be mailed. Electronic submissions via email or fax are not accepted.
Eligibility Requirements Applicants need documentation certifying severe upper limb mobility impairments, approved by a licensed physician or the Veterans Administration.
Insurance Requirement Proof of insurance, in the form of a copy of the vehicle insurance card, is required to be attached with the application.
Revocation Policy Providing false information or failing to meet the obligations can result in revocation of the toll permit, along with potential legal action.
Contact Information For assistance, contact the Florida Commission for the Transportation Disadvantaged at 1-800-983-2435 or visit their website, www.fdot.gov/ctd.

Guidelines on Utilizing Disabled Toll Permit

After completing the Disabled Toll Permit form, it should be mailed to the Florida Commission for the Transportation Disadvantaged. Allow six to eight weeks for processing. Note that all completed applications must be sent by mail; electronic submissions via email or fax will not be accepted.

  1. Obtain the Disabled Toll Permit Renewal Form from the Florida Commission for the Transportation Disadvantaged website or 605 Suwannee Street, MS-49, Tallahassee, Florida.
  2. Complete the applicant information section by providing your first name, middle name, last name, area code phone number, date of birth, and address details, including apartment number, city, state, and zip code.
  3. Fill in the Orange Disabled Toll Permit number, if applicable.
  4. Provide your driver’s license information, including Florida license number and any other state license number.
  5. Enter the vehicle information: year, make, model, VIN number, and permanent license plate number. Indicate to whom the vehicle is registered.
  6. Attach a copy of your vehicle insurance card as proof of insurance.
  7. Review and acknowledge the obligations regarding vehicle disposition if sold or if the individual is no longer eligible.
  8. Sign and date the application to certify the accuracy of the provided information and compliance with requirements.
  9. Request a physician’s or adjudication officer’s certification stating the disability details and signature. This certification will confirm eligibility.
  10. Complete the physician's/adjudication officer’s information, including their name, medical license number, state, phone number, and address.
  11. Mail the completed application packet to the Florida Commission for the Transportation Disadvantaged at the address provided on the form.

What You Should Know About This Form

What is the Disabled Toll Permit, and who is eligible for it?

The Disabled Toll Permit allows eligible individuals with severe physical disabilities to pass through toll facilities without paying. To qualify, applicants must have a valid driver's license and operate a vehicle equipped for handicapped use. The applicant must be certified by a licensed physician or the Adjudication Office of the Veterans Administration, confirming that they have permanent upper limb mobility or dexterity impairments that make depositing coins into toll baskets difficult.

How do I apply for the Disabled Toll Permit?

To apply for the Disabled Toll Permit, you must complete the application form. All completed applications must be mailed to the Florida Commission for the Transportation Disadvantaged. Remember to include a copy of your vehicle insurance card with your application. Make sure to allow six to eight weeks for processing from the time they receive your application. Electronic submissions, such as email or fax, will not be accepted.

What should I do if my vehicle changes?

If you sell, trade, or otherwise dispose of the vehicle for which the permit was issued, you are responsible for removing the decal and returning it to the Florida Commission for the Transportation Disadvantaged. If the person for whom the permit was issued is no longer eligible or has passed away, the permit must also be returned to them. Failure to do so could result in issues with permit eligibility in the future.

What happens if I provide false information on my application?

Providing false information on your application is a serious matter. It can lead to the revocation of all toll permits and Non-Revenue SunPass Transponders you hold. It may also result in legal action taken against you by the Florida Department of Transportation or other authorities. Ensuring that all information submitted is accurate and truthful is essential to avoid any complications.

Common mistakes

Filling out the Disabled Toll Permit form requires attention to detail. Unfortunately, many applicants make mistakes that can delay processing. A common error is failing to provide complete personal information. Ensure that every field, including first name, last name, and contact details, is filled accurately. Missing sections can lead to immediate rejection of your application.

Another frequent issue is inadequate proof of insurance. You must attach a copy of your vehicle insurance card to the application. Without this document, processing will be put on hold. Your application may be deemed incomplete, and you will need to resubmit it.

Some individuals forget to sign the application. Without a signature, the application cannot be processed. This might seem like a trivial oversight, but it is crucial. Take a moment to check your application before submitting it to ensure that you have signed it.

Also, many applicants neglect to provide the correct details about their vehicles. Double-check the vehicle's year, make, model, and VIN before submission. Providing incorrect information may lead to the denial of your permit.

Another mistake is sending the application electronically instead of mailing it. The guidelines clearly state that all applications must be mailed. Using email or fax is not acceptable. Always use the specified mailing address to ensure that your application reaches the right office.

Applicants sometimes misinterpret eligibility criteria. Make sure you understand the requirements for the Disabled Toll Permit. You will need a valid driver’s license and certification from a licensed physician or the Adjudication Office. Review these criteria to ensure your application is valid.

Finally, forgetfulness regarding the renewal process itself can be a significant hurdle. Allow yourself enough time, as processing can take six to eight weeks. If you wait too long to submit your renewal, you may find yourself unable to use the tolls while your application is in limbo. Planning ahead is essential, so don’t leave your renewal to the last minute.

Documents used along the form

When applying for a Disabled Toll Permit, several other forms and documents may be required or helpful in the process. Each of these documents plays a crucial role in establishing eligibility and facilitating the application. Below is a list of commonly associated forms and documents.

  • Proof of Disability: This document serves as formal verification of the applicant's disability status. It can come from a licensed physician or the Adjudication Office, confirming that the applicant has severe and permanent upper limb mobility or dexterity impairments.
  • Driver's License: A valid driver’s license is necessary to apply for the Disabled Toll Permit. The applicant must provide their state-issued driver's license number to ensure they are legally allowed to operate a vehicle.
  • Vehicle Registration: A document showing the vehicle’s registration is vital. This assures the authority that the vehicle for which the permit is issued is recognized and associated with the applicant.
  • Insurance Card: Applicants must attach a copy of their vehicle insurance card. This proves that the vehicle is covered and satisfies a requirement for permit issuance.
  • Application for Renewal: Every few years, permit holders must renew their permit. This renewal application typically mirrors the original application and requires updated information about the applicant and their vehicle.
  • Appeal Form (if applicable): In cases of rejection or denial of a permit, applicants may need to submit an appeal form to challenge the decision. This document outlines the reasons for the appeal and any additional information that supports the applicant’s case.
  • Identification Verification: While a driver's license often suffices, additional identification may be requested to verify the applicant's identity, particularly if there are discrepancies within provided documents.

Understanding these associated forms and documents is essential for a smooth application process. Ensuring that you have all necessary paperwork in order not only expedites your application but also enhances your chances of approval. It is always advisable to check with the relevant authorities for any specific requirements that may apply.

Similar forms

  • Disabled Parking Permit: Like the toll permit, a disabled parking permit is designed for individuals with disabilities. It allows easier access to designated parking areas, reducing mobility challenges when accessing facilities and services.

  • Handicap Accessible Vehicle Registration: This document identifies vehicles that are specially equipped for individuals with disabilities. Similar to the toll permit, it requires certification of the individual’s disability and may grant access to certain benefits.

  • Veterans Affairs Benefits Application: Veterans may apply for several benefits due to disabilities, much like applying for a toll permit. Both processes require documentation proving eligibility and disability status.

  • Health Insurance Claim Form: This form submits claims for medical expenses. Like the toll permit, it requires personal information and proof of eligibility, ensuring coverage for necessary services due to disabilities.

  • Medicaid Disability Application: Individuals with disabilities can apply for Medicaid to assist with healthcare costs. This application, similar to the toll permit, needs details proving disability and income eligibility to receive benefits.

  • Social Security Disability Insurance Application: Applying for this insurance entails proving severe disability, much like the requirements for the Disabled Toll Permit. Documentation from medical professionals is also necessary in both cases.

Dos and Don'ts

Things You Should Do:

  • Make sure to accurately fill out all sections of the application.
  • Attach a copy of your vehicle insurance card with the application.
  • Mail the completed application to the Florida Commission for the Transportation Disadvantaged.
  • Sign the application to certify the information provided is true.
  • Allow 6 to 8 weeks for processing after mailing your application.
  • If the permit is no longer needed, return it to the Commission.

Things You Shouldn't Do:

  • Do not use email or fax to submit your application.
  • Avoid providing false information on the application.
  • Refrain from sending incomplete applications; ensure all necessary documents are included.
  • Do not neglect to update the Commission if your vehicle is sold or the permit holder is no longer eligible.
  • Do not assume the application is processed without confirmation from the Commission.
  • Never keep the permit if it is no longer valid or needed; return it promptly.

Misconceptions

Here are some common misconceptions regarding the Disabled Toll Permit form:

  • Application Can Be Submitted Electronically: Many believe that they can email or fax their applications. All applications must be mailed. No electronic submissions are accepted.
  • Processing Time Is Instant: Some applicants think their application will be processed immediately. In reality, processing can take six to eight weeks once the completed application is received.
  • Proof of Insurance Is Not Required: There is a misconception that insurance documentation is optional. In fact, a copy of your vehicle insurance card must be attached to the application.
  • Only Florida Residents Can Apply: While it may seem like a Florida-specific program, residents from other states who qualify can receive a permit if they have the proper documentation.
  • Permit Is Automatic Upon Application: It's incorrect to assume that submitting an application guarantees receipt of a permit. The application is subject to review and eligibility requirements.
  • Permit Remains Valid Indefinitely: Many individuals think that once they receive a permit, it lasts forever. Permits must be renewed, especially if the individual becomes ineligible or is deceased.
  • Any Doctor Can Certify the Application: Not all medical professionals can validate the application. Only licensed physicians under Chapter 458 or 459, or designated officials from the Veterans Administration can provide certification.

Key takeaways

Applying for a Disabled Toll Permit is a crucial process that individuals must navigate carefully. Here are several key takeaways regarding the completion and use of the Disabled Toll Permit form:

  • Submission Method: All completed applications should be mailed directly to the Florida Commission for the Transportation Disadvantaged. Electronic submissions, including email and fax, are not accepted.
  • Processing Time: Expect a wait of six to eight weeks from the date your application is received for processing. Plan accordingly to avoid delays in obtaining your permit.
  • Documentation Requirement: A copy of your vehicle insurance card must be attached with your application. This is a mandatory requirement to support your request.
  • Eligibility Conditions: Ensure you meet all eligibility criteria as outlined under the Beverly Chapman Act. The information you provide must be truthful and accurate to avoid any repercussions, such as revocation of permits.
  • Return Policy: If your vehicle is sold or if the individual for whom the permit was issued becomes ineligible or is deceased, the decal must be returned to the Florida Commission for the Transportation Disadvantaged to maintain compliance.

Understanding these key points about the Disabled Toll Permit form can facilitate a smoother application experience and ensure adherence to important regulations.