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The MV 145A form is a crucial application used to request a Person with Disability Parking Placard in Pennsylvania. This form comes with no fee and provides options for original requests, renewal requests, and replacements. It also accommodates specific situations for severely disabled veterans. To complete the application, you need to provide details about the person with the disability, including their name, address, and Pennsylvania driver’s license number or business ID if applicable. The form requires certification from a health care provider who is licensed in Pennsylvania or a nearby state, thereby ensuring that only those with legitimate disabilities are granted access to special parking privileges. Additional sections allow for changes in address or name, ensuring that the placard information remains up to date. Understanding the eligibility requirements is essential since not all disabilities qualify. Thus, the completion of this form is vital for those seeking the necessary accommodations to enhance mobility and access to services.

Mv 145A Example

MV-145A (7-21)

www.dmv.pa.gov

PERSON WITH DISABILITY PARKING PLACARD APPLICATION NO FEE REQUIRED

SEE REVERSE SIDE FOR INSTRUCTIONS AND ELIGIBILITY REQUIREMENTS

FOR DEPARTMENT USE ONLY

Bureau of Motor Vehicles • P.O. Box 68268 • Harrisburg, PA 17106-8268

q ORIGINAL REQUEST - qPermanent Placard

CHECK ( 4) APPROPRIATE BLOCKS BELOW

qSeverely Disabled Veteran qTemporary Placard

q RENEWAL REQUEST - (For Permanent Placards Only)

q REPLACEMENT REQUEST - qPLACARD

qID CARD qDefaced qLost q Stolen q Never Received PREVIOUS PLACARD # __________________

q CHANGE OF ADDRESS - Complete Sections A and E. NOTE: Notarization is not required.

qCHANGE OF NAME - Complete Sections A and E. Check here to indicate reason for change of name: qMarriage qDivorce qOther: ______________________

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

City

 

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

20/

 

 

 

 

 

NOTE: If reason code #1 is listed above, please indicate the individual's visual acuity by completing the chart to the right:

 

 

B

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If reason code #4 is listed above, please indicate the type of device used: ________________________________________________

 

 

CORRECTED

 

 

R

20/

 

 

 

 

 

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

 

 

 

 

 

L

20/

 

 

 

 

 

the placard issued, the applicant must be recertified by a health care provider.

 

 

 

 

B

20/

 

 

 

 

 

Health Care Provider’s Printed Name

 

 

Health Care Provider’s Signature

 

 

 

 

 

Medical License No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office Street Address

 

 

 

City

 

State

Zip Code

 

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.

qis blind, OR does not have full use of a leg or both legs as evidenced by the use of a: qwheelchair

qwalker

 

qcrutches

q cane/quad cane

 

 

q other prescribed device

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Officer’s Printed Name

 

 

 

 

Officer’s Signature

 

 

 

 

 

Badge Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office Street Address

 

 

 

City

 

State

Zip Code

 

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

CERTIFICATION FROM U.S. DEPARTMENT OF VETERANS AFFAIRS REGIONAL OFFICE ADMINISTRATOR (PHILADELPHIA OR PITTSBURGH)

DOR 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.

qThis 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: ____________________________________________

qIn 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 NOTARIZATION AND APPLICANT SIGNATURE - Person with disability, natural parent or other authorized person listed in Section A must sign below.

SUBSCRIBED AND SWORN

 

 

 

I state that I have read and signed this application after its completion, and I swear or

TO BEFORE ME:

MONTH

DAY

YEAR

 

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.

 

 

 

 

 

 

 

 

SIGNATURE OF PERSON ADMINISTERING OATH

 

 

Section 4903 (a)(2) (relating to false swearing), which shall include punishment of a

 

 

 

 

fine not exceeding $5,000, or to a term or imprisonment of not more than two years,

S

 

 

 

 

 

or both.

 

 

 

 

 

 

T

 

SIGN IN PRESENCE OF NOTARY

 

 

 

 

(

)

 

A

 

 

 

 

Person with Disability Signature

 

Date

 

 

Telephone Number

 

M

 

 

 

 

 

 

THIS APPLICATION MAY BE DUPLICATED

P

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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. NOTE: Notarization is not required.

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. NOTE: Notarization is not required.

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. NOTE:

Notarization is not required.

*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.

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)A passenger vehicle or truck with a registered gross weight of not more than 14,000 lbs.

(2)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-

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.dmv.pa.gov or call us at 717-412-5300. TTY callers — please dial 711 to reach us.

Form Characteristics

Fact Name Details
Form Purpose The MV-145A form is used to apply for a Person with Disability Parking Placard in Pennsylvania.
Application Fee No fee is required to submit the MV-145A form for a disability parking placard.
Types of Placards Applicants may request a permanent placard, a temporary placard, a renewal, or a replacement.
Eligibility Requirements Eligibility is based on specific health conditions, including blindness or limited mobility.
Certification Requirement A health care provider must certify the applicant's disability within their scope of practice.
Temporary Placard Limit Temporary placards are valid for a maximum of six months and must be recertified before expiration.
Change of Information Applicants can change their address or name by completing the relevant sections of the form.
Governing Laws This form is governed by the Pennsylvania Vehicle Code, specifically 75 Pa.C.S. Section 7122.
Notarization Notarization is not required for submitting the MV-145A form.
Submission Instructions Completed applications must be sent to the Bureau of Motor Vehicles in Harrisburg, PA.

Guidelines on Utilizing Mv 145A

Completing the MV 145A form can be an important step towards securing a parking placard for individuals with disabilities. This process ensures that those who need special parking accommodations can easily access the assistance they require. To begin, gather all necessary information and documents that will help you accurately fill out the form.

  1. Determine the type of placard you are applying for: permanent, temporary, or for a severely disabled veteran.
  2. Check the appropriate box at the top of the form to indicate if this is an original request, renewal, replacement, or change of address or name.
  3. In Section A, provide the person with a disability's information, including their last name, first name, middle name, PA Driver’s License or Photo ID number, date of birth, address, city, state, zip code, and email address.
  4. If applying on behalf of a minor, complete the section for the parent, guardian, or spouse, including their name, relationship to the applicant, and contact information.
  5. Move to Section B to obtain a certification from a licensed health care provider. This section must be completed fully. Ensure the provider lists the specific condition of the applicant as required.
  6. If the applicant qualifies under a condition listed in Section B, they may proceed to Section E without filling out Section C. If applicable, have a police officer complete Section C to certify specific disabilities.
  7. For applicants who are veterans, Section D should be filled out by the U.S. Department of Veterans Affairs or provide documents supporting the claim of disability.
  8. Finally, in Section E, the person with a disability or an authorized individual must sign and date the application. Ensure all information is accurate before submission.

Once the MV 145A form is completed and signed, submit it to the appropriate authorities for processing. Be sure that all sections relevant to your application are filled out accurately. It may take some time to receive your parking placard, but this important step will aid in your mobility and accessibility needs.

What You Should Know About This Form

What is the MV 145A form and who is eligible to apply for a disability parking placard?

The MV 145A form is an application used in Pennsylvania for obtaining a parking placard designated for individuals with disabilities. This form accommodates different types of placards, including permanent, temporary, and those specifically for severely disabled veterans. To qualify for a disability parking placard, the applicant must have a disability that meets one of the eligibility criteria outlined in the form, such as being blind, having limited use of limbs, or having specific lung or cardiac conditions. Additionally, a caregiver or parent can apply on behalf of a minor child.

How should I fill out the MV 145A form if I need to renew my permanent placard?

If you are looking to renew your permanent disability placard, fill out Section A and Section E of the MV 145A form. It’s important to note that notarization is not required for this process. Be prepared to provide any necessary identification details, including your Pennsylvania Driver’s License or Photo ID number. Submit the completed form to the Bureau of Motor Vehicles at the address provided in the instructions.

What documents or certifications are required when applying for a temporary placard?

When applying for a temporary placard, an applicant must have their disability certified by a licensed healthcare provider. This certification must be included in Section B of the MV 145A form. Temporary placards are issued for a maximum of six months and are not extendable. If further time is needed post-expiration, a new application must be submitted, along with a new certification from the healthcare provider. Ensure that the previous placard number is listed on the application to clarify your request.

What steps should I take if my placard has been lost or stolen?

If your disability parking placard has been lost, stolen, or damaged, you will need to indicate this on the MV 145A form by checking the appropriate box in the replacement request section. Provide your previous placard number if available. Complete Sections A and E and submit the form to the Bureau of Motor Vehicles. No notarization is needed for replacement requests, ensuring a straightforward process for applicants who face such situations.

Common mistakes

Filling out the MV-145A form can be straightforward, but mistakes can happen. One common error is not selecting the appropriate placard type. The form offers options for a permanent placard, temporary placard, renewal request, or replacement request. Failing to check the right box can lead to delays in processing your application. Make sure to review your selection carefully before submitting.

Another frequent error involves incomplete information. It's essential to provide all required details, especially in sections concerning the person with the disability. Missing a name, birth date, or address can result in the form being returned. Double-checking each section during completion can help prevent this issue.

Many applicants also overlook the importance of getting the proper certification from a health care provider. This step is crucial when applying for a temporary placard. Without a complete and accurate certification, your application may be rejected. Always ensure that a licensed health care provider fills out this part, as only they can certify the disabilities listed on the form.

Lastly, some individuals forget to sign the application. Not having a signature can lead to significant delays. The section labeled "Applicant Signature" requires your attention. Remember, your signature acts as a verification of the information provided, so don't skip this vital step. Taking a moment to review your application can save you time and hassle down the road.

Documents used along the form

The MV-145A form is an important document used to apply for a Person with Disability Parking Placard in Pennsylvania. However, there are several other forms and documents that may accompany the MV-145A form during the application process. Each of these documents serves a unique purpose to ensure that applicants receive the appropriate privileges and assistance. Below is a brief overview of these additional documents.

  • Form MV-8: This form is required if the applicant lists an out-of-state address. It collects specific information to confirm eligibility and ensures compliance with state requirements.
  • Health Care Provider Certification: This document is essential for verifying the disability status of the applicant. A health care provider licensed in Pennsylvania or a contiguous state must complete it, attesting to the applicant's condition.
  • Police Officer Certification: In cases where the applicant does not have full use of a leg or is blind, this certification must be filled out by a police officer. This verification adds an extra layer of validation to the application.
  • U.S. Department of Veterans Affairs Documentation: Veterans applying for a placard must provide proof of their service-connected disability, typically in the form of a letter from the VA or relevant documentation that confirms their eligibility.
  • Application for Replacement or Renewal Forms: If a placard is lost, stolen, or requires renewal, specific forms detailing these requests must be submitted, ensuring timely updates to the applicant’s status.
  • Proof of Identity: Applicants may be required to submit copies of identification (such as a Pennsylvania driver's license or state ID) to authenticate their identity and eligibility for the placard.
  • Notary Signature Requirement: In some cases, notarization may be required for the application process, particularly for changes of name or other significant requests. This ensures that all statements are legally recognized and binding.

Having a clear understanding of these documents is vital for a smooth application process. Each form plays a crucial role in ensuring that individuals with disabilities receive the parking privileges they need, thereby enhancing their mobility and independence. It is important for applicants to gather all necessary documents and complete them accurately to avoid delays.

Similar forms

  • Form MV-8: This document is required when the applicant has an out-of-state address. It ensures that all necessary information regarding the disability and applicant is communicated effectively. Just as the MV-145A requires details about the disability, MV-8 certifies the applicant's need for a parking placard in another state.
  • Form MV-145B: Used for the application process for a person with a disability parking placard in a slightly different context. Whereas MV-145A focuses specifically on general disability benefits, MV-145B typically includes additional information regarding various eligibility requirements that may vary by situation.
  • Form MV-46: This application is similar in that it requests special privileges based on disability but focuses specifically on permits for wheelchair accessible vehicles. The criteria for approval are distinct yet share the underlying goal of improving accessibility for individuals with disabilities.
  • Form MV-22: This form serves to apply for a disabled person registration plate, which is adjacent to the purpose of MV-145A. The MV-22 focuses less on placard issuance and more on vehicular registration, maintaining the same emphasis on proving the applicant's disability and their need for mobility aid.

Dos and Don'ts

When filling out the MV-145A form, it is important to adhere to certain guidelines to ensure the application is processed smoothly. Below is a list of actions to take and avoid.

  • Do complete all relevant sections appropriate to your request type, whether for a permanent or temporary placard.
  • Do provide accurate information for the person with a disability, including their name and address.
  • Do include the previous placard number if you are applying for a replacement.
  • Do have a health care provider sign and complete the certification section if required.
  • Do check the box for any applicable changes, such as change of address or name.
  • Don't leave any required sections blank, as this may delay processing.
  • Don't attempt to forge or alter the application, as this is a serious offense.

Following these guidelines can help ensure your application for a disability parking placard is successful and efficient.

Misconceptions

Here are seven common misconceptions about the MV 145A form, which is used for the application of a person with disability parking placard.

  • Not all disabilities qualify. Many people think any disability qualifies for a placard. However, only specific conditions as listed on the form are eligible.
  • Temporary placards are easy to renew. Some believe temporary placards can be simply extended. In reality, they are issued for a maximum of six months and require a new application.
  • Notarization is always required. Contrary to popular belief, notarization is not necessary when submitting the application, which can make the process simpler.
  • Anyone can certify the application. A misconception exists that friends or family members can certify disabilities. Only licensed health care providers may do so.
  • Change of name requires additional steps. While some believe changing a name on the placard involves a complicated process, it only requires filling out specific sections on the form.
  • Placards are only for vehicles owned by disabled individuals. This is incorrect. A placard can be used in any vehicle transporting the individual with a disability.
  • Replacing a lost placard is time-consuming. Many think it takes ages to get a replacement. In fact, the process is straightforward and allows for quick replacement with the right form filled out.

Being informed about these misconceptions can help facilitate a smoother application process. Always refer to the official guidelines for accurate information.

Key takeaways

When filling out the MV-145A form for a person with a disability parking placard, keep the following key points in mind:

  • Eligibility Criteria: Ensure that the person applying meets the specific eligibility requirements. These can include being blind or unable to walk certain distances without assistance. Different conditions are outlined in the form, and proper certification must be obtained from a healthcare provider.
  • Types of Placards: Understand the different types of placards available. Permanent placards are long-term; temporary placards are valid for a maximum of six months. Renewals and replacements also have specific requirements and must be clearly indicated on the form.
  • Sections to Complete: Pay close attention to which sections need to be filled out based on your application type. For example, a renewal requires sections A and E to be completed, while a request for a temporary placard needs sections A, B, and E. Missing sections can delay processing.
  • Submission Details: Once the application is correctly filled out, send it to the specified address: PennDOT, Bureau of Motor Vehicles, P.O. Box 68268, Harrisburg, PA 17106-8268. It's vital to ensure that you check and confirm all details before mailing your application.