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The HSMV 83039 form plays a vital role in ensuring that disabled individuals in Florida can access appropriate parking accommodations. This form is an application for a disabled person parking permit, allowing those with mobility impairments or visual limitations to park in designated spaces. Applicants must provide personal details, such as their name, contact information, and specific disability information, which includes certification from a qualified health professional. It’s important to note that the form must be submitted to a local county tax collector’s office or license plate agency and is only valid for 12 months once signed by a certifying authority. The submission process also includes an explicit description of the applicant's disability, whether temporary or permanent, as outlined in section 320.0848 of Florida Statutes. Different types of disabilities are specified, ranging from the need for assistive devices to conditions that permanently impair walking abilities. Moreover, both temporary and permanent permits have distinct requirements and guidelines, ensuring that eligible individuals receive the correct parking privileges. Misrepresentation on the form can lead to serious consequences, underscoring the need for accuracy and honesty in the application process. This form not only facilitates mobility for those who need it but also upholds the integrity of the parking permit system in Florida, making it an essential document for eligible applicants.

Hsmv 83039 Example

FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

APPLICATION FOR DISABLED PERSON PARKING PERMIT

*******SUBMIT APPLICATION TO YOUR LOCAL COUNTY TAX COLLECTOR'S OFFICE OR LICENSE PLATE AGENCY*******

www.flhsmv.gov/offices/

This form is not valid for more than 12 months from the date of the certifying authority’s signature.

Please Print/Type belowAPPLICATION BY DISABLED PERSON (See Warning Below)

I certify that I am a person with one of the disabilities listed in section 320.0848, Florida Statutes. I further state that my physician or other certifying practitioner has completed the statement of certification below on my behalf, as required in section 320.0848, Florida Statutes.

Name of Disabled Person as printed on their

 

Current Disabled Parking Permit Number

 

Signature of Disabled Person or Guardian of the Disabled

Florida Driver License or Florida ID Card

 

(if applicable)

 

Person

 

 

Date of Birth

Sex

 

Disabled Person’s E-mail Address

 

Disabled Person’s Phone Number

Date Signed

 

 

Address

 

 

 

 

City

 

 

 

 

 

State

 

Zip

Florida Driver License or Florida ID Number:

 

 

 

 

 

 

 

 

If applicable, check one of the following:

(Required for permanent and temporary parking permits

 

 

 

 

 

 

 

 

I am a frequent traveler.

 

I am a quadriplegic.

unless exception is noted by physician below)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHYSICIAN/CERTIFYING PRACTITIONER'S STATEMENT OF CERTIFICATION (See Warning Below)

TEMPORARY PERMIT: This is to certify that the applicant named above is a person with a temporary disability (six months or less) that limits or impairs his/her ability to walk or is temporarily sight impaired. Due to the temporary specific disability(ties) checked below (2-8), the disabled person parking permit should be issued from

(date) through

 

(date).

PERMANENT PERMIT: This is to certify that the applicant named above is legally blind or is a disabled person with a permanent disability (ties) that limits or impairs his/her ability to walk 200 feet without stopping to rest. Specify below (2-8) either legally blind or the specific disability (ties).

DISABILITY TYPE AS DISPLAYED IN FRVIS:

2. Inability to walk without the use of or assistance from a brace, cane, crutch, prosthetic device, or other assistive device, or without assistance of another person. If the assistive device significantly restores the person's ability to walk to the extent that the person can walk without severe limitation, the person is not eligible for the exemption parking permit.

3.The need to permanently use a wheelchair.

4.Restriction by lung disease to the extent that the person's forced (respiratory) expiratory volume for 1 second, when measured by spirometry, is less than one liter or

the person's arterial oxygen is less than 60 mm/hg on room air at rest.

5.Use of portable oxygen.

6.Restriction by cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association.

7. Severe limitation in a person's ability to walk due to an arthritic, neurological, or orthopedic condition. 8. Legally Blind

WARNING: Any person who knowingly makes a false or misleading statement in an application or certification under section 320.0848, Florida Statutes, commits a misdemeanor of the first degree, punishable as provided in section 775.082 or 775.083, F.S. The penalty is up to one year in jail or a fine of $1,000 or both.

Certification or License No. (Required)

 

 

 

 

 

of a Physician, Osteopathic or Podiatric Physician,

 

 

 

Chiropractor, Optometrist, Advanced Practice Registered Nurse under the protocol of a licensed physician or a Physician Assistant licensed

 

 

 

under Chapter 458 or 459.

 

 

 

 

 

 

 

 

 

 

LICENSED IN THE STATE OF

Print/Type Name of Certifying Authority

 

 

 

 

Business Address

 

City

State

 

Zip

Certifying Authority Signature

 

 

 

 

Date Signed:

 

 

 

(Area Code)Telephone Number

 

 

 

 

 

 

 

 

 

 

SPECIAL EXCEPTION: The severely disabled applicant named above applying for a permanent placard is unable to obtain a Florida driver license or Identification card.

 

 

If the Special Exception box is checked, the certifying physician must provide his/her signature and date signed below.

 

 

 

 

 

If the Special Exception box is checked, one of the conditions in boxes 2-8 above must also be checked.

 

 

 

 

 

 

Certifying Authority Signature:

 

 

 

 

 

 

 

Date Signed:

 

 

 

APPLICATION BY AN ORGANIZATION (See Warning Above)

 

 

 

provides regular transportation service to disabled persons having disabilities that limit or impair

This is to certify that

 

 

 

 

 

 

 

 

 

 

 

 

 

 

their ability to walk or are certified to be legally blind.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of Vehicles in fleet for this purpose:

Organization’s E-mail Address

 

 

 

 

 

 

Signature of Organization’s Authorized Representative

 

 

 

 

 

 

 

 

 

Date Signed:

 

 

 

Address:

 

 

 

 

 

City:

 

 

State:

 

Zip:

 

 

 

 

 

 

 

TAX COLLECTOR USE ONLY

 

 

 

 

 

 

Agency Personnel Processing this Application

 

 

 

 

 

 

 

 

 

 

Date

 

 

NOTE: For renewals and replacements only, a veteran who has been previously evaluated and certified by the United States Department of Veterans Affairs or any branch of the United States Armed Forces as permanently and totally disabled from a service-connected disability may provide a United States Department of Veterans Affairs Form Letter 27-333, or its equivalent, issued within the last 12 months in lieu of a certificate of disability.

HSMV 83039 - REV. 10/18

www.flhsmv.gov
1.
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Osteopathic Physician. Podiatric Physician. Chiropractor. Optometrist.
Advanced Practice Registered Nurse licensed under Chapter 464, under the protocol of a licensed physician. Physician Assistant licensed to practice under Chapter 458 or Chapter 459.
MISCELLANEOUS INFORMATION:
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CERTIFYING AUTHORITIES:
The "Physician/Certifying Practitioner's Statement of Certification" section on the reverse side of this form MUST be completed by one of the following and must include the certifying authority's license number and the name of the state where their license was issued:
• Physician licensed to practice under Chapters 458, 459 or 460, Florida Statutes, or similarly licensed by another state.
NOTE: Documentation of the physician's licensure in the other state must be submitted with a signed statement verifying the physician's knowledge of Florida's eligibility guidelines (s. 320.0848(1)(b)2., 2, Florida Statutes).
The form HSMV 83039 must be accurately completed, including the "Physician/Certifying Practitioner's Statement of Certification" section, verifying the disability. See list below for acceptable "certifying authorities”.
A Florida driver license number or Florida identification number is required unless the authorized physician certifies that the applicant’s disability is too severe to visit or be transported to an office to obtain a driver’s license or identification card.
Fees: There is no charge for a Permanent Parking Placard. A Temporary Parking Placard is $15.
Note: If a second Temporary Parking Placard is required within one year of the initial Temporary Parking Placard, there will be no charge. If a second Temporary Parking Placard is required outside the one year issuance, a fee of $15 would be required.
PROVISIONS OF LAW:
Section 316.1958, Florida Statutes, provides that motor vehicles displaying a license plate or parking permit issued to a disabled person by any other state or district subject to laws of the United States, shall be recognized as a valid plate or permit, allowing such vehicle the special parking privileges in Florida, provided such other state or district grants reciprocal recognition for disabled residents of this state. All of the United States has agreed to reciprocate.
Section 320.0848, Florida Statutes, provides for the issuance of the disabled person parking permit. The person must be currently certified as being legally blind or having a disability that renders him or her unable to walk 200 feet without stopping to rest. The disability must be due to a condition listed in (2‐8) on the reverse side of this form in the "Physician/Certifying Practitioner's Statement of Certification" section.
Section 320.0848(1)(d), Florida Statutes, provides that the department shall renew the disabled parking permit of any person certified as permanently disabled on the application if the person provides a certificate of disability issued within the last 12 months pursuant to this subsection.
RENEWAL INSTRUCTIONS:
Submit a copy of the registration for your expiring parking permit and a certificate of disability (form HSMV 83039). The form must be completed and signed by the certifying authority within the last 12 months. Send form by mail or in person to the tax collector office or license plate agency in the county where you live. For a temporary permit, submit the appropriate fees.
Please visit our online renewal site at www.GoRenew.com.
APPLICATION REQUIREMENTS:

Proof of identity is required when submitting this application.

An additional permit may be issued to a disabled person who qualifies as a frequent traveler or as a quadriplegic.

An organization may be issued as many disabled person parking permits as it has vehicles (that are used to transport disabled persons).

Temporary parking permits are issued for the time period specified by the certifying authority, not to exceed six (6) months. Permits issued to disabled persons will expire in four years on the owner's birthday. Permits issued to an organization will expire in four years on June 30.

The permit must be hung on the rear view mirror of any vehicle used to transport the disabled person(s) while parked in a designated disabled person parking space. The permit number must be visible from the front of the vehicle.

It is unlawful for any person to obstruct the path of travel to an accessible parking space, curb cut or access aisle by standing or parking a vehicle within any such designated area.

Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/

HSMV 83039 - REV. 10/18

www.flhsmv.gov
Get Hsmv 83039 PDF Form

Form Characteristics

Fact Description
Purpose The HSMV 83039 form is used to apply for a disabled person parking permit in Florida.
Governing Law The form is governed by section 320.0848 of the Florida Statutes, which outlines eligibility and certification requirements.
Validity Period This form's validity lasts for 12 months from the date of the certifying authority’s signature.
Submission Location Applicants must submit the completed form to their local county tax collector's office or license plate agency.
Fees There is no fee for a permanent parking placard; however, a temporary placard costs $15.

Guidelines on Utilizing Hsmv 83039

To fill out the HSMV 83039 form, follow the steps outlined below. Ensure all required information is accurately completed, as this form must be submitted to your local county tax collector's office or license plate agency for processing.

  1. Gather necessary information: Obtain your Florida Driver License or ID card number, e-mail address, phone number, and the details of your disability as certified by a physician.
  2. Complete the applicant section: Fill in your name as printed on your current disabled parking permit number, along with your signature, date of birth, sex, e-mail address, and phone number.
  3. Address section: Enter your residential address, including city, state, and zip code.
  4. Florida Driver License or ID number: If applicable, include your Florida Driver License or ID number.
  5. Disability type: Check the applicable box indicating your specific disability as listed in the form. You can choose from options 2 to 8.
  6. Physician's certification: Ensure your physician or certifying authority completes their statement of certification section. This includes their license number, state of licensure, and signature.
  7. Authorized representative: If submitting on behalf of an organization, provide the signature and date signed by the authorized representative, alongside the organization’s address and e-mail.
  8. Submission: Review the completed form for accuracy and submit it to your local county tax collector's office or license plate agency.

What You Should Know About This Form

What is the purpose of the HSMV 83039 form?

The HSMV 83039 form is an application for a disabled person parking permit in Florida. It allows disabled individuals to request special parking privileges due to their disabilities. This permit enables access to designated parking spaces that are typically closer to buildings, helping individuals with mobility impairments. The application must be completed with a physician's certification confirming the disability, as outlined in Florida Statutes Section 320.0848.

How long is the HSMV 83039 form valid?

The HSMV 83039 form is valid for a period not exceeding 12 months from the date it is signed by the certifying authority. It is important for applicants to renew their permits before the expiration date to maintain their parking privileges. For permanent permits, the renewal process will involve submitting a certificate of disability, ensuring it is completed and signed by the certifying authority within the last 12 months.

Who can certify my disability for the HSMV 83039 application?

A range of licensed medical professionals can complete the certification section of the HSMV 83039 form. This includes physicians, osteopathic physicians, podiatric physicians, chiropractors, optometrists, and advanced practice registered nurses. The certifying authority must hold a valid license in the state where they practice and must include their license number and state on the application. These professionals verify that the applicant meets the eligibility criteria for a disabled person parking permit.

Are there any fees associated with the application for a disabled person parking permit?

There are no fees for obtaining a permanent disabled person parking placard. However, fees apply for temporary parking placards, which cost $15. If an applicant requires a second temporary placard within one year of the initial issue, they will not incur an additional charge. However, if a second temporary placard is needed outside that one-year period, the fee of $15 will apply again.

Common mistakes

Filling out the HSMV 83039 form for a disabled parking permit can seem straightforward, but many applicants make common mistakes that can delay their application or lead to complications. One frequent error involves missing signatures. Both the applicant and the certifying authority must provide their signatures. If either is absent, the application will not be processed.

Another mistake people often make is improperly documenting the disability type. The form requires specific information about the disability, including its type and severity. Incomplete or vague descriptions can result in the application being rejected. Applicants should ensure that the certifying authority specifies the disability clearly as listed in the instructions.

Often, individuals neglect to include their Florida Driver License or ID card number when applicable. This omission can hinder the processing of the application. If the applicant does not have a Florida ID, the certifying authority must indicate this clearly, but neglecting to provide any identification may cause confusion.

Many applicants also forget to enter their contact information. Providing an email address and phone number is crucial for follow-ups or inquiries about the application status. Failure to include this information may lead to missed communications from the tax collector's office.

One critical aspect that often goes overlooked is the expiration date of the application. The form is only valid for 12 months from the date of the certifying authority's signature. Submitting an outdated application can bring an automatic denial.

When checking applicable boxes, some applicants mistakenly fail to select a category under the disability section. Each disabled parking permit type requires specific criteria to be met. Ensuring the right box is checked aids in the appropriate classification of disability.

It is essential to understand the requirement for a certifying authority to complete the necessary statement. Often, applicants do not realize that this section must be filled out by a recognized professional licensed in Florida. Failure to provide a valid signature from a licensed physician can result in withdrawal from the process.

Fees are another area of confusion. Some applicants are unaware that temporary permits come with a fee while permanent ones do not. Understanding the applicable fees, including potential costs for a second temporary permit, is essential to prevent unexpected delays.

Finally, many people do not double-check their application before submission. Small errors can lead to significant delays as forms may need to be returned for corrections. Taking the time to review all information before sending can greatly improve the likelihood of a smooth approval process.

Documents used along the form

When applying for a Disabled Person Parking Permit using the HSMV 83039 form, several other documents may be required to support the application. Each of these documents serves a specific purpose in facilitating the approval process, ensuring that individuals receive the accommodations they need.

  • Certificate of Disability: This document, completed by a healthcare provider, certifies that an applicant has a qualifying disability. It provides necessary medical documentation supporting the claims made in the HSMV 83039 form.
  • Florida Driver License or ID Card: If applicable to the applicant, a valid Florida driver's license or identification card is often required. This serves as proof of identity and residency.
  • Renewal Application: For those renewing their parking permit, a renewal application must be submitted alongside their existing permit registration. This document reaffirms the applicant’s continued eligibility.
  • Veterans Affairs Letter: A veteran who is permanently disabled due to a service-connected disability can provide a letter from the United States Department of Veterans Affairs to verify their status in lieu of other certifications.
  • Physician's License Documentation: If a physician from another state certifies the applicant's disability, documentation of their licensure and familiarity with Florida guidelines should be submitted to validate their assessment.
  • Organization Application: For organizations applying on behalf of disabled persons, this form is required. It documents the organization's intent to provide transportation services for individuals with disabilities.

Collecting these documents ensures a smoother application process and increases the likelihood of swift approval. Being well-prepared not only helps applicants but also supports the broader goal of accessibility in public spaces.

Similar forms

  • Form HSMV 83040: This form is used to apply for a disabled parking permit in other states. Similar to HSMV 83039, it requires a statement of disability from a physician to validate eligibility for parking privileges tailored for individuals with disabilities. Both forms mandate certification and are updated annually.

  • Form VDF 0042: This form is the application for designated parking for persons with disabilities in Virginia. Like HSMV 83039, it necessitates a physician's certification confirming the disability, and it also honors the need for a representation of both permanent and temporary disabilities.

  • Form DMV 1212: In California, this application serves as a disabled parking placard request, aligning it closely with HSMV 83039. It too calls for a medical professional’s endorsement to confirm the applicant's disability status and facilitates similar parking privileges.

  • Form MV-198: Pennsylvania's application for a disabled parking placard shares similarities with HSMV 83039, especially in requiring medical certification. It acknowledges both temporary and permanent disabilities, aligning parking privileges accordingly.

  • Form 1604: This is Kentucky’s application for a disabled person parking permit. In essence, it matches the HSMV 83039 form by asking for certification from a healthcare provider to document the applicant's disability, ensuring clear entitlement to special parking privileges.

  • Form MVC-4: In New Jersey, this is the application for a disabled person parking placard. Similar to HSMV 83039, it requires a physician’s certification of a qualifying disability and includes provisions for both temporary and permanent permits, reflecting consistent standards.

Dos and Don'ts

When filling out the HSMV 83039 form, consider these guidelines to ensure accuracy and compliance.

  • Do print or type clearly to avoid any confusion.
  • Do ensure that you provide all required personal information, including your current disabled parking permit number, if applicable.
  • Do have your physician or certifying practitioner complete the certification section fully.
  • Do include a valid Florida driver license or ID number when possible.
  • Don't submit the form without the certifying authority's signature.
  • Don't misrepresent your disability on the application; providing false information is illegal.
  • Don't forget to check the correct box regarding your disability type.
  • Don't skip the renewal process; your permit is only valid for 12 months unless certified otherwise.

Misconceptions

Understanding the HSMV 83039 form can help clarify the application process for disabled parking permits in Florida. However, several misconceptions can lead to confusion. Here are nine common misunderstandings:

  • Anyone can fill out the form. Only a disabled person or their legal guardian can apply, and a physician or certifying practitioner must complete the certification section.
  • Temporary permits last indefinitely. Temporary parking permits are valid for a maximum of six months, as specified by the certifying authority.
  • Having a disability automatically qualifies for a permit. The applicant must meet specific criteria set by Florida Statutes, which detail the disabilities qualifying for the permit.
  • A disability diagnosis suffices for the application. The form requires a certifying statement from a healthcare professional, including their license number and state of licensure.
  • The permit is transferable. A disabled parking permit belongs to the individual, not the vehicle. It cannot be used by anyone else without permission.
  • No fees are involved for any permit. Permanent parking permits are free, but a temporary permit costs $15. Additional fees may apply under certain circumstances, like replacing a permit.
  • Once applied, the permit never needs renewal. Permits must be renewed every four years, or in the case of a temporary permit, upon expiration after six months.
  • All physicians can certify the application. Only licensed physicians, osteopathic physicians, or other designated healthcare providers can complete the certification section.
  • Out-of-state permits work similarly in Florida. While Florida recognizes permits from other states, it’s essential to verify that those states offer reciprocal recognition for disabled parking privileges.

Being aware of these misconceptions can simplify the application process and ensure compliance with Florida's regulations for disabled parking permits.

Key takeaways

Here are key takeaways regarding the HSMV 83039 form, which is necessary for obtaining a disabled person parking permit in Florida:

  • The application must be submitted to your local county tax collector's office or license plate agency.
  • The certification from a physician or qualified practitioner is crucial for confirming the disability.
  • The form is valid for only 12 months following the certifying authority's signature.
  • Temporary permits are issued for a maximum of six months, while permanent permits last for four years.
  • There is no fee for a permanent parking placard, but a temporary one costs $15.
  • Permits must be displayed on the rearview mirror, ensuring visibility from the front of the vehicle.

These essentials help guide users through the process, making it more efficient and straightforward.

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