Article Structure
The TriMet LIFT Eligibility form is a crucial step for individuals seeking paratransit transportation services due to disabilities. This form dictates who may qualify for the LIFT service, which aligns with the standards set by the Americans with Disabilities Act (ADA). Essential requirements for eligibility include having a disabling health condition that limits the ability to use regular public transport and demonstrating this limitation in conjunction with environmental factors. The assessment process includes completing a detailed application, obtaining professional verification, attending an in-person interview with a TriMet LIFT Eligibility Coordinator, and potentially undergoing a functional ability assessment. Those applying will receive clarity on their eligibility within 21 days post-evaluation. Whether the applicant needs unconditional or temporary services will depend on their specific situation. Information regarding the appeals process is also provided to ensure that all applicants understand their options if they disagree with the initial determination. Completing the application accurately is key, as incomplete submissions may be returned, delaying access to needed services. Guidance for gathering necessary information and understanding transportation options for evaluations is included to simplify the experience for applicants.
Lift Eligibility Example
LIFT ELIGIBILITY PROCESS INSTRUCTIONS
Step 1: WHO MAY BE ELIGIBLE FOR LIFT SERVICE?
The TriMet LIFT service provides paratransit transportation to persons who are certified as eligible under the standards of the Americans with Disabilities Act (ADA). The ADA is a federal law that requires paratransit transportation be provided for persons when their disability in combination with their functional abilities prevents them from using regular public transportation.
Please read the enclosed brochure entitled LIFT Eligibility and the Americans with Disabilities Act and the information about TriMet’s services including bus and MAX before completing your application.
Requirements for LIFT Eligibility
The ADA includes two requirements for LIFT eligibility:
1.you must have a disabling health condition, and
2.your disabling health condition must prevent you from using regular bus and/or MAX services on your own, either some or all of the time.
The basis for the eligibility decision is your ability to use TriMet’s regular bus and/or MAX services and the most limiting conditions presented by your disability and the environment.
LIFT eligibility is not based on:
•age alone
•a disability or medical diagnosis by itself
•a lack of TriMet bus or MAX service in an area
•an inability to drive
•personal finances
LIFT eligibility may be granted upon the following basis:
•Unconditional (the person may use LIFT service for all trips)
•Conditional (the person may use LIFT service under some conditions for some trips)
•Temporary (the person may have conditional/unconditional eligibility for a defined period of time because limitations are expected to change)
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Step 2: HOW IS YOUR ELIGIBILITY DETERMINED?
The TriMet LIFT eligibility determination process includes:
1.Submission of a completed application and signed Medical Release Form,
2.Professional verification of disability and abilities,
3.An
4.A functional and/or cognitive assessment as needed.
Interview
At the interview, the Eligibility Coordinator will review the application with you and discuss your travel abilities and limitations in more detail. This information will help the Eligibility Coordinator to identify the best mobility option based on your functional abilities.
The interview will take up to 30 minutes. At the end of the interview, the Eligibility Coordinator will determine if a functional ability assessment is required.
If you will require a
Functional Ability Assessment
You may be asked to complete an assessment of your functional abilities immediately following the interview. The assessment is designed to help determine whether you have the ability to use
The functional assessment will be conducted by an independent Mobility Assessor and consist of demonstrating your abilities on a simulated course that includes slopes, inclines, negotiating a curb and curb cut and crossing the street. Skills evaluated also include balance, strength, coordination and range of motion.
The assessment may also include a walk outside in the neighborhood and/or a short trip on bus and/or MAX. Please dress appropriately for the weather.
The Functional Assessment of Cognitive Transit Skills (FACTS) may be administered to applicants with cognitive disabilities. This assessment tool uses a set of photos of a simulated bus trip to assess a person’s transit skills including bus travel, community safety and general orientation.
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Personal Care Assistance
If you require personal assistance in any daily life functions including using the bathroom, you will need to have someone accompany you to the evaluation to provide this assistance.
TriMet staff is not trained and is unable to assist you with personal care issues.
Depending on the time of day for your appointment, you may also want to bring a light snack with you and any required medications.
Mobility Equipment
Please bring the mobility equipment you will use on LIFT and/or in your daily mobility (i.e. mobility device, walker, cane, etc.).
Transportation to the Evaluation
LIFT eligibility evaluations take place at the TriMet Transit Mobility Center (TMC) at 515 NW Davis Street, Portland, OR 97209. The TMC is located on the MAX Green and Yellow Lines between NW 5th and 6th Avenues and NW Davis and Everett Streets. LIFT will provide transportation for your trips to and from the evaluation at no charge to you if necessary. This location is also served by several bus routes and there is parking available at your cost.
STEP 3: HOW WILL I KNOW IF I AM ELIGIBLE?
Notice of Eligibility Determination
You will be notified of the eligibility determination by letter within 21 days after completion of the evaluation process. If you are eligible, you will also receive a LIFT Rider’s Guide with information about how to use the service.
Appeals Process
If you have any questions about your eligibility determination, you may contact your LIFT Eligibility Coordinator as indicated in the letter to review his or her decision.
Applicants who are determined not eligible or who do not agree with the conditions established for their use of the LIFT service may request an appeal which must be filed within 65 days from the date of the initial eligibility determination. Information on how to request an appeal will be included with the eligibility determination letter.
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STEP 4: INSTRUCTIONS FOR COMPLETING THE APPLICATION
1.Answer all questions completely and to the best of your ability.
2.Be sure to sign the application in Part F on Page 3. Incomplete and/or unsigned applications may be returned to you.
3.Complete and sign the attached Medical Release Form (the last page of the application). Incomplete or unsigned Medical Release Forms may be returned to you.
PLEASE NOTE: This is not a request for medical records or a requirement for you to get a signature from your health professional. Once your application has been received, TriMet will contact your health professional to confirm your disability.
Examples of health professionals include:
Certified Orientation & Mobility Specialist
Chiropractor
DSHS/DDD Case/Resource Manager
HCS/AAA Case Manager
MSW employed by a medical facility
Occupational/Physical Therapist
Physician/ Physician Assistant
Psychiatrist/Psychologist
Recreation Therapist
Registered Nurse/Nurse Practitioner
Special Education Teacher
Vocational Rehabilitation Counselor
4.Return the completed application in the enclosed
515 NW Davis Street Portland, OR 97209
Or fax the application to LIFT Eligibility
5.After your application has been reviewed, you will be contacted by phone by LIFT staff to schedule your appointment for the
Questions? Please call the LIFT office at
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FOR TRIMET USE ONLY
APPLICATION FOR TRIMET LIFT PARATRANSIT SERVICE
Please read carefully. All questions must be answered. Incomplete or unsigned applications may be returned.
Part A. Personal Information
Name
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Phone Number(s)
Email Address_________________________________________________________
Preferred Method of Contact: ☐ Phone ☐ Email ☐TTY ☐VRS ☐Web/Video Chat
Date of Birth ______________________Language of Choice
Are you currently a LIFT Customer? ☐ Yes ☐No
Are you a TriMet Employee, Dependent of a TriMet Employee, TriMet Retiree, or TriMet Contractor? ☐ Yes ☐No
Part B. Emergency Contact Person
Name ____________________________ Relationship to Applicant ______________
Phone Number(s) _____________________________________________________
Email Address________________________________________________________
Additional Emergency Contact: ___________________________________________
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Part C. Disability and/or Health Condition Limiting Your Mobility
1.What is the disability or health condition(s) that limits your mobility and prevents you from using TriMet regular bus and/or MAX service?
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Do the effects or symptoms of your condition vary daily? |
☐ Yes |
☐ No |
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If yes, please explain |
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Is your condition: ☐ Permanent ☐ Temporary |
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If temporary, what is the estimated recovery period? |
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Part D. Mobility Equipment
1.Indicate which mobility equipment you presently use and would be using when traveling on TriMet LIFT.
☐None |
☐Manual Wheelchair |
☐Service Animal |
☐Cane |
☐Power Wheelchair |
☐Portable Oxygen |
☐Walker |
☐Power Scooter |
☐Respirator |
☐Crutches |
☐Extended Footrests |
☐Chest Restraint |
☐White Cane |
☐Lift Mechanism (to board the bus) |
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☐Prosthetic device |
☐Other - please describe: |
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2. If you use a Manual or Power wheelchair or scooter, do you want to transfer to a seat from your device when riding on TriMet LIFT?
☐ Yes ☐ No ☐ Sometimes, please explain:
Part E. Optional Information:
The following questions are optional and will have no bearing on your eligibility for TriMet LIFT service.
1.What is your ethnicity?
☐African American |
☐Asian/Pacific Islander |
☐Caucasian |
☐Hispanic/Latino |
☐Native American |
☐Other____________ |
2.What is your gender? ☐Female ☐Male
3.Are you a US Veteran? ☐Yes ☐No
4.How did you find out about TriMet LIFT service?
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Part F. Please read the following and sign the application
For the applicant: Applications must be signed. Unsigned applications may be returned.
I understand that the purpose of this application is to determine whether I am eligible to use TriMet LIFT paratransit services. I certify that the information in this application is true and correct. I understand that providing false information may result in denial of service as well as penalty under the law. I understand that information I provide will be disclosed only as needed to evaluate eligibility for LIFT paratransit, and to provide LIFT services if I am determined to be eligible, unless I give other specific authorization.
I understand that it may be necessary for me to participate in an
*For the purpose of simplifying the administration of the LIFT program, social service agencies and other organizations that are interested in assisting with completing LIFT applications for their clients may be selected, at TriMet’s discretion, to operate as a Designated Administrative Agency.
If a legal representative signs this application:
I acknowledge that I may be present with the applicant during the
_____________________________________________________________________
Applicant signature, or signature of legal representative |
Date |
If someone other than the applicant assisted in completing this application, in part or in whole, that person must complete and sign the following:
Name:____________________________Relationship to applicant: ______________
Organization or Agency affiliation: _________________________________________
Address:_____________________________________________________________
Phone: _________________ Fax: ______________ Email: _____________________
I have knowledge of the applicant’s disability or health condition and am aware of how the applicant’s disability or health condition prevents their use of TriMet regular bus and/or MAX: ☐Yes ☐No
____________________________________________________________________
Representative’s signature |
Date |
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Part G. Instructions regarding signatures and submitting application
Before returning the application, please make sure that:
1.You answer all questions in Parts A through F.
2.You sign Part F on Page 3.
NOTE: If another person (not the applicant) completed the application, please have that person complete the information in Part F and sign the application.
3.You complete and sign the attached Medical Release – Authorization For Use and Disclosure Of Protected Health Information on Page 6. The Medical Release form is available in large print upon request .
It may be necessary for TriMet to contact a health professional who is familiar with your disability or health condition. TriMet will not release any medical information obtained with the release(s) you provide to any other party.
Please use the enclosed
TriMet Transit Mobility Center
515 NW Davis Street
Portland, OR 97209
You may instead fax the application to
If you have any questions or need assistance in completing the application, including an alternative format, please call the Transit Mobility Center at
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MEDICAL RELEASE
AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
All sections must be completed.
I, _______________________________________ authorize:
(Applicant or Patient Name)
Name of professional ________________________________________________________
Address ___________________________________________________________________
Phone ________________________________ FAX _______________________________
to disclose Protected Health Information (PHI) to the TriMet LIFT (paratransit) Program, 515 NW Davis Street, Portland, OR 97209, for the purpose of assessing whether I am eligible under the Americans with Disabilities Act for TriMet’s LIFT transportation service. Only those persons with disabilities whose disabilities prevent their use of regular TriMet buses and/or MAX service are eligible to use LIFT service.
My PHI may include medical records, diagnostic reports, physical therapy records, and any personal and medical information pertinent to my application for LIFT eligibility. If the information to be disclosed contains any of the types of records or information listed below, additional laws relating to the use and disclosure of the information may apply. I understand and agree that this information will be disclosed only if I place my initials in the space next to the type of information:
___________ Chemical dependency
___________ Sexually transmitted diseases HIV/AIDS
___________ Genetic information
___________ Mental health information (excludes psychotherapy notes)
___________ Reproductive health (including abortion)
I may cancel this authorization at any time by sending a written request to the TriMet LIFT Program,
515 NW Davis Street, Portland, OR 97209. My cancellation of this authorization will not affect any uses or disclosures made before my request is received. If I do not revoke this authorization, it will automatically expire in 90 days.
I understand that I am not legally obligated to sign this authorization and that TriMet will not refuse to accept my application for LIFT eligibility based on my refusal to sign this authorization. I also understand that if TriMet is unable to obtain information necessary to determine my disability or health condition and how the disability or health condition limits or prevents my use of regular bus and/or MAX services, my application for LIFT eligibility may not be processed or may be denied.
I understand that the information used or disclosed pursuant to this authorization may be subject to
I understand that by signing this statement I am authorizing TriMet to provide a copy of this statement to the above listed professional for the purposes of compliance with the Health Insurance Portability and Accountability Act (HIPAA).
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Signature of applicant or legal representative |
Date |
Applicant’s Date of Birth _____________________________ |
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Form Characteristics
| Fact Name | Details |
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| Eligibility Criteria | To be eligible for LIFT services, individuals must have a disabling health condition and be unable to utilize regular bus or MAX services independently. |
| Governing Law | The eligibility for LIFT services is governed by the Americans with Disabilities Act (ADA), a federal law. |
| Types of Eligibility | Eligibility can be classified as unconditional, conditional, or temporary based on the individual's needs and situation. |
| Application Process | Eligibility determination requires a completed application, a signed Medical Release Form, professional verification, and a possible interview. |
| Assessment Requirement | A functional and/or cognitive assessment may take place following the interview to evaluate the applicant's abilities. |
| Notification Timeline | Applicants will receive a notification of the decision regarding their eligibility within 21 days post-evaluation. |
| Appeals | If deemed ineligible, individuals can appeal the decision within 65 days from the notification date. |
| Transportation for Evaluation | TriMet provides free transportation to and from the LIFT eligibility evaluation location if needed. |
| Personal Assistance | Applicants requiring personal care assistance must bring someone to provide necessary support during the evaluation process. |
Guidelines on Utilizing Lift Eligibility
After submitting the Lift Eligibility form, you will undergo several steps to determine if you qualify for the TriMet LIFT service. This process includes submitting the form, an in-person interview, and possible assessments to evaluate your individual needs and abilities. It is crucial to be thorough and complete when filling out the form to ensure a smooth assessment.
- Carefully read the enclosed brochure about Lift Eligibility and the Americans with Disabilities Act (ADA) to understand the qualifications for service.
- In Part A of the form, provide your personal information accurately, including your name, address, date of birth, and phone numbers.
- Complete Part B by listing an emergency contact person and their relationship to you.
- Answer all questions in the form fully and honestly, including whether you are currently a LIFT customer or associated with TriMet.
- In Part F on Page 3, make sure to sign the application. Failure to sign may result in your application being returned.
- Sign and complete the attached Medical Release Form, which verifies your disability with your health professional.
- Return the completed application using the self-addressed envelope provided or fax it to the designated number.
- Once your application is received, be prepared for a phone call from LIFT staff to schedule your in-person evaluation appointment.
What You Should Know About This Form
1. Who is eligible for the LIFT service?
The TriMet LIFT service is available to individuals who have been certified as eligible under the Americans with Disabilities Act (ADA) standards. To qualify, a person must have a disabling health condition that prevents them from using standard public transportation services. It is essential to understand that eligibility considers both the individual’s disability and their ability to use regular bus or MAX services.
2. What are the specific requirements for LIFT eligibility?
Eligibility for the LIFT service under the ADA hinges on two main requirements: having a disabling health condition and being unable to use regular bus or MAX services independently, at least some of the time. Notably, eligibility does not depend solely on age, a disability diagnosis alone, financial status, or other factors such as the absence of public transport options in a certain area.
3. How is eligibility determined after submission of the application?
The LIFT eligibility determination process involves several steps. Applicants must submit a completed application and a signed Medical Release Form, undergo professional verification of their disability, participate in an in-person interview with a TriMet LIFT Eligibility Coordinator, and if necessary, complete a functional assessment. Each of these components helps to assess the individual’s travel capabilities and limitations.
4. What can I expect during the in-person interview?
During the interview, which lasts approximately 30 minutes, the Eligibility Coordinator will review the application and discuss the applicant’s travel abilities and limitations. At this point, the Coordinator may decide if further functional ability assessments are required. If interpreters are needed, applicants should indicate their language preference on the application form, and an interpreter will be provided without charge.
5. What does the functional ability assessment entail?
For those who need it, the functional ability assessment occurs immediately after the interview. This assessment evaluates the ability to use fixed-route services through practical demonstrations on a simulated course, testing skills like balance, strength, and coordination. Those with cognitive disabilities may undergo a specialized assessment focused on transit skills through the Functional Assessment of Cognitive Transit Skills (FACTS).
6. How will I be notified of my eligibility decision?
Once the evaluation process is completed, applicants will receive a notice of eligibility determination via mail within 21 days. If approved, the notification will include a LIFT Rider’s Guide with instructions on how to use the service. Should there be any questions regarding the determination, the Eligibility Coordinator’s contact information will be provided for further discussion.
7. What should I do if I disagree with the eligibility determination?
If an applicant disagrees with the decision or the established conditions for using LIFT services, they may request an appeal. This request must be made within 65 days from the date of the eligibility determination letter. Detailed instructions for requesting an appeal will be included in the letter received from TriMet.
Common mistakes
Filling out the Lift Eligibility form can be challenging, and several common mistakes can hinder the application process. One prevalent issue is providing incomplete information. Many individuals overlook sections or fail to answer all the questions fully, which can lead to an application being returned. Be thorough; every question is designed to help assess your eligibility accurately.
Another mistake often made is neglecting to sign the application. An unsigned form is a frequent reason for delays in processing. Remember, a signature signifies that the information you provided is accurate and complete. Ensure that you check Part F on Page 3 to confirm your signature is present before submission.
Many applicants also misunderstand the Medical Release Form's requirements. Some individuals may think they need to get a health professional's signature, but that is not the case. The form simply allows TriMet to contact your healthcare provider for confirmation of your disability. If you don’t complete or sign this form correctly, it could result in your application being returned or delayed.
Lastly, failing to provide accurate contact information can create unnecessary hurdles. If TriMet cannot reach you due to incorrect phone numbers or email addresses, scheduling the next steps in the eligibility process could be complicated. It is vital to ensure that all information is current and correct. Taking the time to avoid these mistakes can streamline your application and improve your chances of receiving the necessary support through the LIFT service.
Documents used along the form
When applying for the TriMet LIFT service, several essential documents work in conjunction with the Lift Eligibility form. These documents are critical as they facilitate the application process and ensure a comprehensive understanding of an individual’s needs.
- Medical Release Form: This form grants TriMet permission to contact healthcare professionals for verification of the applicant's disability and their ability to use public transportation.
- LIFT Rider's Guide: Provided to eligible applicants, this guide contains valuable information on how to utilize the LIFT service effectively, including policies, procedures, and contact information.
- Americans with Disabilities Act (ADA) Brochure: This educational resource explains the rights and requirements under the ADA, clarifying the eligibility criteria for LIFT service.
- Functional Abilities Assessment: This evaluation determines an individual’s capacity to use regular bus and MAX services through a practical assessment of their abilities.
- Eligibility Determination Letter: This is the official notification sent to applicants regarding their eligibility status following the evaluation process.
- Emergency Contact Information Form: This document provides details about a designated contact person in case of emergencies during travel.
- Non-English Interpreter Request Form: If needed, this form allows applicants to request language support during their interview process, ensuring effective communication.
- Transportation Request Form: This form is used to arrange for complimentary transportation to and from the LIFT evaluation appointment, if necessary.
- Appeals Request Form: Applicants who wish to contest a negative eligibility decision use this form to initiate the appeals process within the designated timeline.
- Personal Assistance Authorization: If an applicant requires personal assistance for daily activities, this document authorizes an accompanying person to provide help during the evaluation.
These documents collectively streamline the LIFT application process and provide essential support to ensure that individuals receive the transportation services they need. Understanding these forms can significantly enhance the experience of potential LIFT users.
Similar forms
The Lift Eligibility form shares similarities with several other important documents related to disability and transportation services. Here are four documents with which the Lift Eligibility form has common features:
- Americans with Disabilities Act (ADA) Certification Form: Like the Lift Eligibility form, this certification form assesses whether an individual meets the ADA criteria for receiving paratransit services based on disability. Both require proof of a disability and an evaluation of functional abilities.
- Medical Release Form: This document, similar to the Medical Release Form attached to the Lift Eligibility application, authorizes healthcare providers to disclose necessary medical information. Both forms ensure that relevant medical details are shared only for eligibility assessment purposes.
- Social Security Disability Insurance (SSDI) Application: Much like the Lift Eligibility form, the SSDI application evaluates the individual’s disability and its impact on daily activities. Both require detailed personal and medical information to establish the need for assistance or support.
- Paratransit Service Application: This document, similar to the Lift Eligibility form, assesses eligibility for various paratransit services. Both applications look at a person’s ability to use regular public transportation and establish the criteria for eligibility based on disability-related limitations.
Dos and Don'ts
When filling out the Lift Eligibility form, consider the following do's and don'ts:
- Do provide complete and accurate information in all sections of the application.
- Do sign the application and the Medical Release Form to avoid delays in processing.
- Do bring any necessary mobility equipment needed for the evaluation.
- Do indicate on the form if you require a non-English language interpreter.
- Don’t leave any questions unanswered; incomplete applications may be returned.
- Don’t forget to provide the contact information for your health professional.
- Don’t assume all medical documentation is required; only the Medical Release Form is necessary.
- Don’t stress about transportation; LIFT provides rides to and from the evaluation if needed.
Misconceptions
The TriMet LIFT Eligibility form often faces misunderstandings. Here are five common misconceptions:
- Misconception 1: LIFT eligibility is based solely on age. Many people believe that age alone determines eligibility. However, age is not a factor. The eligibility process focuses on a person's disability and functional ability to use standard transportation services.
- Misconception 2: A medical diagnosis guarantees LIFT service. Having a disability or medical diagnosis does not automatically qualify someone for LIFT. The key requirement is that the disability must prevent the use of regular bus or MAX services.
- Misconception 3: A lack of public transportation in a neighborhood qualifies for LIFT. The presence or absence of bus or MAX service in an area does not influence eligibility. Instead, it's about the individual's capacity to utilize the existing services.
- Misconception 4: Personal finances affect LIFT eligibility. Financial status is not considered in the eligibility evaluation process. The focus remains solely on the health condition and travel capabilities of the person requesting service.
- Misconception 5: Conditional eligibility means limited use of LIFT. Conditional eligibility doesn't mean restricted service. It indicates that the individual can use LIFT under specific circumstances, ensuring that appropriate transportation options are available as needed.
Understanding these misconceptions helps clarify the LIFT eligibility process and ensures the right information is available for those seeking assistance.
Key takeaways
Understanding the LIFT Eligibility form is essential for those seeking paratransit service. Here are some key takeaways about the process:
- Eligibility Criteria: You must have a disabling health condition that prevents you from using regular public transportation.
- Not Based On: Eligibility is not determined by age, a standalone medical diagnosis, inability to drive, or personal finances.
- Application Requirements: Complete the application thoroughly and sign the Medical Release Form.
- In-Person Interview: Attend an interview with a TriMet LIFT Eligibility Coordinator, lasting up to 30 minutes.
- Functional Ability Assessment: You may undergo an assessment to evaluate your ability to use fixed-route services after the interview.
- Assistance: Bring someone to assist you with personal care needs, as TriMet staff cannot provide this support.
- Mobility Equipment: Bring any mobility aids you typically use (like a walker or cane) to your evaluation.
- Transportation: If needed, LIFT will cover your transportation to and from the evaluation site.
- Notification of Eligibility: You will receive a letter within 21 days informing you of your eligibility determination.
- Appeals Process: If found ineligible or if the terms do not meet your needs, you can appeal within 65 days of the determination.
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