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Outline

The BFS 108 Michigan form serves as a critical tool for individuals seeking disability parking placards within the state. This application process is designed to ensure that those with qualifying disabilities receive the appropriate accommodations for parking. The form is divided into several sections, requiring the applicant to provide personal information and a medical certification from a qualified healthcare professional. Applicants must complete Part 1, which includes a release of information and their signature, affirming the accuracy of the information provided. The healthcare provider, whether a physician, chiropractor, or nurse practitioner, must then fill out Part 2 to determine medical eligibility based on specific criteria that affect the applicant's mobility. Should the applicant also qualify for free parking, Part 3 must be completed, detailing additional medical conditions that warrant this exemption. Organizations seeking to provide transportation services for disabled individuals can apply through Part 4, which outlines the necessary information and requirements for such entities. Once completed, applicants can submit the form at any Secretary of State branch office or by mail, although processing is contingent upon the inclusion of all required signatures and certifications. The form is governed by Public Act 300 of 1949, which outlines the legal framework for disability parking placards in Michigan.

Sample - Bfs 108 Michigan Form

MICHIGAN DEPARTMENT OF STATE

Disability Parking Placard Application

Directions:

Office Use Only:

Expiration

Date:

Placard

Number:

Applicants please complete and sign Part 1. Your physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant must complete Part 2 and the certification on the bottom of this page. If you also qualify for free parking, your physician, chiropractor, optometrist, nurse practitioner, physician’s assistant, or physical therapist must also complete Part 3. Organizations applying for parking placards to provide transportation services for disabled persons complete Part 4. Completed applications may be presented at any Secretary of State branch office or mailed to the address on the reverse side of this form. (Application cannot be processed without signed release of information and physician’s certification.)

Part 1: Release of Information and Signature

I am applying for a disability parking placard as provided in Public Act 300 of 1949. I authorize the release of the medical information described below to the Michigan Department of State. I certify the information is true and realize by making a false statement on this application I am subject to the penalties described on the reverse side of this form.

 

PLEASE PRINT OR TYPE INFORMATION REQUESTED

 

Print Form

Clear Form

 

Asterisks (*) indicate required fields.

 

 

 

 

 

 

 

 

 

 

 

 

Name (First, Middle, Last)*

 

Date of Birth*

Michigan Driver’s License or State ID Card #*

 

 

 

 

 

 

 

Street Address*

 

County*

 

Disability Plate Number (if any)*

 

 

 

 

 

 

City, State, Zip*

 

Daytime Phone Number*

Last Parking Permit Number

 

 

(

)

 

 

 

Signature of Disabled Person*

 

Today’s Date*

Are you a Michigan resident?*

X

 

 

 

 

YES

NO

Signature of Representative (If presented by representative)*

 

Representative’s Driver’s License Number*

X

 

 

 

 

 

 

Part 2: Medical Eligibility Standards and Physician’s Determination

The Michigan Vehicle Code [MCL 257.19a] states that a disabled person be determined by a licensed physician, physician’s assistant, chiropractor, nurse practitioner, physical therapist, or optometrist identifying one or more of the following characteristics which affect your patient’s ability to walk.

Circle all letters that apply*

Right Eye:

 

Left Eye:

 

Both Eyes:

Visual field (in degrees):

a) Blindness. Corrected acuity level:

20/

 

20/

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b)An inability to walk more than 200 feet without having to stop and rest. Please provide the diagnosis for this ambulatory disability:

____________________________________________________________________________________________________________________

c)Patient must use a wheelchair, walker, crutch, brace, or other ambulatory aid to walk. Describe:

d)Patient has a lung disease from which the forced expiratory volume for one second, when measured by spirometry, is less than one liter, or from which the arterial oxygen tension is less than 60mm/hg of room air at rest.

e)Patient has a cardiovascular condition which measures between 3 and 4 on the New York Heart Classification Scale, or which renders the patient incapable of meeting a minimum standard for cardiovascular health established by the American Heart Association and approved by the Michigan Department of Health and Human Services.

f)Patient has an arthritic, neurological, or orthopedic condition that severely limits ability to walk. Describe:

g)Patient has persistent reliance upon an oxygen source other than ordinary air.

Physician’s Certification

A parking placard will be issued solely on the physician’s evaluation

 

 

 

 

 

 

 

 

Patient’s condition is*:

Permanent

Temporary

If temporary, estimated duration:

 

months (maximum 6 months)

 

 

 

 

 

Physician’s Name*

 

 

Medical Specialty*

Office Telephone*

 

 

 

 

 

 

 

Street Address*

 

 

City, State, Zip*

 

Office Fax*

 

 

 

 

 

 

 

 

 

I certify the person listed above is eligible for a disability placard as provided in Public Act 300 of 1949. I also understand that making a false statement to obtain a disability parking placard is a misdemeanor and may result in fines, imprisonment, or both.

Medical License Number**

Physician’s Signature*

Date*

 

X

 

**If the medical license was issued in a state other than Michigan, the Physician/Physical Therapist must submit a copy of their medical license.

NOTE: If the individual listed above is also eligible for free parking, Part 3 on the reverse side of this application must also be completed.

BFS-108 (10/19/2023)

Page 1

Part 3: Free Parking Application and Physician’s Certification

(Complete Parts 1, 2, and 3)

The free parking application is completed only when the applicant qualifies for free parking. To qualify, your patient must be a Michigan licensed driver, have an ambulatory disability described in Part 2, and have one of the following conditions. Economic need is not a consideration.

Circle all letters that apply:

a)The patient cannot insert coins or tokens in a parking meter or cannot accept a ticket from a parking lot machine due to a lack of fine motor control of both hands.

b)The patient cannot reach above their head to a height of 42 inches from the ground, due to a lack of finger, hand, or upper extremity strength or mobility.

c)The patient cannot approach a parking meter due to use of a wheelchair or other ambulatory device.

d)The patient cannot walk more than twenty feet due to an orthopedic, cardiovascular, or lung condition in which the degree of debilitation is so severe that it almost completely impedes the patient’s ability to walk. (A condition requiring applicant to rest after walking twenty feet when not using a wheelchair or other ambulatory device.)

I certify the person listed on the front of this application is also eligible for free parking as provided in state law [MCL 257.675]. I understand that making a false statement to obtain a free parking sticker is a misdemeanor and may result in fines, imprisonment, or both.

Physician’s signature: X

 

 

 

 

 

Date

 

 

 

 

(Physician / Chiropractor / Physician’s Assistant / Optometrist / Nurse Practitioner / Physical Therapist)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 4: Organization Request for Disability Parking Placards

 

 

 

 

 

 

 

 

PLEASE PRINT OR TYPE INFORMATION REQUESTED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Organization

 

 

FEIN

County

 

Telephone Number

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

City, State, Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe the transportation services your organization provides to persons with disabilities:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of disability placards you are requesting:

 

 

 

(No more than one per vehicle used to transport clients.)

 

 

 

I am applying for a disability parking placard as provided in Public Act 300 of 1949 and certify the above information is true.

 

 

 

 

 

 

 

Signature of Organization Officer

 

Printed Name of Organization Officer

 

 

 

Date

X

 

 

 

 

 

 

 

 

 

 

Organization Officer’s Driver’s License Number

 

Position (Title) Within Organization

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note: If the organization ceases to provide specialized services to disabled persons, the parking placard must be returned to the Secretary of State for cancellation.

Penalties

Michigan Vehicle Code Section 257.676 prohibits:

•Using a disability parking placard to park in a designated parking space unless the disabled person is driving or being transported.

•Altering, modifying, or selling a disability parking placard or free parking sticker.

•Copying or forging, or using a copied or forged disability parking placard or free parking sticker.

•Making a false statement to obtain a disability parking placard or free parking sticker or committing a deception or fraud on a medical statement attesting to a disability.

•Knowingly using or displaying a disability parking placard that has been canceled by the Secretary of State.

A violation is a misdemeanor and punishable by a fine up to $500 or imprisonment for up to 30 days, or both. A law enforcement officer may immediately confiscate a disability parking placard for improper use.

Return completed applications to any Secretary of State branch office or mail to:

Michigan Department of State

 

Internal Services Section

 

PO Box 30764

 

Lansing, MI 48918

If you have any questions regarding disability parking placards, please call the Department of State Information Center at 1-888-767-6424.

The personally identifiable information collected on this form will be used by MDOS to complete the requested transaction. MDOS limits the amount of personally identifiable information to only that information which is relevant and necessary to complete your transaction. Please be aware that under the Federal Driver’s Privacy Protection Act, 18 U.S.C. 2751, et seq. and the Michigan Driver’s Protection law, MCL 257.208c, your personal information may be provided to third parties without additional prior notice or consent when permitted or required by law. As a public body, MDOS is subject to the Michigan Freedom of Information Act (FOIA), MCL 15.231 et seq., and information such as a name or address may be disclosed in response to a FOIA request pursuant to law.

Authority granted under Public Act 300 of 1949, as amended.

BFS-108 (10/19/2023)

Page 2
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Form Information

Fact Name Details
Form Title BFS-108 Disability Parking Placard Application
Governing Law Public Act 300 of 1949 and Michigan Vehicle Code (MCL 257.19a)
Application Parts The form consists of four parts: Part 1 for applicant information, Part 2 for medical eligibility, Part 3 for free parking application, and Part 4 for organizational requests.
Eligibility Criteria Applicants must have a qualifying disability as determined by a licensed medical professional.
Submission Process Completed applications can be submitted at any Secretary of State branch office or mailed to the designated address.
Medical Certification A licensed physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant must complete the medical certification section.
Free Parking Qualification Applicants may qualify for free parking if they meet specific conditions outlined in Part 3 of the application.
Penalties for Misuse Violating the rules regarding the use of the disability parking placard can result in fines up to $500 or imprisonment for up to 30 days.
Contact Information For questions, applicants can call 1-888-767-6424 for assistance regarding disability parking placards.

Detailed Guide for Filling Out Bfs 108 Michigan

Filling out the Bfs 108 Michigan form is a straightforward process, but it requires attention to detail. Once you have completed the form, you can submit it in person at any Secretary of State branch office or mail it to the designated address. Ensure that all necessary sections are filled out accurately to avoid any delays in processing your application.

  1. Begin with Part 1: Release of Information and Signature. Fill in your name (first, middle, last), date of birth, Michigan driver's license or ID card number, street address, county, disability plate number (if applicable), city, state, zip code, daytime phone number, and last parking permit number.
  2. Indicate if you have a CDL endorsement and whether you have a medical waiver. Confirm your Michigan residency by marking 'YES' or 'NO'.
  3. Sign and date the application in the designated area. If someone is presenting the application on your behalf, they must also sign and provide their driver's license number.
  4. Move to Part 2: Medical Eligibility Standards and Physician’s Determination. This section must be completed by your physician or qualified medical professional. They will need to circle applicable characteristics affecting your ability to walk and provide a diagnosis for your ambulatory disability.
  5. Your physician must indicate whether your condition is permanent or temporary and provide their name, medical specialty, office telephone number, street address, city, state, zip code, office fax, and medical license number. They must also sign and date this section.
  6. If you qualify for free parking, complete Part 3: Free Parking Application and Physician’s Certification. This part must also be filled out by your physician, who will circle applicable conditions and sign it.
  7. If you are representing an organization, fill out Part 4: Organization Request for Disability Parking Placards. Provide the organization's name, county, telephone number, street address, city, state, zip code, and a description of transportation services offered. Indicate the number of disability placards requested and have an organization officer sign and date this section.
  8. Review the entire application for completeness and accuracy. Ensure all required signatures are present.
  9. Submit the completed application in person or mail it to the specified address.

Obtain Answers on Bfs 108 Michigan

  1. What is the Bfs 108 Michigan form?

    The Bfs 108 form is an application for a disability parking placard in Michigan. It allows eligible individuals to obtain a placard that grants them access to designated parking spaces. The form must be completed by the applicant and certified by a qualified medical professional.

  2. Who can complete the medical certification section?

    A licensed physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant can complete the medical certification section. This professional must evaluate the applicant’s condition and determine their eligibility based on specific medical criteria.

  3. How do I apply for a disability parking placard?

    To apply, complete Part 1 of the Bfs 108 form, which includes your personal information and signature. Then, have your medical professional fill out Part 2. If you qualify for free parking, Part 3 must also be completed. Finally, submit the completed application at any Secretary of State branch office or mail it to the address provided on the form.

  4. What are the eligibility criteria for a disability parking placard?

    Eligibility is determined by specific medical conditions that affect your ability to walk. These include blindness, inability to walk more than 200 feet without resting, reliance on ambulatory aids, and certain lung or cardiovascular conditions. Your medical professional will assess your condition and confirm eligibility.

  5. Can I apply for free parking as well?

    If you meet the criteria for a disability parking placard and also have specific conditions that limit your ability to use parking meters or approach parking areas, you may qualify for free parking. Your medical professional must complete Part 3 of the application to certify this eligibility.

  6. What happens if I provide false information on the application?

    Providing false information on the application is a serious offense. It is considered a misdemeanor and can result in fines, imprisonment, or both. Additionally, your application may be denied, and any placard issued may be revoked.

  7. How many placards can an organization request?

    Organizations applying for disability parking placards can request only one placard per vehicle used to transport clients. This ensures that the placards are used appropriately for the transportation of individuals with disabilities.

  8. What should I do if my organization stops providing services?

    If your organization ceases to provide specialized transportation services to disabled persons, you must return the parking placard to the Secretary of State for cancellation. This is important to prevent misuse of the placard.

  9. Where can I get more information or assistance?

    If you have questions about the Bfs 108 form or disability parking placards, you can call the Michigan Department of State at 1-888-767-6424. They can provide guidance and answer any specific questions you may have.

Common mistakes

When filling out the Bfs 108 Michigan form, applicants often make several common mistakes that can delay the processing of their application. One frequent error is failing to complete all required sections. Each part of the form serves a specific purpose, and omitting information can lead to rejection. Ensure that all fields are filled out accurately before submitting.

Another common mistake is not obtaining the necessary signatures. Part 1 requires the applicant’s signature, while Part 2 must be signed by a qualified medical professional. Without these signatures, the application cannot be processed. It is crucial to double-check that all required signatures are present.

Applicants sometimes overlook the importance of providing accurate medical information. In Part 2, specific medical conditions must be circled and described. Incomplete or vague descriptions can result in delays or denials. Providing clear and thorough details about the disability is essential for a successful application.

Additionally, some individuals forget to include the physician’s medical license number. This information is vital for verifying the qualifications of the medical professional completing the form. Failing to include this number can lead to unnecessary complications.

Lastly, applicants may neglect to submit any additional documentation required for their specific circumstances. For instance, if applying for free parking, the relevant section must be completed, and supporting documents may be necessary. Always review the instructions carefully to ensure all necessary documents are included with the application.

Documents used along the form

When applying for a disability parking placard in Michigan using the BFS 108 form, several other forms and documents may also be required or helpful in the process. Each of these documents serves a specific purpose and can streamline your application experience. Here’s a brief overview of five commonly associated documents.

  • Physician’s Certification Form: This document is crucial as it provides the necessary medical evaluation of the applicant's disability. A licensed medical professional must complete it, confirming the applicant's eligibility based on specific criteria outlined in the Michigan Vehicle Code.
  • Proof of Residency: Applicants must demonstrate that they are Michigan residents. This can be achieved by submitting a copy of a Michigan driver’s license, state ID, or any official document that verifies their address within the state.
  • Free Parking Application: If the applicant qualifies for free parking, this additional form must be completed. It requires further medical certification to confirm that the applicant meets specific criteria for free parking privileges.
  • Organization Request Form: For organizations applying for disability parking placards to provide transportation services, this form is necessary. It details the organization's services and the number of placards requested, ensuring compliance with state regulations.
  • Release of Information Form: This form allows the Michigan Department of State to access the applicant’s medical information. It must be signed by the applicant to ensure that their medical data can be shared with relevant authorities as part of the application process.

Being prepared with these documents can significantly enhance the application process for a disability parking placard. Each form plays a vital role in ensuring that the application is complete and compliant with Michigan law, ultimately making it easier for individuals with disabilities to access the parking accommodations they need.

Similar forms

The BFS 108 Michigan form, used for applying for a disability parking placard, has similarities with several other documents related to disability services and parking. Each of these documents serves a specific purpose but shares common elements, such as the need for medical verification and the focus on assisting individuals with disabilities. Below is a list of ten documents that are similar to the BFS 108 Michigan form, along with explanations of their similarities:

  • ADA Paratransit Eligibility Application: This document is used to determine eligibility for paratransit services under the Americans with Disabilities Act. Like the BFS 108, it requires medical documentation to confirm the applicant's disability and need for specialized transportation.
  • State Disability Parking Permit Application: Similar to the BFS 108, this application allows individuals to apply for a parking permit specifically for people with disabilities. Both forms require medical certification and personal identification details.
  • Social Security Administration Disability Benefits Application: This form is used to apply for disability benefits. It also necessitates medical evidence of disability, highlighting the importance of documentation in both contexts.
  • Medicaid Disability Determination Form: Used to assess eligibility for Medicaid based on disability, this form similarly requires medical evaluations and personal information, paralleling the BFS 108's structure.
  • Veterans Administration Disability Claim Form: Veterans seeking disability benefits must complete this form, which also demands medical documentation and personal details, much like the BFS 108.
  • State Rehabilitation Services Application: This application is for individuals seeking vocational rehabilitation services. It requires medical verification of disability, similar to the requirements of the BFS 108.
  • Home and Community-Based Services Waiver Application: This document is used to apply for services that support individuals with disabilities living at home. It requires medical documentation, echoing the BFS 108's emphasis on medical certification.
  • Disability Tax Credit Application: Individuals applying for tax credits due to disability must provide medical evidence of their condition, akin to the requirements set forth in the BFS 108.
  • Special Needs Trust Application: This form is used to establish a trust for individuals with disabilities. It often requires medical documentation to confirm the individual's disability status, similar to the BFS 108.
  • Accessible Housing Application: When applying for accessible housing, individuals must often provide medical proof of their disability, paralleling the medical verification needed in the BFS 108.

Each of these documents plays a crucial role in ensuring that individuals with disabilities receive the support and accommodations they need. They emphasize the importance of medical certification and personal information, mirroring the structure and purpose of the BFS 108 Michigan form.

Dos and Don'ts

When filling out the BFS 108 Michigan form, consider the following do's and don'ts:

  • Do complete all required sections of the form.
  • Do ensure your physician or qualified professional signs the certification.
  • Do provide accurate and truthful information throughout the application.
  • Do include your contact information for any follow-up questions.
  • Don't leave any sections blank; incomplete forms may delay processing.
  • Don't submit the application without the physician’s signature and necessary certifications.
  • Don't attempt to alter or forge any part of the application.
  • Don't forget to check if you qualify for free parking if applicable.

Misconceptions

Understanding the Bfs 108 Michigan form can be challenging. Here are seven common misconceptions about this disability parking placard application:

  • Only doctors can certify eligibility. Many healthcare professionals, including nurse practitioners and physician assistants, can complete the certification.
  • All disabilities qualify for a placard. Only specific disabilities that significantly impair mobility are eligible, as outlined in the form.
  • You can apply for a placard without medical documentation. A signed certification from a qualified healthcare provider is mandatory for processing the application.
  • The placard is permanent once issued. Placards can be temporary, depending on the individual's condition, and must be renewed or re-evaluated.
  • Economic need is a factor in eligibility. The application for free parking is based solely on medical conditions, not financial status.
  • Organizations can request unlimited placards. Each organization is limited to one placard per vehicle used for transporting clients.
  • Using a placard when not transporting the disabled person is allowed. The law requires that the disabled individual must either be driving or being transported in the vehicle.

These misconceptions can lead to confusion and potential issues with compliance. Understanding the requirements and limitations of the Bfs 108 Michigan form is essential for ensuring proper use of disability parking privileges.

Key takeaways

When filling out the Bfs 108 Michigan form for a disability parking placard, there are several important points to keep in mind. Here are key takeaways to ensure a smooth application process:

  • Complete All Required Sections: The form consists of multiple parts, including personal information, medical eligibility, and, if applicable, free parking certification. Make sure each section is filled out completely.
  • Medical Certification is Essential: Part 2 of the form must be completed by a qualified medical professional. This includes a physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant who can confirm your disability.
  • Accurate Information is Crucial: Ensure that all information provided is accurate and truthful. Any false statements can lead to penalties, including fines or imprisonment.
  • Submission Options: Completed applications can be submitted in person at any Secretary of State branch office or mailed to the designated address. Choose the option that is most convenient for you.
  • Free Parking Eligibility: If you believe you qualify for free parking, ensure that Part 3 is also completed by your physician. This section requires specific criteria to be met.
  • Understand the Penalties: Familiarize yourself with the penalties associated with misuse of a disability parking placard. Violations can result in significant fines or legal repercussions.
  • Contact for Assistance: If you have questions or need assistance while filling out the form, do not hesitate to contact the provided phone number for guidance.

By following these key takeaways, applicants can navigate the Bfs 108 Michigan form process with greater ease and confidence.