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Outline

The Illinois Placard form is an essential document designed for individuals with disabilities seeking parking accommodations. This form facilitates the issuance of a Persons with Disabilities Parking Placard, which allows eligible individuals to park in designated spaces. Applicants can either be new or renewing their placard, and specific procedures must be followed depending on their situation. For instance, if a placard is lost, stolen, or damaged, a replacement form must be utilized instead. The placard is valid for a limited time, with temporary placards lasting three months and permanent ones lasting six months from the date a physician signs the form. Importantly, the form requires comprehensive information, including the applicant's details, a certification from a medical professional, and, if applicable, the involvement of a parent or guardian for minors. Each section of the form must be completed accurately to ensure timely processing. Additionally, there are strict guidelines regarding the misuse of the placard, emphasizing the importance of adhering to the rules to avoid penalties. Understanding the requirements and procedures of the Illinois Placard form is crucial for individuals seeking the necessary accommodations to enhance their mobility and access.

Sample - Illinois Placard Form

State of Illinois Secretary of State 501 S. 2nd Street Springfield, IL 62756

NNEW APPLICANT

NRENEWAL

*If your valid placard was lost/stolen/damaged,

use replacement form VSD 415,

available online at cyberdriveillinois.com or visit your local Secretary of State facility.

Persons with Disabilities Certification for Parking Placard

*This form is valid for three months from your physician’s signature date for a Temporary Placard and six months for a Permanent Placard.

NOTE TO DISABILITY LICENSE PLATE OWNERS: If you have a disability license plate, you MUST complete the form and renew your placard.

DIRECTIONS: Both sides of this document must be signed and completed fully. All fields are required.

Applicants complete Part 1. If the applicant is a MINOR, then Parent/Guardian(s) MUST also complete Part 2. The applicant’s medical profes- sional MUST complete Part 3. If the applicant is applying for meter-exempt parking, his/her medical professional MUST also complete Part 4.

Part 1: Applicant Information (MUST have a valid Illinois driver’s license and/or ID card)

I hereby certify that I meet the definition of a person with a disability as provided in 625 ILCS 5/1-159.1, and I certify that my physical condition entitles me to the issuance of a Persons with Disabilities Parking Placard. By affixing my signature below, I understand that the parking placard may not be used unless I am the driver or passenger of the vehicle.

*If a military veteran, please provide a copy of your DD214 showing proof of service.

 

 

 

 

 

 

 

 

Disability Parking Placard # (if any)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full Name of Person with Disability (If Minor, complete Part 2 also.)

 

 

 

 

 

Male/Female

 

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Valid Illinois Driver’s License or ID Card # of Applicant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Illinois Address

Apt/Unit #

City

 

 

 

 

 

IL

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address if Different from Above

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

Email Address

 

 

 

 

Military Veteran? Yes / No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Person with Disability

 

 

 

 

 

 

 

Today’s Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 2: For Parent or Legal Guardian (MUST have a valid Illinois driver’s license and/or ID card)

I hereby certify that the above applicant is a minor and I have primary responsibility for his/her transportation. By affixing my signature below, I understand that the disability placard is issued to the person with disability and may not be used unless I am transporting the disabled person in the vehicle.

Name of Parent or Legal Guardian

 

 

Relationship to Person with Disability

 

 

 

 

 

 

 

Valid Illinois Driver’s License or ID Card #

 

 

 

 

 

 

 

 

 

 

 

 

 

Illinois Address

Apt/Unit #

City

 

 

IL

ZIP

 

 

 

 

 

 

 

Telephone Number

Email Address

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Parent or Legal Guardian

 

 

 

Today’s Date

 

 

 

 

 

 

 

Warning: Any misuse of the disability parking placard/plates or making a false application may result in the revocation of the placard, a 12- month suspension or revocation of your driver’s license, and a fine of up to $1,000.

Temporary Disabled Parking Placard Applications — May be taken to any Secretary of State facility or mailed in. Permanent Disabled Parking Placard Applications MUST be mailed to the following address:

Secretary of State, Persons with Disabilities Placard Unit, 501 S. 2nd Street, Room 541, Springfield, IL 62756.

*If you have a permanent disability placard and would like a Persons with Disabilities License Plate, please visit your local Secretary of State facility to apply. You will need your permanent placard number and current plate number or VIN.

Please complete Page 2 to ensure timely processing.

Printed by authority of the State of Illinois. July 2021 — 1 — VSD 62.28

Part 3: Medical Eligibility Standards and Medical Professional Certification

As the medical professional(s) executing this document and verifying the nature of the applicant’s disability, I understand that making a false representation of a person’s disability for the purposes of obtaining any type of disabled parking placard may result in suspension or revocation of my license and a fine of up to $1,000. As a licensed physician, advanced practiced nurse, optometrist, chiropractor or physician’s assistant, I certify the applicant has a condition that constitutes him/her as a person with disabilities.

Length of Disability: (Check one)

NTemporary Disability; the duration of this disability is ________________________(maximum 6 months)

NPermanent Disability

NMeter-Exempt Disability (Must complete and sign Part 4 also.)

Check all that apply: (MUST check at least one):

NIs restricted by a lung disease to such a degree that the person’s forced (respiratory) expiratory volume (FEV) for 1 second, when measured by spirometry, is less than 1 liter.

NUses a portable oxygen device.

NHas Class III or Class IV cardiac condition according to the standards set by the American Heart Association.

NCannot walk without the use of or assistance from a wheelchair, a walker, a crutch, a brace, a prosthetic device, or another person.

NIs severely limited in the ability to walk due to an arthritic, neurological, oncological, or orthopedic condition.

NCannot walk 200 feet without stopping to rest because of one of the above five conditions.

Check all that apply: (MUST check at least one diagnosis):

 

 

N Amputation of extremity(s) _________________________

N Arthritis of the ______________________________________

N Spina Bifida

N Osteoarthritis of the

_________________________________

N Multiple Sclerosis

N Chronic Pain due to

_________________________________

N Quadriplegia/Paraplegia

N Legally Blind with limited mobility

NCerebral Palsy

NOther Diagnosis: _________________________________________________________________________________________

If none of the above conditions apply, list the medical condition that impacts the person’s mobility.

Medical Professional’s Printed Name

Specialty

 

 

 

 

Office Address

City, State, ZIP

 

 

 

 

Medical Professional’s Signature

State Professional License Number (NOT NPI#)

Today’s Date

 

 

 

Signature of Collaborating/ Supervising Physician (if signed above by resident/assistant)

Supervising State Professional License Number

 

 

 

 

Part 4: Medical Eligibility for Meter-Exempt Parking

The meter-exempt parking certification must be completed only when the applicant qualifies. To qualify, the applicant MUST have a VALID Illinois driver’s license, have an ambulatory disability described in Part 3, and also have one of the following conditions listed below.

Economic need is not a consideration for meter-exempt parking.

The applicant is eligible for meter-exempt parking as provided by statue due to the following PERMANENT medical condition or disability:

Check all that apply:

NCannot manage, manipulate or insert coins, or obtain tickets in parking meters/ticket machines due to lack of fine motor control of BOTH hands.

NCannot reach above his/her head to a height of 42 inches from the ground due to a lack of finger, hand or upper-extremity strength or mobility.

NCannot approach a parking meter due to his/her use of a wheelchair or other device for mobility.

NCannot walk more than 20 feet due to an orthopedic, neurological, cardiovascular or lung condition in which the degree of debilitation is so severe that it almost completely impedes the ability to walk.

NMissing a hand(s) or arm(s) or has permanently lost the use of a hand or arm.

NPatient is under 18 years of age and incapable of driving.

Medical Professional’s Signature

State Professional License Number (NOT NPI#)

Today’s Date

Signature of Collaborating/ Supervising Physician (if signed above by resident/assistant)

Supervising State Professional License Number

FOR SECRETARY OF STATE OFFICE USE ONLY

Parking Placard Number: ________________________________

Expiration Date: ______________________________________

Issued By: ___________________________________________

Issue Date: __________________________________________

Form Information

Fact Name Description
Governing Law The Illinois Placard form is governed by 625 ILCS 5/1-159.1.
Application Types Applicants can apply for a new placard or a renewal of an existing one.
Replacement Form If a placard is lost, stolen, or damaged, a replacement form (VSD 415) must be used.
Validity Period A Temporary Placard is valid for three months; a Permanent Placard is valid for six months.
Minor Applicants For applicants who are minors, a Parent or Guardian must complete a separate section of the form.
Medical Professional Signature A licensed medical professional must certify the applicant's disability on the form.
Meter-Exempt Parking Additional certification is required for applicants seeking meter-exempt parking privileges.
Misuse Consequences Misuse of the placard can lead to revocation, fines up to $1,000, and suspension of the driver’s license.
Application Submission Temporary applications can be submitted in person or by mail; Permanent applications must be mailed.
Veteran Status Military veterans must provide a copy of their DD214 to confirm their service when applying.

Detailed Guide for Filling Out Illinois Placard

Filling out the Illinois Placard form requires attention to detail and accuracy. Once you have completed the form, you can submit it to the appropriate office, either in person or by mail, depending on whether you are applying for a temporary or permanent placard. Below are the steps to guide you through the process of filling out the form correctly.

  1. Obtain the Form: Download the Illinois Placard form from the Secretary of State's website or pick up a physical copy at your local Secretary of State facility.
  2. Determine Your Status: Indicate whether you are a new applicant or renewing an existing placard at the top of the form.
  3. Complete Part 1: Fill in your personal information, including your full name, date of birth, and address. Ensure you provide a valid Illinois driver’s license or ID card number.
  4. Sign the Form: Sign and date the form in the designated area, confirming that you meet the criteria for a disability placard.
  5. For Minors: If the applicant is a minor, a parent or legal guardian must complete Part 2. They will need to provide their own information and sign the form as well.
  6. Medical Professional Certification: Have a licensed medical professional complete Part 3. They will need to certify your disability and provide their professional details.
  7. Meter-Exempt Parking: If you are applying for meter-exempt parking, ensure the medical professional also completes Part 4, confirming your eligibility.
  8. Review Your Form: Double-check all sections to ensure that every field is filled out accurately and completely.
  9. Submit the Form: Depending on whether you are applying for a temporary or permanent placard, either take the completed form to a Secretary of State facility or mail it to the specified address.

Obtain Answers on Illinois Placard

  1. What is the Illinois Placard form?

    The Illinois Placard form is a document that individuals with disabilities must complete to obtain a parking placard. This placard allows eligible individuals to park in designated spaces, providing easier access to various locations. The form must be filled out accurately and submitted to the appropriate authorities to ensure compliance with state regulations.

  2. Who is eligible to apply for a parking placard?

    Individuals with disabilities that significantly impair their mobility may apply for a parking placard. To qualify, applicants must have a valid Illinois driver’s license or ID card and meet specific medical criteria outlined in the form. If the applicant is a minor, a parent or legal guardian must also complete part of the application.

  3. How long is the placard valid?

    The validity of the placard depends on its type. A temporary placard is valid for three months from the date of the physician's signature, while a permanent placard remains valid for six months. It is essential to renew the placard before its expiration to continue enjoying the benefits it provides.

  4. What should I do if my placard is lost, stolen, or damaged?

    If your valid placard is lost, stolen, or damaged, you must use the replacement form VSD 415. This form is available online at cyberdriveillinois.com or can be obtained at your local Secretary of State facility. Prompt action is recommended to avoid any inconvenience.

  5. What are the consequences of misusing the placard?

    Misuse of the disability parking placard can lead to serious consequences. Such actions may result in the revocation of the placard, a 12-month suspension or revocation of your driver’s license, and a fine of up to $1,000. It is crucial to use the placard only as intended to avoid these penalties.

  6. Where should I submit my application for a permanent disabled parking placard?

    Applications for a permanent disabled parking placard must be mailed to the following address: Secretary of State, Persons with Disabilities Placard Unit, 501 S. 2nd Street, Room 541, Springfield, IL 62756. Ensure that all sections of the form are completed before mailing to facilitate timely processing.

  7. Can I apply for a meter-exempt parking placard?

    Yes, you can apply for a meter-exempt parking placard if you meet specific criteria outlined in the form. This certification must be completed by your medical professional and requires that you have a valid Illinois driver’s license and a qualifying ambulatory disability. It is essential to check the relevant boxes on the form to indicate your eligibility.

Common mistakes

Filling out the Illinois Placard form can be straightforward, but many applicants make common mistakes that can delay the process or lead to complications. Here are eight mistakes to avoid.

One frequent error is neglecting to complete both sides of the form. All fields are required, and missing information can result in rejection. Ensure every section is filled out completely. This includes verifying that both the applicant and, if applicable, the parent or guardian sign the document.

Another common mistake involves not providing accurate personal information. Applicants must ensure that their full name, address, and contact details are correct. Double-checking this information can prevent unnecessary delays in receiving the placard.

People often forget to include their valid Illinois driver’s license or ID card number. This number is essential for processing the application. Without it, the form may be deemed incomplete.

Some applicants mistakenly assume that only one medical professional's signature is required. If the applicant is applying for meter-exempt parking, the medical professional must complete Part 4 as well. Failing to do so can lead to a denial of that specific request.

Misunderstanding the definition of a disability can also lead to mistakes. Applicants should carefully review the eligibility criteria outlined in Part 3 of the form. If the medical professional does not check at least one condition, the application may be rejected.

Another error is not providing the necessary documentation for military veterans. If the applicant is a veteran, including a copy of the DD214 is crucial. This documentation serves as proof of service and is required for processing the application.

Some people overlook the importance of the medical professional's signature. The application cannot be processed without this signature, as it certifies the applicant's disability. Ensure that this is completed accurately to avoid delays.

Lastly, applicants sometimes fail to pay attention to the submission process. Temporary placard applications can be submitted in person or by mail, while permanent placard applications must be mailed. Knowing the correct procedure is vital for timely processing.

By avoiding these common mistakes, applicants can streamline their experience and increase the likelihood of a smooth application process for their Illinois Placard.

Documents used along the form

The Illinois Placard form is an essential document for individuals with disabilities seeking parking privileges. Alongside this form, several other documents may be required or helpful in the application process. Below is a list of these documents, each serving a specific purpose to support the application for a parking placard.

  • VSD 415 Replacement Form - This form is used when a valid placard has been lost, stolen, or damaged. It is available online and can be submitted to the Secretary of State's office for a replacement.
  • Medical Professional Certification - This document is completed by the applicant’s healthcare provider to certify the applicant's disability. It outlines the nature and duration of the disability, ensuring that the applicant meets the necessary criteria.
  • DD214 Form - Veterans applying for a placard may need to provide this form as proof of military service. It helps establish eligibility for certain benefits related to disability parking.
  • Application for Meter-Exempt Parking - If the applicant qualifies for meter-exempt parking, this additional certification must be completed. It details specific conditions that justify the need for exemption from parking meter fees.
  • Proof of Identity - A valid Illinois driver’s license or ID card is required to verify the identity of the applicant. This ensures that the placard is issued to the correct individual.

Having these documents ready can streamline the application process and ensure compliance with state regulations. Each form plays a vital role in supporting the applicant's need for disability parking privileges.

Similar forms

The Illinois Placard form shares similarities with several other documents that serve to certify eligibility for disability-related services or benefits. Below are four such documents:

  • Disability License Plate Application: Like the Illinois Placard form, this application requires proof of a qualifying disability and is used to obtain special parking privileges. Both forms necessitate medical certification and must be completed by the applicant or their guardian.
  • Temporary Disability Parking Permit Application: This document is similar in that it provides temporary parking privileges for individuals with disabilities. Both require medical verification and have specific time limits for validity based on the applicant's condition.
  • Social Security Administration Disability Benefits Application: This application also requires detailed medical information to establish eligibility for benefits. Both forms aim to assist individuals with disabilities and necessitate documentation from medical professionals regarding the applicant's condition.
  • Medicaid Disability Determination Form: This form is used to assess eligibility for Medicaid based on disability. Similar to the Illinois Placard form, it requires medical documentation and is designed to support individuals with disabilities in accessing necessary services and benefits.

Dos and Don'ts

When filling out the Illinois Placard form, it is essential to follow specific guidelines to ensure a smooth application process. Here are five things you should and shouldn't do:

  • Do ensure all required fields are completed. Every section of the form must be filled out accurately. Missing information can lead to delays.
  • Don't forget to sign the form. Both the applicant and, if applicable, the parent or guardian must provide their signatures. This step is crucial for validation.
  • Do provide accurate medical information. The medical professional must certify the applicant’s disability clearly and completely. This certification is vital for approval.
  • Don't submit the form without a valid ID. Applicants must have a valid Illinois driver’s license or ID card. This is a requirement for processing the application.
  • Do check for any additional documentation. If the applicant is a military veteran, include a copy of the DD214. This can expedite the application process.

By following these guidelines, applicants can help ensure their forms are processed efficiently and accurately. Taking the time to double-check the application can save significant frustration later on.

Misconceptions

Understanding the Illinois Placard form is essential for individuals seeking assistance with parking due to disabilities. However, several misconceptions can lead to confusion. Here are nine common misunderstandings:

  • Temporary placards are valid indefinitely. Many believe that temporary placards last longer than their designated three-month validity period. In reality, they must be renewed after this timeframe.
  • Only the applicant can use the placard. Some individuals think that anyone can use the placard as long as they are in the vehicle. However, the placard is only valid when the person with the disability is a driver or passenger.
  • All medical professionals can certify disabilities. It's a common misconception that any doctor can sign off on the placard application. Only licensed physicians, advanced practice nurses, and specific other professionals are authorized to certify disabilities.
  • Renewals are optional if you have a disability license plate. Many assume that having a disability license plate means they do not need to renew their placard. In fact, both must be renewed to maintain compliance.
  • There are no penalties for misuse. Some believe that misusing the placard has no consequences. Misuse can lead to serious penalties, including fines and revocation of driving privileges.
  • Meter-exempt parking is available for everyone. A common misunderstanding is that all disabled individuals qualify for meter-exempt parking. This is not true; specific medical conditions must be met for this benefit.
  • Application forms can be submitted anywhere. Many think they can submit their permanent placard applications at any Secretary of State facility. However, these must be mailed to a specific address for processing.
  • Only the applicant needs to sign the form. Some people believe that only the individual applying for the placard needs to sign. If the applicant is a minor, a parent or guardian must also sign the form.
  • All disabilities are automatically recognized. There is a belief that any disability qualifies for a placard. In reality, specific medical criteria must be met, and a qualified professional must certify the condition.

By clarifying these misconceptions, individuals can navigate the application process more effectively and ensure they are following the necessary guidelines. Understanding the requirements and responsibilities associated with the Illinois Placard form is vital for both applicants and their families.

Key takeaways

  • When applying for an Illinois Placard, ensure that you have a valid Illinois driver’s license or ID card. This is a requirement for both the applicant and any parent or guardian involved.

  • The form is divided into several parts, and all fields must be completed fully. Missing information can delay the processing of your application.

  • Temporary placards are valid for three months from the date of the physician's signature, while permanent placards are valid for six months.

  • If you are a minor, a parent or legal guardian must also complete a section of the form, certifying their responsibility for your transportation.

  • Medical professionals must certify the applicant’s disability. This includes checking specific conditions that qualify the applicant for a disability placard.

  • Be aware that misuse of the placard can lead to serious consequences, including fines up to $1,000 and potential revocation of driving privileges.

  • Applications for temporary placards can be submitted in person at any Secretary of State facility or mailed in, while permanent placard applications must be sent to a specific address in Springfield.

  • If you have a permanent disability placard and wish to obtain a disability license plate, visit your local Secretary of State facility with your placard number and vehicle information.

  • For any lost, stolen, or damaged placards, a replacement form (VSD 415) is available online or at local Secretary of State facilities.