Free Illinois Placard Template

Free Illinois Placard Template

The Illinois Placard form serves as an essential tool for individuals with disabilities, facilitating their access to designated parking spaces. It ensures that persons who meet specific medical criteria can obtain either a temporary or permanent placard, based on their physician's certification. By streamlining the application process for parking placards and license plates for drivers with disabilities, the form seeks to improve mobility and quality of life for these individuals. If you are in need of such a placard, consider filling out the form by clicking the button below.

Open Illinois Placard Editor

In the State of Illinois, the Secretary of State oversees the issuance of parking placards for persons with disabilities, a critical resource for enhancing mobility and accessibility. The Illinois Placard form, designed for both new applicants and those seeking renewals, encompasses a comprehensive procedure aimed at verifying the eligibility of individuals based on medical criteria. It necessitates detailed input from the applicant, a healthcare professional's certification, and, in cases involving minors, a guardian's acknowledgment. Besides aiding in the application for temporary and permanent disability parking placards, the form cater to those applying for meter-exempt parking, thereby accommodating a wider range of disabilities and needs. Importantly, the form underscores the legal implications of misuse or falsification of information, highlighting fines and potential revocation of driving privileges as deterrents. Furthermore, the form addresses veterans by offering them an avenue to submit proof of service. This structured approach reflects a blend of regulatory thoroughness and sensitivity to the varied needs of individuals with disabilities, ensuring that the benefits are reserved for those genuinely in need. The prescribed process, which includes mailing the application for permanent placards and the possibility of in-person submissions for temporary ones, showcases the state's commitment to accessibility while maintaining integrity and oversight in the issuance of such critical aids.

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 Properties

Fact Detail
Applicable Law The form adheres to the Illinois Compiled Statutes (625 ILCS 5/1-159.1), setting forth requirements for the issuance of Disability Parking Placards.
Placard Validity Temporary Placards are valid for three months from the physician’s signature date, while Permanent Placards are valid for six months.
Form Submission Applications for Temporary Disabled Parking Placards can be taken to any Secretary of State facility or mailed in. Applications for Permanent Disabled Parking Placards must be mailed to the specified address.
Medical Certification A licensed physician, advanced practiced nurse, optometrist, chiropractor, or physician’s assistant must certify the applicant's disability. For meter-exempt parking, additional certification is required.

Detailed Guide for Filling Out Illinois Placard

Filling out the Illinois Placard form is a straightforward process aimed at ensuring that individuals who meet the necessary criteria are provided with the accessibility they require. This procedure assists in making mobility and parking more manageable for those with disabilities. Careful attention to detail when completing this form will help in avoiding delays. Here's how to correctly fill out the form:

  1. Begin with Part 1: Enter the full name of the person with the disability. If the applicant is a minor, remember that Part 2 must also be completed.
  2. Check the appropriate box indicating the gender of the person with the disability and enter their date of birth.
  3. Provide a valid Illinois driver's license or ID card number of the applicant.
  4. Input the Illinois address of the person with the disability, including apartment or unit number if applicable, followed by the city, and ZIP code.
  5. If the mailing address differs from the above, enter the alternate address.
  6. Add a telephone number and an email address for future communications.
  7. If the applicant is a military veteran, mark 'Yes' and remember to attach a copy of the DD214 showing proof of service.
  8. The person with the disability (or parent/legal guardian if the person is a minor) must sign and date the form to validate the certification.
  9. Move to Part 2 if the applicant is a minor. Here, the parent or legal guardian certifies responsibility for transportation. Fill out the name and relationship to the person with the disability and repeat the process of providing a valid Illinois driver’s license or ID card number, address, and contact information.
  10. The parent or legal guardian also needs to sign and date the form.
  11. In Part 3, to be filled out by the applicant’s medical professional, begin with checking the appropriate box to indicate the length and type of disability.
  12. Check all conditions that apply to the person with the disability’s movement limitations.
  13. If applicable, provide a diagnosis from the list provided or specify another medical condition impacting the person’s mobility.
  14. The medical professional must then print their name, specify their specialty, and provide their office address, including city, state, and ZIP code.
  15. The medical professional needs to sign the form, provide their state professional license number, today's date, and if necessary, the signature and license number of a collaborating or supervising physician.
  16. For those applying for meter-exempt parking, Part 4 must be completed. It requires checking the specific condition that qualifies the applicant for this exemption.
  17. Again, the medical professional must sign, date the form, and provide their license number, along with the collaborating or supervising physician's signature and license number if applicable.
  18. Review the entire form to ensure all parts are completed accurately. Remember, temporary placard applications can be taken to any Secretary of State facility, while permanent placard applications must be mailed to the specified address in Springfield, IL.

After submission, the application will be reviewed, and if approved, the placard will be issued. It's essential to keep a copy of the form for records and follow up if necessary. Accuracy and completeness are crucial to facilitate a smooth processing experience.

Listed Questions and Answers

  1. Who is eligible to apply for a Persons with Disabilities Parking Placard in Illinois?

    Eligibility for a Persons with Disabilities Parking Placard in Illinois includes individuals who meet one of the medical eligibility criteria outlined by state law. This includes persons who cannot walk 200 feet without stopping to rest, use a portable oxygen device, have a Class III or IV cardiac condition, are severely limited in their ability to walk due to a neurological, orthopedic, arthritic, or oncological condition, or have another listed disability that affects their mobility. Both temporary and permanent disabilities are considered.

  2. How does one apply for a parking placard?

    To apply, complete the Persons with Disabilities Certification for Parking Placard form, ensuring both sides are fully completed. The applicant must fill out Section 1, and if the applicant is a minor, a parent or guardian must complete Section 2. A medical professional has to certify the disability in Section 3, and if meter-exempt parking is needed, Section 4 must also be completed. For a temporary disabled parking placard, you can either visit any Secretary of State facility or mail your application in. However, applications for permanent disabled parking placards must be mailed to the designated address.

  3. What must be included with the parking placard application?

    Accompanying the application must be certification from a licensed medical professional verifying the nature and extent of the applicant's disability. If the applicant is a military veteran, a copy of their DD214 showing proof of service should be included if applicable. Ensure all personal identification information is correctly provided, along with a valid Illinois driver's license or ID card number.

  4. Can someone with a disability license plate also need a placard?

    Yes, individuals who have a disability license plate are still required to apply for and renew their parking placard by completing the necessary form. This ensures their right to use designated parking spaces even when not driving a vehicle with the disability license plate.

  5. Is there a fee for the parking placard?

    The information provided does not specify a fee for applying for or renewing a parking placard. Typically, such programs are provided free of charge, but it is advisable to check the latest updates on the Secretary of State's website or contact their office directly for the most accurate information.

  6. How long is the parking placard valid?

    A temporary parking placard is valid for up to six months from the physician's signature date. A permanent parking placard validity period is not explicitly mentioned but will generally have a longer validity period, subject to renewal requirements.

  7. What are the consequences of misuse or false application?

    Misuse of the disability parking placard or plates, or making a false application, can lead to severe penalties, including the revocation of the placard, a 12-month suspension or revocation of the driver's license, and a fine of up to $1,000.

  8. Are there special provisions for meter-exempt parking?

    Yes, individuals with specific permanent medical conditions or disabilities that severely limit their mobility and ability to use parking meters are eligible for meter-exempt parking. This requires separate certification by a medical professional that the individual meets one of the specific conditions listed in the application form.

  9. What should be done if a valid placard is lost, stolen, or damaged?

    If a valid parking placard is lost, stolen, or damaged, one must use the replacement form VSD 415. This form is available online at cyberdriveillinois.com or at a local Secretary of State facility. Completing this form as soon as possible will ensure the continued right to use designated parking spaces.

Common mistakes

Filling out the Illinois Placard form might seem straightforward, but there are common missteps that can lead to delays or even rejection of your application. By being aware of these errors, applicants can ensure a smoother process.

  1. Not completing both sides of the document: The form requires thorough completion, including the signatures on both sides. Many applicants miss filling out the back side which includes crucial medical professional certification.

  2. Incomplete or missing information: Every field on the form needs to be filled out. This includes selecting the type of disability and the medical professional providing a comprehensive diagnosis. Leaving fields blank or providing incomplete details can stall the application process.

  3. Overlooking the meter-exempt parking section: For those who qualify for meter-exempt parking due to their disability, missing the completion of Part 4 is a common error. This section is crucial for those who need this accommodation, and not filling it out can mean missing out on necessary benefits.

  4. Forgetting to include necessary documentation: If you're a military veteran, the application requires a copy of your DD214 as proof of service. Omitting this document can delay the processing of your placard application.

By avoiding these common mistakes, applicants can help ensure their application is completed accurately, which in turn, helps expedite the issuing process. Detailed attention to every part of the form and providing all required documentation upfront will significantly smooth the path to receiving your Illinois Disability Placard.

Documents used along the form

When applying for an Illinois Disabled Parking Placard, individuals may find themselves navigating through a variety of documents and forms, either as prerequisites or as part of supplemental processes. These documents often are crucial for confirming eligibility, ensuring that all legal and procedural requirements are appropriately met. Understanding each document’s purpose can simplify the application process.

  • Physician’s Statement for Disabled Person's Parking Placard/Form: This document is a detailed statement from a licensed medical professional that certifies the applicant's disability status, describing the nature and extent of the disability. It’s imperative as it provides the necessary medical validation for the application.
  • Proof of Illinois Residency: Applicants may need to provide a document verifying their Illinois residence, such as a utility bill, lease agreement, or bank statement with their current address. This confirms that the applicant is a resident of Illinois and thus eligible for a state-issued placard.
  • Copy of State ID or Driver’s License: A photocopy of a valid Illinois driver's license or state identification card is required to prove the applicant’s identity and state residency. This ensures that the placard is issued to the rightful applicant.
  • VSD 415 - Replacement Form: If an individual's valid placard is lost, stolen, or damaged, they must use this specific form to apply for a replacement. It’s a critical form for those seeking to maintain their access to disabled parking amenities without interruption.
  • DD214 Form for Military Veterans: Veterans may need to submit a copy of their DD214 form to show proof of service, which can be particularly pertinent if they are applying for benefits or accommodations due to disabilities sustained during service.

Each of these documents plays a unique role in the application process for an Illinois Disabled Parking Placard. From establishing eligibility and identity to verifying the specific needs based on disability, they collectively ensure that the process is thorough and accessible. Understanding the importance of each can help applicants efficiently navigate the process, ultimately aiding in securing the necessary accommodations to improve their quality of life.

Similar forms

  • The Replacement for Lost, Stolen, or Damaged Parking Placard Form (VSD 415) shares similar features to the Illinois Placard form in its purpose of addressing the needs of individuals with disabilities. While the VSD 415 form specifically caters to the replacement of already issued placards, it complements the initial application or renewal process outlined in the standard placard form by ensuring continuity in the provision of parking privileges to people with disabilities.

  • The Application for Disability License Plates bears resemblance to the Illinois Placard form, as both entail the provision of parking accommodations based on medical certifications of disability. The primary variance rests in the type of accommodation sought – one applies for a placard to be displayed in a vehicle, while the other is for the issuance of special license plates. Both, however, necessitate a verification of disability status by a healthcare provider.

  • The Medical Certification for Persons with Disabilities closely aligns with the Illinois Placard form, especially in the sections requiring medical professional input. This document underscores the necessity for a medical authority to certify the nature and extent of one's disability, a process pivotal in both applications to ensure that only eligible individuals receive the intended benefits.

  • Similar in its administrative process, the Temporary Disabled Parking Placard Application, a component explicitly mentioned within the broader Illinois Placard form, serves individuals with temporary disabilities. The similarity lies in the submission procedure and the requirement for medical certification, albeit this document is targeted at a specific duration and category of disability, emphasizing the temporary nature of the applicants’ conditions.

  • The Meter-Exempt Parking Application, akin to the Illinois Placard form, especially part 4, offers a distinctive accommodation by focusing on individuals who cannot feasibly use parking meters due to their disabilities. This document parallels the meter-exempt section of the placard form, both necessitating certification from a medical professional regarding the applicant's inability to operate or access standard parking meter mechanisms due to physical impairments.

Dos and Don'ts

When dealing with the Illinois Placard form, particular steps should be followed to ensure that the application process is smooth and free from errors. The form is an essential document for individuals with disabilities seeking parking accommodations, so careful attention to detail is crucial. Here are six dos and don'ts to consider:

  • Do ensure that all fields in the form are completed accurately. Incomplete forms may lead to delays in processing or rejection of the application.
  • Do check that the medical professional completes and signs Part 3 of the form, which is mandatory for verifying the applicant's disability status.
  • Do remember to sign the form in the designated areas, as an unsigned form is considered incomplete and will not be processed.
  • Don't forget to include a copy of your DD214 if you are a military veteran. This documentation is crucial for validating your status.
  • Don't use the form for parking placard renewal or replacement. A different form (VSD 415) should be used for those purposes.
  • Don't overlook the warning about misuse of the disability parking placard. It's vital to understand the legal implications of incorrect use, which can result in severe penalties.

Taking these do's and don'ts into account will aid in the hassle-free completion and submission of the Illinois Placard form, facilitating a smoother process for obtaining the necessary parking accommodations for persons with disabilities.

Misconceptions

The Illinois Placard form is a crucial document for persons with disabilities seeking parking accommodations in Illinois. However, several misconceptions surrounding the form and its application process can lead to confusion. Here's a look at 10 common misunderstandings:

  1. It's often believed that the form is only for permanent disabilities. In reality, both temporary and permanent disability placards are available, catering to the varying needs of individuals with disabilities.

  2. Many think that renewing a placard is automatic. However, renewal requires completing the form again to ensure all information is current and accurate.

  3. A common misconception is that you can use someone else's placard if they are not in the car. The law clearly states that the placard can only be used if the person with the disability is driving or being transported in the vehicle.

  4. Some believe all disabilities qualify for meter-exempt parking. The truth is, meter-exempt eligibility is strict and based on specific criteria, such as severe mobility limitations or the inability to operate parking meters due to lack of fine motor control.

  5. There's a false idea that any medical professional can sign the form. Only licensed physicians, advanced practice nurses, optometrists, chiropractors, or physician’s assistants can certify the disability and the need for a parking placard.

  6. A prevalent misunderstanding is that the application process is long and cumbersome. While thorough, the process is designed to be as straightforward as possible, especially with the clear directions provided on the form itself.

  7. Some assume that temporary placards are valid for an arbitrary time period. The form specifies that temporary placards are valid for a maximum of six months, based on the medical professional’s certification of the disability's expected duration.

  8. There's also a misconception that having a disability license plate negates the need for a placard. In fact, individuals with a disability license plate must still complete the form to obtain a placard, providing flexibility for using different vehicles.

  9. Another false belief is that applicants need to visit a Secretary of State facility in person. While this is true for temporary placards, permanent placard applications can be mailed to the address provided on the form.

  10. Lastly, many think the form only asks for basic personal and disability information. However, it also includes provisions for meter-exempt parking and requires detailed certification from a medical professional, ensuring a comprehensive evaluation of the applicant's needs.

Understanding these common misconceptions helps in demystifying the process of obtaining a parking placard in Illinois, making it more accessible for those who truly need it.

Key takeaways

When filling out and utilizing the Illinois Placard form for Persons with Disabilities Certification for Parking, it's crucial to be aware of several key aspects to ensure the process is completed accurately and efficiently. Here are ten essential takeaways:

  • There are different categories for placard applications: new applicants, renewals, and replacements for lost, stolen, or damaged placards. Each of these has specific instructions and requirements.
  • The form's validity is contingent upon the medical professional's signature date—three months for a Temporary Placard and six months for a Permanent Placard.
  • For those with disability license plates, completing and renewing the form is mandatory to maintain the placard.
  • Completing all fields in the application is required, including information about the applicant and the medical certification.
  • If the applicant is a minor, a parent or legal guardian must also provide information and sign the form.
  • Applicants must certify that they meet the definition of a person with disabilities according to Illinois Compiled Statutes and acknowledge that the placard can only be used when they are the driver or a passenger in the vehicle.
  • Military veterans are asked to provide a copy of their DD214 form as proof of service.
  • The application highlights the importance of submitting the form correctly; temporary placard applications can be submitted in-person or via mail, but permanent placard applications must be mailed.
  • Medical professionals must verify the applicant's disability, and for meter-exempt parking, specific criteria related to the disability's impact on mobility and the ability to use parking meters or ticket machines must be met.
  • The misuse of disability parking placards or making false applications can lead to severe consequences, including revocation of the placard, suspension or revocation of the driver's license, and a fine of up to $1,000.

Understanding these key points can help applicants navigate the process seamlessly, ensuring they receive the support and resources entitled to them under the law.

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