The Mv 145A form is an application for a parking placard designated for individuals with disabilities. This form allows eligible applicants to request a permanent or temporary placard, ensuring they have access to designated parking spaces. It is crucial to complete this form accurately to avoid delays in receiving your placard; fill it out by clicking the button below.
The MV-145A form serves as the application for a Person with Disability Parking Placard in Pennsylvania. This form allows individuals with disabilities to request a parking placard that grants them access to designated parking spaces, ensuring greater mobility and accessibility. It includes options for original requests, renewals, replacements, and changes of address or name. Applicants must provide personal information, including the name and address of the person with a disability, and must indicate the type of placard they are applying for—permanent, temporary, or for severely disabled veterans. A health care provider must certify the applicant’s disability, confirming that it falls within the specified eligibility requirements. This form also emphasizes the importance of accurate information, as any alterations or forgeries can result in severe penalties. By completing the MV-145A, individuals can secure their right to convenient parking, which is essential for maintaining independence and access to essential services.
MV-145A (6-25)
PERSON WITH DISABILITY PARKING PLACARD APPLICATION NO FEE REQUIRED SEE REVERSE SIDE FOR INSTRUCTIONS AND ELIGIBILITY REQUIREMENTS
(The space above is for Department use only)
Bureau of Motor Vehicles • P.O. Box 68268 • Harrisburg, PA 17106-8268
CHECK ( 4) APPROPRIATE BLOCKS BELOW
qORIGINAL REQUEST - q Permanent Placard q Severely Disabled Veteran q Temporary Placard
qRENEWAL REQUEST - (For Permanent Placards Only)
q REPLACEMENT REQUEST - q PLACARD q ID CARD q Defaced q Lost q Stolen q Never Received PREVIOUS PLACARD # ______________________
qCHANGE OF ADDRESS - Complete Sections A and E.
qCHANGE OF NAME - Complete Sections A and E. Check here to indicate reason for change of name: q Marriage q Divorce q Other: ______________________
APERSON WITH DISABILITY INFORMATION - LIST NAME AND ADDRESS OF PERSON WITH DISABILITY - NOTE: If listing an out-of-state address, you must also complete and attach Form MV-8.
Last Name (or Full Business Name)
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
or Bus. ID#
Street Address
City
State
Zip Code
Email Address
NOTE: If you are the parent or adult charged by law with the natural parent’s rights, duties and responsibilities acting on behalf of a minor child (under 18) in place of the child’s natural parents (person in
loco-parentis), you must complete the information below. In addition, a parent, including an adoptive or foster parent who has custody care or control of the child or adult child or a spouse may sign on
behalf of the child, adult child or spouse (applicant) provided the applicant meets eligibility requirements (1) through (8).
Name of Parent, Person in Loco Parentis or Spouse
Relationship to Applicant
CERTIFICATION FROM A HEALTH CARE PROVIDER LICENSED OR CERTIFIED IN PA OR A CONTIGUOUS STATE (NEW YORK, NEW JERSEY, DELAWARE, MARYLAND, WEST VIRGINIA OR
B
OHIO). THIS SECTION MUST BE COMPLETED IN FULL. HEALTH CARE PROVIDERS MAY ONLY CERTIFY DISABILITIES WITHIN THEIR SCOPE OF PRACTICE. WARNING: Altering or forging a
document issued by the Department, such as a disabled person parking placard, or possessing, using or displaying such a document knowing it to have been altered, forged or counterfeited,
is a misdemeanor of the first degree pursuant to the Vehicle Code, 75 Pa.C.S. Section 7122, punishable by a fine of not more than $10,000 or imprisonment of not more than five years, or both.
I hereby certify that the person with the disability listed above is under my care and has the following condition listed on the reverse side of this
UNCORRECTED
application under “Eligibility Requirements”: _______________
(NOTE: Only those conditions listed on the reverse side of this application qualify
R
20/
List Reason Code # Here
an applicant for a person with disability placard.)
L
NOTE: If reason code #1 is listed above, please indicate the individual's visual acuity by completing the chart to the right:
If reason code #4 is listed above, please indicate the type of device used: ________________________________________________
CORRECTED
Temporary placards are only issued for a period of time not to exceed six months. If the applicant requires additional time after the expiration of
the placard issued, the applicant must be recertified by a health care provider.
Health Care Provider’s Printed Name
Health Care Provider’s Signature
Medical License No.
Office Street Address
Telephone Number
(
)
C
CERTIFICATION BY POLICE OFFICER - Police officer may only certify that the applicant does not have full use of a leg or both legs, or is blind.
NOTE: If Section B above is completed, please skip this Section and go on to Section E.
This is to certify that the person with disability listed above has the condition listed and is entitled to the use and privileges of the person with disability
parking placard.
q is blind, OR does not have full use of a leg or both legs as evidenced by the use of a: q wheelchair
q walker
q crutches
q cane/quad cane
q other prescribed device
Officer’s Printed Name
Officer’s Signature
Badge Number
D
CERTIFICATION FROM U.S. DEPARTMENT OF VETERANS AFFAIRS REGIONAL OFFICE ADMINISTRATOR (PHILADELPHIA OR PITTSBURGH)
OR SERVICE UNIT IN WHICH THE VETERAN SERVED OR A LEGIBLE PHOTOCOPY OF THE APPLICANT'S LETTER OF PROMULGATION,
AWARDS LETTER, SINGLE NOTIFICATION, OR SUMMARY OF BENEFITS LETTER.
q
This is to certify that the veteran listed above with VA number ___________________________, has a 100% service-connected disability or has the
following service connected disability reason code number _______, listed on the reverse side of this application under “Eligibility Requirements.”
NOTE: If reason code #4 is listed, please indicate the type of device used: __________________________.
Authorized Printed Name and Title: ____________________________________________ Authorized Signature: ____________________________________________
In lieu of the U.S. Department of Veterans Affairs Regional Office Administrator certification, I have attached a legible photocopy of my Letter of
Promulgation, Awards Letter, Single Notification Letter, or Summary of Benefits Letter that indicates I have a 100% service-connected disability.
E
UNSWORN DECLARATION AND APPLICANT SIGNATURE - Person with disability, natural parent or other authorized person listed in Section A must sign below.
I/We declare under penalty of perjury under the law of the Commonwealth of Pennsylvania, that the foregoing is true and correct, and that application was made for the above product or that the items as indicated were never received in the mail. Furthermore, I/we state that I/we have read and signed this application after its completion, and I/we swear or affirm that the statements made herein are true and correct, and that any statement made on or pursuant to this application is subject to the penalties of 18 Pa.C.S. Section 4904 (relating to unsworn falsification), which include criminal prosecution and a term of imprisonment, the maximum of which may be one year [18 Pa.C.S. 4904(b)], or up to two years[18 Pa.C.S. 4904(a)]. In addition to any other penalty, a person convicted under this section shall be sentenced to pay a fine of at least $1,000 [18 Pa.C.S. 4904(d)].
Signed on the _____ day of _______________, ___________________ at ________________________________________, _________________________.
(county or other location, and state)
(country)
Printed Name of Person with Disability
Person with Disability/Loco Parentis Signature
THIS APPLICATION MAY BE DUPLICATED
INSTRUCTIONS
1.Permanent Placard - Complete Sections A, B or C (NOT BOTH) and E. NOTE: Individuals should list their PA Driver’s License (PA DL) or Photo ID# in the space provided. Businesses should list their Business ID# (Bus. ID) where indicated (i.e. E.I.N.).
2.Severely Disabled Veteran Placard - Complete Sections A, D and E.
3.Temporary Placard - Complete Sections A, B and E. NOTE: Only licensed health care providers* may certify disabilities for temporary placards. Temporary placards may be issued for a period up to six months and may not be extended for an additional period of time. When additional time is needed, a new application must be completed and certified by a health care provider. In addition, please list your previous placard number.
4.Renewal Request - Complete Sections A and E.
5.Replacement Request - Indicate if applying for a replacement placard or ID card. Please check reason for replacement; Lost, Stolen, Defaced or Never Received. List your previous placard number and complete Sections A and E. NOTE: If product was not received within 90 days, please check the "Never Received" box or if product was not received for over 90 days please check the "Lost" box.
6.Change of Address - Complete Sections A and E.
7.Change of Name - Complete Sections A and E. Check the block on the front of this application to indicate reason for change of name.
*Health Care Provider is defined as a physician, chiropractor, optometrist, podiatrist, physician assistant, or a certified registered nurse practitioner licensed or certified in Pennsylvania or a contiguous state. Health care providers may only certify disabilities within their scope of practice.
NOTE: Customers with a permanent placard have the option to renew their placard, request a replacement placard or change the address their placard online at https://www.placard.penndot.pa.gov/PlacardWeb/public/external/placardLogin.xhtml or scan the QR code on the front of this application.
Placard Type
Eligibility Requirements
Qualifying Vehicles
Benefits
Person with Disability Placard
“Reason Codes”
Applicant:
(1)is blind.
(2)does not have full use of an arm or both arms.
(3)cannot walk 200 feet without stopping to rest.
(4)cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair or other assistive device.
(5)is restricted by lung disease to such an extent that the person’s forced (respiratory) expiratory volume for one second, when measured by spirometry, is less than one liter or the arterial oxygen tension is less than 60 MM/HG on room air at rest.
(6)uses portable oxygen.
(7)has a cardiac condition to the extent that the person’s functional limitations are classified in severity as Class III or Class IV according to the standards set by the American Heart Association.
(8)is severely limited in their ability to walk due to an arthritic, neurological or orthopedic condition.
NOTE: If you are the parent or adult charged by law with the natural parent’s rights, duties, and responsibilities, acting on behalf of a minor child (under 18) in place of the child’s natural parents (person in loco-parentis), complete the appropriate information on the front side of this application.
In addition, a parent, including an adoptive or foster parent who has custody, care, or control of the child or adult child or a spouse, may sign on behalf of the child, adult child, or spouse (applicant) provided the person with disability meets eligibility requirements (1) through (8).
(1)The placard is required to be displayed when the vehicle is parked in areas designated for use by persons with disability only and must not be displayed when the vehicle is being operated on the highway.
NOTE: Organizations that operate a passenger vehicle to transport persons with disabilities must supply the Department with the following:
a)A notarized statement of how the placard will be used and the type of services that will be provided.
b)The weekly or monthly number of hours that the services are provided.
c)The make of the vehicle(s), including the title number, vehicle identification number and registration plate number. The vehicle(s) must be titled in the name of the organization and must be a passenger vehicle.
d)The number of placards required: (Organizations may not be issued more than eight placards in the organization’s name.)
(1)Parking permitted in spaces designated for disabled persons and for 60 minutes in excess of legal parking period except where local ordinances or police regulations provide for the accommodation
of heavy traffic during morning, afternoon or evening hours.
(2)Upon request of a person with disability, local authorities may erect on the highway as close as possible to the person’s residence a sign(s) indicating that the place is reserved for the person with disability, that no one else may park there unless a person with disability plate or placard is displayed and that any unauthorized person parking there will be subject to a fine.
Severely
Disabled
Veteran
Placard
(1)100% service-connected disability certified by the U.S. Department of Veterans Affairs (Pittsburgh or Philadelphia) or service unit in which the veteran served or as shown on the applicant’s Letter of Promulgation, Awards Letter, Single Notification Letter, or Summary of Benefits Letter.
(2)Same disabilities as listed above for Person with Disability Placard but must be service-connected.
Same as 1 and 2 above for Person with Disability Placard.
Same as above for Person with Disability Placard.
Use of Person with Disability and Severely Disabled Veteran Placards:
. Parking in a designated persons with disability parking space is only permitted with this parking placard when the vehicle is being used for the transportation of the person for which the parking placard was issued.
. Any vehicle lawfully displaying a parking placard will qualify for parking in areas designated only for use by persons with a disability. NOTE: This parking placard can not be used to park where parking is prohibited.
Send completed application to: PennDOT, Bureau of Motor Vehicles, P.O. Box 68268, Harrisburg, PA 17106-8268
Visit us at www.pa.gov/dmv or call us at 717-412-5300. TTY callers — please dial 711 to reach us.
Completing the MV-145A form is an important step in applying for a parking placard for individuals with disabilities. This form requires specific information to ensure the application is processed correctly. Follow these steps carefully to fill out the form accurately.
After submitting the application, you can expect to receive a response from the Department of Motor Vehicles. If approved, you will receive your placard in the mail, allowing you to utilize designated parking spaces for individuals with disabilities.
What is the MV-145A form?
The MV-145A form is an application for a Person with Disability Parking Placard in Pennsylvania. It allows eligible individuals to obtain a placard that grants them special parking privileges. This form can be used for original requests, renewals, replacements, and changes of address or name.
Who is eligible to apply for a disability parking placard?
Eligibility is determined by specific criteria. Applicants must have a qualifying disability as defined by the state. This includes being blind, having limited use of limbs, or having conditions that significantly impair mobility. A healthcare provider must certify the disability for the application to be valid.
How do I apply for a temporary placard?
To apply for a temporary placard, complete Sections A, B, and E of the MV-145A form. A licensed healthcare provider must certify your disability. Temporary placards are valid for up to six months and cannot be extended. If you need additional time, a new application must be submitted.
What should I do if my placard is lost or stolen?
If your placard is lost or stolen, you must submit a replacement request on the MV-145A form. Indicate whether the placard was lost, stolen, defaced, or never received. Be sure to complete Sections A and E and provide your previous placard number.
Can someone else apply for a placard on my behalf?
Yes, a parent, spouse, or authorized person can apply on your behalf if they have the legal rights and responsibilities to do so. They must complete the necessary sections of the form and provide their relationship to you.
Is there a fee for the MV-145A application?
No, there is no fee required to submit the MV-145A form. This makes it easier for individuals with disabilities to obtain the necessary parking privileges without financial burden.
How long does it take to receive the placard after submitting the application?
The processing time can vary, but you should expect to receive your placard within a few weeks after your application is submitted. If you do not receive it within 90 days, you may need to check the status of your application.
Where should I send my completed MV-145A form?
Once completed, send your MV-145A form to the PennDOT Bureau of Motor Vehicles at P.O. Box 68268, Harrisburg, PA 17106-8268. For more information, you can also visit their website or call their office directly.
Completing the MV-145A form can be a straightforward process, but many individuals encounter common pitfalls that can delay their application or result in denial. One significant mistake is failing to provide complete and accurate personal information. Applicants must ensure that all fields, including the name, address, and identification numbers, are filled out correctly. Missing or incorrect information can lead to processing delays.
Another frequent error is neglecting to include the required certification from a health care provider. This section must be completed in full, and only licensed professionals can certify disabilities. Without this certification, the application cannot be processed. It is essential to check that the health care provider’s information is legible and that the signature is present.
Many applicants also forget to indicate the type of placard they are requesting. The form offers options for permanent, temporary, or replacement placards, and selecting the appropriate type is crucial. Failure to do so can result in confusion and may require the applicant to resubmit the form.
In addition, some individuals do not check the eligibility requirements carefully. Each type of placard has specific criteria that must be met. Misunderstanding these requirements can lead to submitting an application that does not meet the necessary standards, resulting in denial.
Another common mistake involves the renewal process. Applicants often forget to provide their previous placard number when renewing a permanent placard. This oversight can complicate the renewal process and may lead to additional delays.
Additionally, when changing an address or name, individuals sometimes fail to complete all required sections. It is vital to ensure that both Sections A and E are filled out when making these changes. Omitting information can lead to complications in updating records.
Finally, many applicants overlook the importance of signing the application. The signature is a critical component that confirms the accuracy of the information provided. An unsigned application will not be processed, leading to unnecessary delays and frustration.
The MV-145A form is used to apply for a parking placard for persons with disabilities in Pennsylvania. Along with this form, several other documents may be required or useful in the application process. The following is a list of four commonly associated forms and documents.
Each of these documents plays a critical role in ensuring that the application process is thorough and compliant with the necessary regulations. Proper completion and submission of all required forms can help facilitate a smoother application experience.
When filling out the MV-145A form, consider the following guidelines:
There are several misconceptions surrounding the MV-145A form, which is used to apply for a person with a disability parking placard in Pennsylvania. Here’s a breakdown of ten common misunderstandings:
Understanding these misconceptions can help ensure that individuals correctly navigate the application process for disability parking placards. Always refer to the official instructions for the most accurate and updated information.
Here are key takeaways regarding the MV-145A form for a person with a disability parking placard: