The Illinois Placard form is a document designed for individuals with disabilities, allowing them to apply for a parking placard that provides access to designated parking spaces. This form ensures that those who qualify can receive the necessary accommodations to facilitate their mobility. By completing this form, applicants affirm their eligibility based on medical conditions that limit their ability to walk or navigate typical parking situations.
The Illinois Placard form is an essential document for individuals seeking to obtain a parking placard designated for persons with disabilities. This form serves multiple purposes, including applications for new placards, renewals, and replacements for lost, stolen, or damaged placards. It is crucial to understand that the form is valid for a limited time—three months for temporary placards and six months for permanent placards—after the physician’s signature. The process requires comprehensive information, including details about the applicant, such as their name, date of birth, and Illinois driver’s license number. If the applicant is a minor, a parent or guardian must also provide their information and signature. Medical professionals play a vital role in certifying the applicant's disability, and their signature is necessary in multiple parts of the form. Additionally, specific conditions must be met for applicants seeking meter-exempt parking, which requires additional certification from a medical professional. Misuse of the placard can lead to significant penalties, including fines and revocation of driving privileges. Therefore, completing the form accurately and fully is essential for a smooth application process.
What is the Illinois Placard form used for?
The Illinois Placard form is used to apply for a Persons with Disabilities Parking Placard. This placard allows individuals with disabilities to park in designated spaces, ensuring they have easier access to facilities and services. The form must be completed by the applicant, and in the case of minors, by their parent or guardian, along with a medical professional's certification of the applicant's disability.
How long is the Illinois Placard valid?
The validity of the placard depends on the type issued. A Temporary Placard is valid for three months from the date of the medical professional's signature. In contrast, a Permanent Placard remains valid for six months. It is essential to renew the placard before it expires to continue using the designated parking privileges.
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. It is important to address this promptly to avoid any disruptions in your parking privileges.
Who needs to sign the Illinois Placard form?
The form requires signatures from multiple parties. The applicant must complete and sign Part 1, and if the applicant is a minor, a parent or legal guardian must complete and sign Part 2. Additionally, a medical professional must complete and sign Part 3, certifying the applicant's disability. If the applicant is seeking meter-exempt parking, Part 4 must also be completed by the medical professional.
Can I apply for a placard if I already have a disability license plate?
Yes, if you have a disability license plate, you must still complete the placard form and renew your placard. The placard provides additional parking benefits that the license plate alone does not cover. It is crucial to ensure that both the placard and the license plate are valid and renewed as necessary.
What are the consequences of misusing the disability parking placard?
Misusing the disability parking placard can lead to serious consequences. Violations 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 imperative to use the placard only when the person with a disability is either the driver or a passenger in the vehicle.
How do I submit my application for the placard?
Temporary Disabled Parking Placard applications can be submitted in person at any Secretary of State facility or mailed in. However, Permanent Disabled Parking Placard applications must be mailed to the Secretary of State, Persons with Disabilities Placard Unit, at 501 S. 2nd Street, Room 541, Springfield, IL 62756. Ensure all parts of the form are completed before submission to avoid delays.
Incomplete Information: Many applicants fail to fill out all required fields. Each section of the form must be fully completed to avoid delays.
Incorrect Signatures: Signatures are crucial. Applicants often forget to sign or have a parent/guardian sign when it is not required, leading to confusion.
Invalid Medical Professional Certification: The medical professional must be appropriately licensed. Using an unlicensed individual can invalidate the application.
Missing Supporting Documents: Applicants often neglect to include necessary documents, such as proof of military service for veterans, which is required for certain applications.
Failure to Check Eligibility: Some applicants do not verify if they meet the eligibility criteria for a disability placard, which can lead to unnecessary applications.
Incorrect Mailing Procedures: Permanent placard applications must be mailed to a specific address. Applicants sometimes send them to the wrong location, causing delays.
Ignoring Renewal Requirements: Individuals with existing placards often forget to renew their placards on time, which can lead to legal issues and fines.
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 #
Signature of Parent or Legal Guardian
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#)
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.
FOR SECRETARY OF STATE OFFICE USE ONLY
Parking Placard Number: ________________________________
Expiration Date: ______________________________________
Issued By: ___________________________________________
Issue Date: __________________________________________
When filling out the Illinois Placard form, it’s essential to approach the process with care. Here are some helpful tips on what you should and shouldn’t do:
By following these guidelines, you can help ensure a smoother application process and avoid potential issues down the line.
When applying for an Illinois Placard, there are several other forms and documents that may be necessary. Each serves a specific purpose in the application process or provides additional information regarding your eligibility. Below is a list of these important documents.
Understanding these forms and documents can help streamline your application process for the Illinois Placard. Make sure to gather all necessary paperwork to ensure a smooth experience. If you have questions, consider reaching out to your local Secretary of State facility for assistance.
Understanding the Illinois Placard form is essential for anyone applying for a disability parking placard. However, several misconceptions can lead to confusion. Here’s a list of ten common misunderstandings:
By understanding these misconceptions, applicants can navigate the process more effectively and ensure they meet all requirements for the Illinois Placard form.
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