APPLICATION FOR DISABLED PERSON PLACARD OR PLATES

IMPORTANT INFORMATION, DISCLOSURES AND CERTIFICATIONS

Use this form to apply for a disabled person (DP) parking placard or license plates. Complete this form legibly in ink. Illegible, incomplete, and/or unsigned forms will be returned. Use an Application for Replacement Plates, Stickers, and Documents form (REG 156) to request replacement of a lost, stolen, or damaged placard or plates. Attention Disabled Veterans with a service-connected disability: You may be eligible for Disabled Veteran License Plates which exempts one vehicle from the payment of registration and license fees. Medical certification or documentation from a county veterans service officer, the Department of Veterans Affairs, or the United States Department of Veterans Affairs that certifies that the applicant is a disabled veteran as described in California Vehicle Code (CVC) §295.7, along with a completed DMV REG 256 A form is required. Visit dmv.ca.gov or call 1-800-777-0133 for forms and additional information.

ELIGIBILITY

You may qualify for a DP parking placard or license plates if you have impaired mobility due to having lost use of one or more lower extremities, both hands, have a diagnosed disease that substantially impairs or interferes with mobility, or if you are unable to move without the aid of an assistive device. You may also qualify if you have specific, documented visual problems, including lower-vision or partial-sightedness, or specific cardiovascular or respiratory illnesses. (CVC §§295.5, 5007, 22511.55)

APPROPRIATE USE OF YOUR DP PLACARD/PLATES

With your valid DP placard or plates, you may park (CVC §22511.5):

• In parking spaces with the wheelchair symbol.

• Next to a blue or green curb for an unlimited period.

• In an area requiring a resident or merchant permit.

• In any on-street metered parking space at no charge.

You do not have to own or drive the vehicle to use the placard. You will receive a placard identification (ID) card with your placard. This ID card identifies you as the placard owner and must be kept with you at all times whenever the placard is in use. (CVC §4461)

Additionally:

• You must present ID and the placard ID card upon request of a peace officer or a person authorized to enforce parking laws. (CVC §§5007, 22511.56) Your DP placard cannot be loaned to anyone, including family members or friends, even if that person is also disabled. (CVC §4461)

• Your DP placard cannot be loaned to anyone, including family members or friends, even if that person is also disabled. (CVC §4461)

• DP parking placard abuse and misuse can result in the confiscation and cancellation of the placard. (CVC §22511.56)

• DP plates and/or parking placard(s) must be surrendered to DMV within 60 days of the death of the disabled person. (CVC §§5007, 22511.55)

IT IS ILLEGAL - Punishable by fine, imprisonment or both fine and imprisonment (CVC §§22511.55, 22511.56, 22511.57, 22511.6)

• To alter, forge, or counterfeit a DP parking placard or placard ID card.

• To provide false information to obtain a DP parking placard or plates.

• To allow someone to use your DP parking placard if you are not in the vehicle. For an individual to have more than one permanent DP parking placard.

• For an individual to have more than one permanent DP parking placard.

• To forge a medical provider's signature.

• To possess or display a counterfeit DP parking placard.

The court may also impose a civil penalty if a person attempts to pass, acquires, possesses, sells, or attempts to sell a genuine or counterfeit placard or if a person displays, with fraudulent intent, or causes or permits to be displayed, a forged, counterfeit, or false placard. (CVC §4463)

PRIVACY NOTICE

DMV uses personal information only for the specified purposes, or purposes consistent with those purposes, unless DMV obtains your consent, or unless authorized by law or regulation.

• CVC §§5007, 22511.55, 22511.58 allows any information contained in this application, including the medical provider substantiation, to be made available to local public law enforcement or the local agencies responsible for the enforcement of parking regulations.

• CVC §1825(a) allows DMV to share information with appropriate regulatory boards to conduct audits of the DP parking placard/plates program. DMV's Privacy Policy is located at dmv.ca.gov under the "Privacy Policy" link at the bottom of the page.

SECTION 1: APPLICANT OR ORGANIZATION INFORMATION (Proof of Legal Name/Birthdate)

California law requires applicants to provide a copy of proof of their legal name and date of birth. A valid driver license (DL) or identification (ID) card is acceptable, or any document necessary to apply for a California DL or ID card. Visit dmv.ca.gov for a list of acceptable documents.

SECTION 2: TYPE OF DISABLED PERSON PARKING PLACARD(S) OR LICENSE PLATES

Temporary DP parking placard:

For temporary disabilities. Valid for up to 180 days or the date noted by your qualifying licensed medical professional, whichever timeframe is less. This placard cannot be renewed more than six times consecutively.

Permanent DP parking placard:

For permanent disabilities. Valid for two years and expires on June 30 of every odd-numbered year. You will receive two automatic renewals, covering a 4-year period. Your third renewal will require you to reapply; a new certification is not required.

Disabled DP plates:

For permanent disabilities. Can only be assigned to vehicles registered in the name of the qualified person.

DP Plates Reassignment:

For existing DP plates to be reassigned to a different vehicle.

Travel DP parking placard:

For California residents who currently have DP Permanent parking placard or plates, or Disabled Veteran License Plates, but not both. For nonresidents who plan to travel in California and have a permanent disability and/or DP plates.

SECTION 3: DISABLED PERSON LICENSE PLATES APPLICANTS ONLY: VEHICLE INFORMATION

DP license plates may be issued for any vehicle or motorcycle registered to a qualified person or an organization involved in the transportation of disabled persons if the vehicle is used solely for the purpose of transporting those persons (CVC §5007, 22511.55). One commercial vehicle with an unladen weight of 8,001 pounds or less registered to a qualified person may be exempt from payment of weight fees (CVC §9410).

SECTIONS 5 AND 6: MEDICAL PROVIDER'S CERTIFICATION, INFORMATION, AND SIGNATURE

If the disability is related to items 4-8 in Section 6, a complete and legible description of the Illness or disability must be provided in Section 6A with enough information to meet state law certification requirements. Descriptions that only contain abbreviations (i.e., "R60.9") or only list symptoms (e.g., "trouble walking") require further explanation. A licensed physician, surgeon, physician assistant, nurse practitioner, or certified nurse-midwife, may certify to items 2-8, a licensed chiropractor may certify to items 6-8 only, a licensed podiatrist may certify to a disability related to the foot or ankle, and a licensed physician or surgeon who specializes in diseases of the eye or a licensed optometrist may only certify to item 1. The medical provider's signature may be compared to documentation filed with the appropriate regulatory agency and the medical provider may be contacted regarding this application.

Completed applications can be submitted in person or by mail. Important! California law requires applicants to provide a copy of their driver's license, identification card, or other proof of their legal name/birthdate with this completed application.

In Person: Visit a DMV field office . No appoinment needed.
Online: virtual.dmv.ca.gov
Mail To: DMV placard
P.o. Box 997600 M/S D238
Sacramento, CA 95899-7600

IMPORTANT! Applicants must provide a copy of acceptable proof of their legal name and date of birth, such as a valid driver's license or identification card, with this application, or the application will be rejected. Only original signatures will be accepted, no photocopies or faxes. Form must be legible and completed in ink. Any alterations, crossovers, or whiteouts (including changes with initials) will void this form. Incomplete applications delay processing and will be returned.

SECTION 1-APPLICANT OR ORGANIZATION INFORMATION (Enclose Proof of Legal Name/Birthdate)

SECTION 2-TYPE OF DISABLED PERSON PARKING PLACARD(S) OR LICENSE PLATES (Check all that apply.)

SECTION 3 - DISABLED PERSON LICENSE PLATES APPLICANTS ONLY: VEHICLE INFORMATION

For organizations – the plated vehicle is used exclusively for transporting disabled persons.

Commercial Vehicles - Weight Fee Exemption. I am requesting an exemption from weight fees for the vehicle described above. It weighs less than 8,001 pounds unladen. I understand that this exemption may be used for ONE commercial vehicle only and I do not have this exemption for any other vehicles I own.

Yes
No

SECTION 4 - APPLICANT OR ORGANIZATION REPRESENTATIVE'S CERTIFICATION AND SIGNATURE

I certify that I have read the "Important Information, Disclosures, and Certifications" on page one and I fully understand and take responsibility for the use of the Disabled Person Parking Placard and/or License Plates that are issued to me. I also certify that I am a disabled person per California Vehicle Code (CVC) §295.5 or that I am an authorized representative of the organization involved in the transportation of disabled persons and the vehicle is used for the purpose of transporting those persons per CVC §§5007(a)(3), 22511.55(a)(4). I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

SECTION 5 - APPLICANT OR ORGANIZATION REPRESENTATIVE'S CERTIFICATION AND SIGNATURE

SECTION 6-MEDICAL PROVIDER'S CERTIFICATION OF DISABILITY (Print patient name in space provided below.)

My patient,    suffers from the condition(s) below and, pursuant to CVC §295.5, is eligible for a:

SECTION 6A-DESCRIPTION OF ILLNESS OR DISABILITY (Not Symptoms) AS NOTED IN 4-8 ABOVE

DMV USE ONLY

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