The BFS 108 Michigan form is a Disability Parking Placard Application used by Michigan residents who have a qualifying disability. This document requests necessary personal and medical information to assess eligibility for a disability parking placard. It requires completion and certification from a healthcare professional and, if applicable, additional information for organizations providing transport services to individuals with disabilities. Need to apply for a disability parking placard? Click the button below to get started.
The BFS 108 Michigan form is a vital document for individuals and organizations in Michigan seeking to obtain disability parking placards. This form serves as an application for disability parking placards and includes sections for personal information, medical eligibility certification, and, if applicable, a request for free parking based on specific eligibility criteria. The Michigan Department of State mandates the completion of this form, with parts requiring accurate information from the applicant and a detailed medical certification from a healthcare provider, such as a physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant. The form contains guidelines on who qualifies for a disability placard, the criteria for free parking eligibility, and the application process for organizations providing transportation services for disabled persons. Penalties for misuse or fraudulent application are clearly outlined, emphasizing the importance of integrity in the application process. Furthermore, the form facilitates communication between applicants and the Michigan Department of State, ensuring that those with legitimate needs have access to parking accommodations that can significantly improve their quality of life.
MICHIGAN DEPARTMENT OF STATE
Disability Parking Placard Application
Office Use Only:
Expiration
Date:
Directions:
Applicants please complete and sign Part 1. Your physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant must complete Part 2 and the certification on the bottom of this page. If you also qualify for free parking, your physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant
must also complete Part 3. Organizations applying for parking placards to provide transportation services for disabled persons complete Part 4. Completed applications may be presented at any Secretary of State branch office or mailed to the address on the reverse side of this form.
(Application cannot be processed without signed release of information and physician’s certification)
Part 1: Release of Information and Signature
I am applying for a disability parking placard as provided in Public Act 300 of 1949. I authorize the release of the medical information described below to the Michigan Department of State. I certify the information is true and realize by making a false statement on this application I am subject to the penalties described on the reverse side of this form.
(Please print)
Name (First, Middle, Last)
Date of Birth
Michigan Drivers License or ID Card #
Street Address
County
Disability Plate Number (if any)
City, State, Zip
Daytime Phone Number
Last Parking Permit Number
(
)
Do you have a CDL endorsement?
If yes, do you have a medical
waiver?
Are you a Michigan resident?
YES
NO
NO
If yes, attach copy of waiver
Signature of Disabled Person
Date
X
Signature of Representative (If presented by representative)
Representative’s Driver License Number
Part 2: Medical Eligibility Standards and Physician’s Determination
The Michigan Vehicle Code [MCL 257.19a] states that a disabled person be determined by a licensed physician, physician’s assistant, chiropractor, nurse practitioner, or optometrist identifying one or more of the following characteristics which affect your patient’s ability to walk.
Circle all letters that apply
Right Eye:
Left Eye:
Both Eyes:
Visual field (in degrees):
a) Blindness. Corrected acuity level:
20/______
____________
b)An inability to walk more than 200 feet without having to stop and rest. Please provide the diagnosis for this ambulatory disability:_______________________________________________________________________________________
c)Patient must use a wheelchair, walker, crutch, brace, or other ambulatory aid to walk.
Describe:_______________________________________________________________________________________
d)Patient has a lung disease from which the forced expiratory volume for one second, when measured by spirometry, is less than one liter, or from which the arterial oxygen tension is less than 60mm/hg of room air at rest.
e)Patient has a cardiovascular condition which measures between 3 and 4 on the New York Heart Classification Scale, or which renders the patient incapable of meeting a minimum standard for cardiovascular health established by the American Heart Association and approved by the Michigan Department of Public Health.
f)Patient has an arthritic, neurological, or orthopedic condition that severely limits ability to walk.
Describe: _______________________________________________________________________________________
g)Patient has a persistent reliance upon an oxygen source other than ordinary air.
Physician’s Certification
A parking placard will be issued solely on the physician’s evaluation
Patient’s condition is: Permanent
Temporary
If temporary, estimated duration: ______months (maximum 6 months)
Physician’s Name
Medical Specialty
Office Telephone
Office Fax
I certify the person listed above is eligible for a disability placard as provided in Public Act 300 of 1949. I also understand that making a false statement to obtain a disability parking placard is a misdemeanor and may result in fines, imprisonment, or both.
Physician’s Signature
(Physician / Chiropractor / Physician’s Assistant / Optometrist / Nurse Practitioner)
Medical License Number *
*If the medical license was issued in a state other than Michigan, the physician must submit a copy of their medical license.
BFS-108 (05/13) NOTE: If the individual listed above is also eligible for free parking, Part 3 on the reverse side of this application must also be completed.
Part 3: Free Parking Application And Physician’s Certification
The free parking application is completed only when the applicant qualifies for free parking. To qualify, your patient must be a Michigan licensed driver, have an ambulatory disability described in Part 2, and also have one of the following conditions. Economic need is not a consideration.
Circle all letters that apply:
a)The patient cannot insert coins or tokens in a parking meter or cannot accept a ticket from a parking lot machine due to a lack of fine motor control of both hands.
b)The patient cannot reach above their head to a height of 42 inches from the ground, due to a lack of finger, hand, or upper extremity strength or mobility.
c)The patient cannot approach a parking meter due to use of a wheelchair or other ambulatory device.
d)The patient cannot walk more than twenty feet due to an orthopedic, cardiovascular, or lung condition in which the degree of debilitation is so severe that it almost completely impedes the patient’s ability to walk. (A condition requiring applicant to rest after walking twenty feet when not using a wheelchair or other ambulatory device.)
I certify the person listed on the front of this application is also eligible for free parking as provided in state law [MCL 257.675]. I under- stand that making a false statement to obtain a free parking sticker is a misdemeanor and may result in fines, imprisonment, or both.
Physician’s signature: X
_________________________________________________________________________________________________
Part 4: Organization Request For Disability Parking Placards
Name of Organization
Telephone Number
( )
Describe the transportation services your organization provides to persons with disabilities:
Number of disability placards you are requesting: ________ (No more then 1 per vehicle used to transport clients.)
I am applying for a disability parking placard as provided in Public Act 300 of 1949 and certify the above information is true.
Signature of Organization Officer
Printed Name of Organization Officer
Organization Officer’s Driver License Number
Position (Title) with Organization
Note: If the organization ceases to provide specialized services to disabled persons, the parking placard must be returned to the Secretary of State for cancellation.
__________________________________________________________________________________________________
Penalties
Michigan Vehicle Code Section 257.675 Prohibits:
●Using a disability parking placard to park in a designated parking space unless the disabled person is driving or being transported.
●Altering, modifying, or selling a disability parking placard or free parking sticker.
●Copying or forging, or using a copied or forged disability parking placard or free parking sticker.
●Making a false statement to obtain a disability parking placard or free parking sticker, or committing a deception or fraud on a medical statement attesting to a disability.
●Knowingly using or displaying a disability parking placard that has been canceled by the Secretary of State.
A violation is a misdemeanor and punishable by a fine up to $500 or imprisonment for up to 30 days, or both. A law enforcement officer may immediately confiscate a disability parking placard for improper use.
Return completed applications to any
Michigan Department of State
Secretary of State branch office or mail to:
Out-of-State Resident Services Unit
PO Box 30764
Lansing, MI 48918
If you have any questions regarding disability parking placards, please call 1-888-767-6424.
Authority granted under Pubic Act 300 of 1949, as amended.
Filling out the BFS 108 Michigan form is essential for individuals seeking a disability parking placard in Michigan. This form must be completed accurately to ensure compliance with the Michigan Department of State's requirements. The process involves sections that must be filled out by the applicant and part of it by a certified health professional. Here are the steps to correctly complete the form:
Once all relevant parts of the BFS 108 Michigan form are completed, it can be submitted to any Secretary of State branch office in Michigan or mailed to the address provided on the form. The form provides individuals and organizations the ability to apply for the necessary disability parking placards in compliance with state regulations. Complete accuracy and honesty in application are paramount to avoid any legal repercussions.
The BFS-108 form is an application for a disability parking placard in Michigan. It allows individuals with specific disabilities to apply for a placard that permits parking in designated disability parking spaces. The form is also used by organizations that provide transportation services to disabled persons, allowing them to apply for parking placards.
Eligibility for a disability parking placard includes individuals who have one or more of the following conditions as certified by a licensed physician, physician's assistant, chiropractor, nurse practitioner, or optometrist:
To apply for the disability parking placard, the applicant must complete Part 1 of the BFS-108 form, and a medical professional must complete Part 2, certifying the disability. If applicable, Part 3 must be filled out to apply for free parking. Organizations must complete Part 4 for their placards. The completed form can then be submitted to any Secretary of State branch office or mailed to the specified address on the form.
Yes, temporary disability parking placards are available for individuals with temporary disabilities. The medical professional certifying the application will indicate whether the condition is permanent or temporary and, if temporary, the estimated duration of the condition (up to a maximum of 6 months).
To qualify for free parking, the applicant must have an ambulatory disability (as certified in Part 2 of the form) and meet one of the additional conditions listed in Part 3. These conditions include the inability to insert coins into parking meters due to fine motor control loss, inability to reach or operate parking equipment, or severe mobility impairments that restrict the individual's capacity to access parking meters.
If there's a change in the disability status or if a placard is lost, stolen, or no longer needed, the individual or organization must notify the Michigan Department of State. If the placard is no longer required, it should be returned to the Secretary of State for cancellation to avoid misuse or potential penalties.
Penalties for misuse of a disability parking placard include fines up to $500, imprisonment for up to 30 days, or both. Misuses include parking in a disability space without the disabled person present, altering or selling placards, using a placard that has been canceled, or making false statements to obtain a placard. Law enforcement may confiscate placards if they're found to be misused.
Filling out the BFS 108 Michigan form, which is required for obtaining a disability parking placard, presents several common pitfalls that can lead to the rejection or delay of an application. Understanding these mistakes is essential to streamline the application process and ensure applicants receive their necessary accommodations without unnecessary hurdles.
Not thoroughly completing Part 1: A frequent mistake is leaving sections of Part 1 incomplete. This part of the form requires personal information, including the applicant's name, date of birth, driver's license or ID card number, and contact details. It's crucial that every field is filled out accurately. Neglecting to provide complete information, such as the Michigan Driver’s License or ID Card #, can result in the application being returned or delayed.
Omitting the signature of the disabled person or representative: Another common error is failing to sign the application. The signature of the disabled person or their representative at the bottom of Part 1 is mandatory for the application to be processed. This signature is a form of consent, authorizing the release of medical information to the Michigan Department of State and certifying the truthfulness of the information provided.
Inadequate details in Part 2 regarding the medical condition: Part 2 of the form must be completed by a licensed physician, physician’s assistant, chiropractor, nurse practitioner, or optometrist. Applicants sometimes submit forms with vague or insufficient details about the medical eligibility standards and the physician’s determination. Specific details about how the applicant's condition affects their ability to walk, along with clear certification of the disability's permanence or temporary nature, are required for the reviewing committee to make an informed decision.
Overlooking Part 3 for applicants eligible for free parking: Often, applicants who qualify for free parking due to severe mobility impairments miss completing Part 3. This section is critical for those who have significant difficulties with parking meters or machines due to their condition. Ensuring that the healthcare provider accurately identifies and circles the applicable conditions and signs the certification is essential for applicants to avail of the free parking benefit.
Applicants and healthcare providers must pay close attention to the specifics when completing the BFS 108 Michigan form. Accurate completion of all sections, providing detailed descriptions of the disability, and including all necessary signatures are fundamental steps in receiving a disability parking placard. By avoiding these mistakes, applicants can help ensure their applications are processed efficiently and without unnecessary delays.
When dealing with disability accessibility and legal documentation in Michigan, understanding the array of forms and documents that complement the BFS 108 Michigan form is crucial. This comprehensive guide explores several essential forms often used alongside the BFS 108 form to facilitate smoother processes for individuals seeking disability accommodations.
Each document plays a pivotal role in ensuring individuals with disabilities receive the appropriate accommodations and support. Whether it's applying for a driver's license, verifying a medical condition, or requesting a hearing, these forms collectively work to streamline the process and uphold the rights of individuals with disabilities in Michigan.
The BFS 108 Michigan form, designed for Disability Parking Placard Applications, is inherently detailed to cater to those with varying degrees of mobility challenges. This form is foundational in providing individuals and organizations the necessary certification for disability parking, underscoring its importance in promoting accessibility and compliance with state laws.
One document similar to the BFS 108 Michigan form is the ADA Application for Parking Placard/License Plate available in many states. Both documents serve a crucial role in identifying individuals with disabilities and granting them special parking privileges. The similarity extends to the need for medical certification to validate the disability claim, ensuring that the privileges are granted to those genuinely in need. The ADA forms, much like the BFS 108, often require detailed personal information, a physician's certification, and sometimes, additional specifics regarding the nature and extent of the disability. Such forms are pivotal in ensuring that the process of allocating parking privileges is both fair and regulated.
Another document that shares similarities with the BFS 108 form is the Application for Disabled Person Parking Permit used in many jurisdictions. Like the BFS 108, this application typically necessitates detailed personal information, the signature of a healthcare provider to verify the disability, and an outline of the criteria that qualify an individual for the permit. The structure of these documents underscores a universal approach to assessing and identifying the needs of individuals with disabilities, aiming to provide them with the necessary accommodations to enhance their mobility and quality of life.
Each document, while similar in purpose to the BFS 108 Michigan form, is tailored to meet the legal and procedural requirements specific to its jurisdiction. These forms collectively reflect a broader commitment to accessibility and support for individuals with disabilities, ensuring they have the necessary means to navigate public spaces with dignity and ease.
Filling out the BFS 108 Michigan form for a disability parking placard requires careful attention to detail and an understanding of the application process. To ensure your application is processed smoothly and without delay, here are some dos and don'ts to keep in mind:
Do:
Don't:
By following these dos and don'ts, you can help ensure that your application for a disability parking placard in Michigan is completed correctly and processed in a timely manner. Remember to consult the Michigan Department of State or call the provided helpline if you have any questions or require assistance with your application.
Understanding the BFS 108 Michigan form, specifically regarding disability parking placards, is crucial for those applying. However, misconceptions can lead to confusion. Here are four common misunderstandings about the form and its requirements:
Clearing up these misconceptions can ease the application process for a disability parking placard in Michigan, ensuring applicants provide all necessary information accurately and according to state guidelines.
Filling out and using the BFS-108 form for a Michigan disability parking placard requires understanding several key aspects to ensure proper completion and adherence to the state's regulations. Here are four critical takeaways:
Proper completion and submission of the BFS-108 form to the Michigan Department of State, along with adherence to the guidelines and legal requirements, ensure that individuals and organizations providing for persons with disabilities can obtain and use parking placards effectively and within the bounds of the law.
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