The DL-43 form is a key document used to apply for or renew a Pennsylvania driver's license for individuals with disabilities. This form ensures that those eligible can receive the necessary accommodations to drive safely. For a smooth application process, consider filling out the form by clicking the button below.
The DL-43 form, an essential document within the realm of contract management, serves a significant role in facilitating the collection of information regarding federal procurements. This form is specifically designed to ensure transparency and accountability in the procurement process, allowing government agencies to streamline their operations while adhering to federal regulations. By collecting diverse data points, such as contractor details, contract performance metrics, and compliance with various mandates, the DL-43 form supports effective decision-making and oversight. It promotes a standardized approach that benefits both the government and its contractors, fostering a relationship built on mutual understanding and cooperation. As organizations navigate the complexities of government contracts, the DL-43 form emerges as a vital tool that not only simplifies reporting requirements but also enhances the integrity of the contracting process. Understanding its purpose and proper use is paramount for stakeholders seeking to optimize their engagement with federal procurement initiatives.
APPLICATION FOR RENEWAL/REPLACEMENT/CHANGE
(Replacement also called Duplicate)
OF A TEXAS DRIVER LICENSE OR IDENTIFICATION CARD
DL or ID NUMBER
APPLICANT INFORMATION
CONTACT INFORMATION
LAST NAME:
HOME PHONE:
FIRST NAME:
OTHER PHONE:
MIDDLE NAME:
EMAIL:
SUFFIX:
ADDRESS INFORMATION
MAIDEN NAME:
RESIDENCE ADDRESS:
DATE OF BIRTH (mm/dd/yyyy):
—
CITY:
STATE:
SSN:
ZIP CODE:
COUNTY:
SEX: (Mark One)
MALE
FEMALE
WEIGHT: lbs.
MAILING ADDRESS:
EYE COLOR:
HEIGHT: ft.
in.
RACE/ETHNICITY:
(I)
American Indian/Alaska
Native
(A) Asian/Pacific Islander
(B) Black (H) Hispanic (O) Other
(W) White
INFORMATION FORM (ALL APPLICANTS please answer questions 1 through 10)
1. YES NO
Are you a citizen of the United States?
2.
If you are a US citizen, would you like to register to vote? If registered, would you like to update your voter information?
By providing my electronic signature, I understand the personal information on my application form and my electronic signature will be used for submitting
my voter’s registration application to the Texas Secretary of State’s office. Wanting to register to vote, I authorize the Department of Public Safety to
3.
transfer this information to the Texas Secretary of State.
Do you wish to donate $1.00 to the Blindness Education Screening and Treatment Program?
4.
Do you want to support the Glenda Dawson Donate Life Texas donor registry? If yes, please indicate a donation amount of $1 or more $
.00
5.
Would you like to register as an organ donor?
6.
Do you want to support survivors of sexual assault? If yes, please indicate a donation amount of $1 or more $
.00 to help fund the testing
7.
of sexual assault evidence collection kits (rape kits).
Do you want to support Texas Veterans?
If yes, please indicate your donation amount $
8.
Do you have a health condition that may impede communication with a peace officer? If yes, please list
9.
(physician must complete form DL-101 prior to the issuance of a DL/ID).
a) Do you want a Veteran designator on your driver license or identification card?
(proof of Honorable discharge required; acceptable documents
b)
are DD214/5, NGB22, VA disability letter, proof of service/verification of honorable service card)
10.
Are you a 60% disabled Veteran receiving compensation and want to waive the application fee? (see 9a for documents required)
In the event of injury or death would you like to provide two (2) emergency contacts? If yes, please list:
a)
Name
Telephone Number
Address
For all Driver License Renewals complete MEDICAL questions 11 to 17. Answers to the questions below are for the confidential use of the Department.
11.
Do you currently have or have you ever been diagnosed with or treated for any medical condition that may affect your ability to safely operate a
motor vehicle?
Examples, including but not limited to: Diagnosis or treatment for heart trouble, stroke, hemorrhage or clots, high blood pressure, emphysema (within past two years)
progressive eye disorder or injury (i.e., glaucoma, macular degeneration, etc.) loss of normal use of hand, arm, foot or leg blackouts, seizures, loss of consciousness
or body control (within the past two years)
difficulty turning head from side to side
loss of muscular control stiff joints or neck inadequate hand/eye
coordination medical condition that affects your judgment dizziness or balance problems
missing limbs
If you answered YES above, has your condition
IMPROVED or
DETERIORATED since your last application for an original/renewal remake of your driver license?
12.
Do you have a mental condition that may affect your ability to safely operate a motor vehicle?
If yes, please explain:
13.
Have you ever had an epileptic seizure, convulsion, loss of consciousness, or other seizure?
14.
Do you have diabetes requiring treatment by insulin?
15.
Do you have any alcohol or drug dependencies that may affect your ability to safely operate a motor vehicle or have you had any episodes
16.
of alcohol or drug abuse within the past two years?
Within the past two years, have you been treated for any other serious medical conditions?
17.
Explain:
Have you EVER been referred to the Texas Medical Advisory Board for Driver Licensing?
Any male United States citizen or immigrant who is at least 18 years of age but less than 26 years of age submitting this application consents to registration with the
United States Selective Service System. You must be registered to qualify for federal student aid (to include Pell grant), job training, federal employment, and citizenship
if an immigrant. In Texas, you must be registered to qualify for state college student aid or state employment. If convicted, failure to register with the Selective Service is
a felony punishable by up to five years in prison and/or a $250,000 fine. If not registered by age 26, you can no longer register and could permanently lose those benefits
associated with registration. For alternative options for applicants who object to conventional military service for religious or other conscientious reasons information is
available at: http://www.sss.gov/FactSheets/FSaltsvc.pdf.
I do solemnly swear, affirm, or certify that I am the person named herein and that the statements on this information form are true and correct. I further certify my resi-
dence address is a (check one): (
) single family dwelling, (
) apartment, ( ) motel, (
) temporary shelter. I agree to immediately report to the Texas Department of
Public Safety any changes in my medical condition which may affect my ability to safely operate a motor vehicle.
DL-43 (Rev. 1/18)
SIGNATURE OF APPLICANT
DATE
SOLICITUD PARA RENOVAR, REEMPLAZAR, Ó HACER
(El reemplazo también es llamado duplicado)
CAMBIOS EN LA LICENCIA DE CONDUCIR O TARJETA DE
NUMERO DE LICENCIA O DE TARJETA DE IDENTIFICACIÓN:
IDENTIFICACIÓN DEL ESTADO DE TEXAS
INFORMACIÓN DEL SOLICITANTE
INFORMACIÓN DE CONTACTO
APELLIDO:
NÚMERO DE TELÉFONO:
PRIMER NOMBRE:
TELÉFONO SECUNDARIO:
SEGUNDO NOMBRE:
CORREO ELECTRÓNICO:
SUFIJO:
SU DOMICILIO
APELLIDO DE SOLTERA:
DOMICILIO DONDE RESIDE:
FECHA DE NACIMIENTO (mm/dd/aaaa):
CIUDAD:
ESTADO:
NÚMERO DE SEGURO SOCIAL:
CÓDIGO POSTAL:
CONDADO:
SEXO: (Marque uno)
HOMBRE
MUJER
PESO: en libres.
DOMICILIO POSTAL (Lugar donde recibe su correspondencia):
COLOR DE LOS OJOS:
ESTATURA: pies
pulg.
RAZA/ETNIA:
(I) Amerindio/Nativo de Alaska
(A) Asiático/nativo
de las Islas del Pacífico (B) Negro (H) Hispano (O) Otro (W) Blanco
INFORMACIÓN SOBRE EL SOLICITANTE (TODOS LOS SOLICITANTES favor de contestar las preguntas 1 a 10)
1.
SI NO
¿Es usted ciudadano de los Estados Unidos?
Si usted es ciudadano de los Estados Unidos, ¿le gustaría registrarse para votar? Si ya está registrado, ¿le gustaría actualizar su información de votante?
Al proporcionar mi firma electrónica, comprendo que la información personal en mi solicitud, junto con mi firma electrónica, se usará para enviar mi
solicitud de registro electoral a la oficina de la Secretaría del Estado de Texas. Deseo registrarme para votar; por lo tanto, autorizo al Departamento
de Seguridad Pública para transferir esta información a la Secretaría del Estado de Texas.
¿Desea usted donar $1.00 al Programa de Educación, Evaluación y Tratamiento de la Ceguera?
¿Desea apoyar el Programa de Registro de Texas-Glenda Dawson Donar Vida? En caso afirmativo, indicar una cantidad de la donación
de $1 o más $
¿Desea registrarse como donador de órganos?
¿Quieres apoyar a los sobrevivientes de asalto sexual? Si es así, porfavor indique la cantidad de donación de $1 o más $
.00 para
ayudar a financiar la recopilación de evidencia de asalto sexual (kit de violación)
¿Desea apoyar los Veteranos de Texas? Si la respuesta es sí, por favor, indique la cantidad de su donación $
¿Tiene usted alguna afección médica que le pueda impedir la comunicación con un oficial de la policía? En caso afirmativo, por favor indique
(el médico debe llenar el formulario DL-101 antes de emitir una licencia de conducir o tarjeta de identificación).
a) Desea una insignia de Veterano en su licencia de conducir o su tarjeta de identificación? (Se requiere comprobante de baja honorable; los
documentos aceptables son DD214/5, NGB22, carta de discapacidad del VA, prueba de servicio/verificación de la tarjeta de servicio honorable)
¿Es usted un Veterano que recibe 60% de compensación por discapacidad y desea quedar exento de los derechos de solicitud?
(vea el punto 9a para conocer qué documentos se requieren).
En caso afirmativo, por favor indique:
En caso de sufrir lesiones o la muerte, ¿le gustaría proporcionar dos (2) contactos para emergencias?
Nombre
Número telefónico
Domicilio
Para todas las Renovaciones de Licencia de Conducir, complete las preguntas MÉDICAS 11 a 17.
Las respuestas a las siguientes preguntas son para uso confidencial del Departamento.
¿Tiene actualmente o alguna vez ha sido diagnosticado con o tratado por alguna enfermedad que pueda afectar su capacidad de
operar un vehículo motorizado de manera segura?
Ejemplos, incluyendo pero no limitado a: Diagnóstico o tratamiento por problemas cardíacos, derrame cerebral, hemorragia o coágulos, presión arterial alta, enfisema (en los últi-
mos dos años) enfermedad progresiva o lesión de la vista (como glaucoma, degeneración macular, etc.) pérdida del uso normal de la mano, brazo, pie o pierna desvanec-
imientos, ataques, pérdida de la consciencia o control del cuerpo (en los últimos dos años)
dificultad para voltear la cabeza de un lado a otro
pérdida de control muscular artic-
ulaciones o cuello rígidos coordinación inadecuada de mano/ojo afección médica que altere su juicio mareos o problemas de equilibrio pérdida de algún miembro
Si respondió SÍ a la pregunta anterior, ¿su afección ha
MEJORADO o
EMPEORADO desde su última solicitud de original/renovación de licencia de conducir?
¿Tiene usted un condición mental que puede afectar su capacidad para operar con seguridad un vehículo motorizado? Si su respuesta es si,
por favor de explicar:
¿Alguna vez ha tenido un ataque epiléptico, convulsión, pérdida de la consciencia u otro ataque?
¿Tiene diabetes que requiera tratamiento con insulina?
¿Tiene alguna dependencia del alcohol o de drogas que pudiera afectar su capacidad de operar un vehículo motorizado de manera
segura o ha tenido algún episodio de abuso de drogas o alcohol en los últimos dos años?
En los últimos dos años, ¿ha recibido tratamiento por alguna otra afección médica grave?
Explique:
¿Alguna vez ha sido remitido al Comité Asesor Médico de Licencias de Conducir de Texas?
Cualquier hombre ciudadano o inmigrante de los Estados Unidos entre 18 y 26 años de edad que presente esta solicitud otorga su consentimiento para ser registrado
en el Sistema de Servicio Militar Selectivo de los Estados Unidos. Usted debe estar registrado para tener derecho a recibir ayuda federal estudiantil (incluso la beca
Pell Grant), capacitación laboral, empleo federal y la ciudadanía si es inmigrante,. En Texas, usted debe estar registrado para tener derecho a recibir ayuda estudiantil
universitaria o empleo con el Estado. No registrarse en el Servicio Militar Selectivo es un delito mayor. Si es declarado culpable de ello, podría ser castigado hasta con
cinco años de prisión y/o una multa de 250,000 dólares. Si no se ha registrado antes de cumplir 26 años, ya no se podrá registrar y podría perder permanentemente los
beneficios asociados con el registro. Para conocer otras opciones alternativas para solicitantes que se oponen al servicio militar convencional por motivos religiosos u otros
motivos de conciencia, podrá encontrar información disponible en: http://www.sss.gov/FactSheets/FSaltsvc.pdf.
Juro solemnemente, afirmo o certifico que soy la persona que se indica en el presente documento y que las declaraciones en esta solicitud son verdaderas y correctas. Además
certifico que mi domicilio de residencia es (marque una opción): (
) casa residencial, (
) apartamento, ( ) hotel, ( ) sitio de refugio temporal. Estoy de acuerdo en informar
inmediatamente al Departamento de Seguridad Pública de Texas cualquier cambio en mi condición médica que pueda afectar mi capacidad para conducir de manera segura
un vehículo motorizado.
FIRMA DEL ASPIRANTE
FECHA
After you have gathered the necessary information, you'll be ready to complete the DL-43 form. This form is often required for certain requests related to your driver's license. Ensure you have everything you need before you begin filling it out.
What is the DL-43 form?
The DL-43 form is a specific document used in the state of Pennsylvania for individuals seeking to obtain or renew a non-driver identification card. This identification card serves as a valid form of ID for those who may not possess a driver's license.
Who needs to fill out the DL-43 form?
Anyone in Pennsylvania who wishes to apply for a non-driver ID must complete the DL-43 form. This includes individuals who are new applicants as well as those looking to renew or replace an existing card. It is particularly useful for individuals who do not drive or who require identification for various purposes.
What information is required on the DL-43 form?
The DL-43 form requests personal information such as:
It may also ask for any previous identification numbers and the reason for applying. Ensure that all information provided is accurate to avoid delays.
Where can I obtain the DL-43 form?
The DL-43 form can be accessed in several ways. You can download it directly from the official Pennsylvania Department of Transportation (PennDOT) website. Additionally, the form is available at PennDOT Driver License Centers throughout the state.
How do I submit the DL-43 form?
Once you have filled out the DL-43 form, you can submit it in person at any PennDOT Driver License Center. If you are applying for a new ID, you may be required to provide documents that prove your identity and residency. Currently, there is no option for submitting this form online or by mail.
What is the fee for obtaining or renewing a non-driver ID?
The fee for obtaining or renewing a non-driver identification card varies depending on the duration of validity you choose. Generally, the fees are relatively low, but it is advisable to check current pricing on the PennDOT website or inquire at a local Driver License Center for the most accurate information.
How long does it take to receive my non-driver ID after submitting the DL-43 form?
After submitting your DL-43 form, you can expect to receive your non-driver ID in the mail within a few weeks. The processing time may vary based on demand and the specific circumstances of your application. If you do not receive your ID within the estimated time frame, contacting PennDOT for an update is recommended.
Filling out the DL-43 form can be a straightforward process, but many people often make mistakes that can delay their application or cause unnecessary complications. Understanding these common errors can help you avoid them and ensure your form is submitted correctly.
One frequent mistake is providing incorrect personal information. This includes misspelling names, entering the wrong date of birth, or misidentifying your address. It's essential to double-check this information before submitting the form, as discrepancies can lead to delays or even denial of your application.
Another common error involves not signing the form. A signature is usually required to validate the application. Without it, the form is incomplete, and you will be notified to rectify this oversight before processing can continue.
Many applicants forget to include supporting documentation. The DL-43 form may require additional documents such as identification or residency proof. Not attaching these documents can result in your application being placed on hold until they are provided.
Additionally, some individuals do not use the correct ink color when filling out the form. It’s generally recommended to use black or blue ink, as other colors can make the form difficult to read and may not be accepted.
Inaccuracies in payment information also arise. If there are fees associated with the DL-43 form, it is crucial to ensure that payment options are filled out correctly. This includes providing accurate credit card numbers or checks, as discrepancies can lead to payment failures.
Additionally, applicants sometimes overlook filling in all required fields. While some fields may seem optional, leaving them blank could lead to processing delays. Always confirm that each section of the form is completed according to the instructions provided.
Failure to review the instructions before filling out the form is another common mistake. The DL-43 may have specific requirements that vary based on individual circumstances. Understanding these requirements before you start filling out the form can save time and effort.
People often neglect to keep a copy of the submitted form. Having a record of your application can help in follow-up communications and in tracking the status of your application.
Another issue arises when applicants miss deadlines for submission. If there's a timeline associated with your application, missing the deadline can result in having to restart the process. Keeping track of important dates is vital.
Lastly, some do not seek help if confused. If at any point you feel uncertain about how to complete the form, reaching out for assistance is a good idea. This can prevent small errors from becoming significant issues later on.
The DL-43 form is commonly associated with various administrative processes, particularly related to driving and vehicle registration. Along with this form, several other documents may be required to facilitate a complete application or request. Below are some of the additional forms and documents frequently used in conjunction with the DL-43 form.
Each of these documents plays a significant role in the process related to the DL-43 form. Having all necessary paperwork ready can streamline the application process and reduce potential delays.
The DL-43 form is a specific document used for certain official purposes, such as obtaining a driver's license in the state of Pennsylvania. Other forms serve similar functions within various contexts. Below are six documents that share similarities with the DL-43 form:
When filling out the DL-43 form, it's essential to approach it with care. Below are some do’s and don’ts that can help ensure your form is completed correctly.
Following these guidelines will help you navigate the process smoothly and avoid potential issues with your application.
The DL-43 form is often surrounded by misunderstandings. Here are six common misconceptions about this form, along with clarifications.
Many believe the DL-43 form is exclusively for individuals obtaining their driver's license for the first time. In reality, it can also be used by those updating their personal information or renewing their licenses.
Some people think that every driver must fill out the DL-43 form. However, those with certain types of licenses or who have met specific conditions may not need to use this form.
Completing the DL-43 form does not automatically result in obtaining a driver's license. Applicants must still meet other requirements, such as passing tests and providing necessary documentation.
While online submission is an option, the DL-43 form can also be completed and submitted in person at designated DMV locations for those who prefer face-to-face interaction.
Many assume that the DL-43 is a standardized form across all states. Each state may have its own version or requirements, so it is important to check the specific guidelines for your state.
Steroid misconceptions exist around the permanence of the DL-43 form's details. Individuals may update their information as needed, including address or name changes, through the proper channels.
The DL-43 form, utilized in the context of driver license applications, is essential for various reasons. Understanding how to correctly fill out and use this form is crucial for applicants. Below are key takeaways regarding the DL-43 form.
Understanding these key points enhances the likelihood of a smooth application process for a driver's license using the DL-43 form.
Vsd001 - The County Veterans Service Office is a vital resource for veterans seeking verification and support.
Doctors Note for Work Template - May need to be submitted within a certain timeframe to be considered valid by employers or schools.