The Metro Access Application form is a crucial document for individuals with disabilities seeking door-to-door paratransit services in the Washington, D.C. metropolitan area. This application facilitates access to MetroAccess, a service designed for those unable to use regular public transportation due to their disabilities. To begin the process of securing this essential service, click the button below to fill out the form.
The Metro Access Application form is essential for individuals with disabilities seeking door-to-door paratransit services in the Washington, DC metropolitan area. This application facilitates access to MetroAccess, a shared ride service designed specifically for those who cannot utilize standard public transportation due to their disabilities. To begin the process, applicants must carefully complete the form, which includes providing personal information and securing the endorsement of a licensed healthcare provider. The application outlines the necessary steps, including how to prepare for an in-person assessment that will determine eligibility based on the functional impact of the applicant's disability. Importantly, the form also highlights the Reduced Fare Program, which allows eligible individuals to travel on accessible Metrobus and Metrorail services at a reduced fare. All applications must be submitted in person to the Transit Accessibility Center, as mailing or faxing is not permitted. The application emphasizes the importance of accurate and complete information, as incomplete submissions will be returned without processing. For assistance, applicants are encouraged to reach out to the Metro Transit Accessibility Center directly.
Application for
MetroAccess Door-to-Door Paratransit Service
For People with Disabilities
DO NOT MAIL OR FAX APPLICATION
Transit Accessibility Center
6005th Street, NW Washington, DC 20001
(Between Chinatown/Gallery Place and Judiciary Square Metro Stations)
(202)962-2700 & select option #5 TTY (202) 962-2033
All Assessments are by Appointment Only
Thank you for yourd oninterMetro’sst in Mdeterminationtro services offoryourpeopleeligibilitywith disabilities. The following services
(A)Reduced Fare Program for People with Disabilities – Eligible people with disabilities
travel on accessible Metrobus and Metrorail for half the regular (rush hour) fare at all times. This
program is available for people with disabilities who use the accessible Metrobus and Metrorailare available base:
system as their primary travel option. For more information on the Reduced Fare program or to
obtain an application please visit our website atunder the section titled “How
dohttp://wwwI get a Metro.wmataDisability.com/accessibility/metroaccessID Card?”_eligibility.cfm
or call (202) 962-2700 and select option 1 from the phone
(B)MetroAccess – Door-to-door, shared ride public paratransit service for people with disabilities who are unable to use regular accessible Metrobus and Metrorail public transportation
for some or all of their public transportation due to a disability. The Americans with Disabilities Act (ADA) outlines specific criteria to determine eligibility for paratransit service and an application anmenu.
in-person assessment is required. MetroAccess operates throughout the metropolitan area where there is regularnd PrincebusGeorge’sand/or railCountyservinceMaryland;. Service isArlingtonprovidedCounty,in Washington,Fairfax County,DC; MontgomeryCity of County a
Alexandria, City of Fairfax, and City of Falls Church in Virginia.
To apply for this service you and your healthcare provider must complete this application. Please read and follow the instructions on page 2.
Instructions
Application revision date: March 2017
Page 1 OF 9
Step 1: Read the entire application and complete Part A.
Step 2: Read Accessible Transportation Options for People with Disabilities and Senior Citizens in
the Washington, DC Metropolitan Area, included with this application packet or also available at http://www.wmata.com/accessibility/doc/Accessible_Transportation_Options.pdf
Step 3: Take the entire application to a healthcare provider holding active licensure or credentials in certifythe areatheofapplication:your disabilityPhysician,to completePhysician’sPart BAssistant,. One of the following health care providers must
Certified Nurse Practitioner, Optometrist
(visual disabilities only), Podiatrist (disabilities of the foot and ankle only) or, Licensed Clinical Psychologist (Psychiatric disabilities only). It is your responsibility to ensure the original signed and completed application is received by the Metro Transit Accessibility Center on the day of your appointment.
Step 4: Upon completion of the application, call 202-962-2700 and select option 5, ( TTY 202-962-2033) to conduct a pre-assessment interview. At that time, a determination will be made as to the type of
appointment and/or assessment that will be required, and an appointment will be made for you. officePleasewithinhave 60yourdayscompletedof the dateapplicationof the healthcareat handprovider’swhen yousignaturecall. Also. Applicatiensure you contact the
ons more than 60
days old will not be accepted. You will be instructed to bring your completed original application with you to the appointment. Do not mail or fax the application. NOTE: We require 24 hours notice if you need to cancel your appointment, except in case of a verified emergency. If you miss or cancel 2 appointments you will be required to complete a new application and be required to wait 120 days to reapply.
Copies, faxes, and scans will not be accepted. Applications with missing information will not be accepted and will be returned to the applicant without processing. Applications that are mailed will be returned to the applicant with instructions to contact the Transit Accessibility Center.
Step 5: Metro will determine your eligibility based on how your disability impacts your functional abilities to use the accessible Metrobus and Metrorail public transportation system. Financial need is not a criterion for MetroAccess eligibility. All assessments take place at the Metro Transit Accessibility Center. If you use a mobility aid, please bring it with you to the assessment. If transportation is needed, advise the Metro Transit Accessibility Center representative at the time of your telephone interview.
If you have questions or need additional information, please contact the Metro Transit Accessibility Center at 202-962-2700 and select option 5, TTY 202-962-2033 or e-mail eligibility@wmata.com. Please do not bring children to the appointment unless the child is the applicant. Please note that the minimum age to apply for the service is 5 years old. The office is open Monday, Wednesday
-Friday from 8:00 AM - 4:00 PM, and Tuesday, 8:00 AM to 2:30 PM. Hours are subject to change without notice so Please call in advance. Phone lines open at 8:30 on all days.
Page 2 OF 9
I am a current MetroAccess customer. MetroAccess ID Card # ________________________
I am a current Reduced Fare customer. Reduced Fare ID Card # ____________________
I have access to the internet and/or have an email account.
Part A: APPLICANT INFORMATION AND RELEASE (Copies, faxes or scans will not be accepted)
Last Name______________________________ First Name______________________________ Middle Initial ________
Street Address:
Apartment #:
City, State, Zip:
County or City:
Gender: Male Female Date of Birth: ____/______/________ E-mail:_________________________________
Primary phone number: ( ) _______________________________ Home Cell Phone Work
Secondary phone number: ( ) _____________________________ Home Cell Phone Work
In case of an emergency, who should be notified?
Name:
Relationship:
Mobility Devices: Do you require the use of a mobility device when traveling? No Yes
Check all that apply: Man
al Wheelchair
Support C
e Portable Oxygen
Power Wheelchair
800 pounds when occupied
CrutchesWalkerorScooterWhiteupCane(forto 48” xvisually30” andimpaired)no more than Other: _____________________________
Do you use a service animal?
No Yes
Sometimes If yes, please describe the type of
animal and what service(s) the animal was trained to perform:
I certify that all information contained in part A of this application were completed by me or my appointed representative and are true.
Original Signature of Applicant: __________________________________________ Date:_________________________
(Under 18, Signature of Parent or Guardian)
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AUTHORIZATION TO HELP ME APPLY FOR METROACCESS SERVICES
Please complete the authorization below if you are providing legal authority to another party to complete this application and act as your agent in the processing of this application.
** This form is only to be used when an applicant is not able to otherwise give consent for
Applicant’sassist ce andNameinformation sharing.
Applicant’s Address______________________________________________________
_____________________________________________________
I would like to apply for MetroAccess door to door paratransit service.
I am appointing _____________________________to help me apply for MetroAccess service. For this
purpose only, he or she has the authority to act on my behalf, including scheduling appointments, completing paperwork, and providing information about me to WMATA (Metro), so long as it relates to my application for MetroAccess service. Metro may release any information it has about me upon request, to this person, including health care information, so long as it relates to my application for services. For this purpose only, my agent may request, receive, and review any information, oral or written, regarding my physical or mental health, including but not limited to, medical and hospital records and other protected health information, and consent to disclosure of this information.
For all purposes related to this document, my agent is my personal representative under the Health Insurance Portability and Accountability Act (HIPAA) and is entitled to request, receive, and review protected health information: any information, oral or written, regarding my physical or mental health, including but not limited to medical and hospital records, and other protected health information. My agent may also consent to disclosure of this information.
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This agreement expires: (Select one from options below.)
_____ At the end of my appointment on __________________; or
_____ At the end of my MetroAccess certification process; or
_____ At the end of my MetroAccess certification and any applicable appeal process.
In any event, this agreement would expire no later than one year from when it is signed. I can cancel this agreement at any time by telling the person and calling Metro to inform them that this authorization is no longer valid.
Signature
Date
Printed Name
I, ________________________________________________, agree to help ______________________________ with
(Agent’s Name)
(Applicant’s Name)
his/her application for MetroAccess services. Either I, or another person from my organization, will come with the applicant to their eligibility appointment and assist him/her.
Page 5 OF 9
Part B: HEALTH CARE PROVIDER CERTIFICATION
holding active licensure or credentials in the area of the applicant’s disability orA healthcarethe applicant’sproviderprimary care provider as outlined on page 2 must complete Part B.
Your patient has requested eligibility for MetroAccess services. MetroAccess is a door to door,
uniquely qualified to clarify his or her functional
the applicant’s healthcare provider you are
shared ride paratransit service for people whose disability(ies) prevent them from riding the fixed
route accessible system, all or part of the time. As
icant’s functional abilities we
that you the healthcare provider not the applicant
abilities and l mitations to ride the M
tro
’s require
accessible bus and rail system. In order to determine this appl
travel independently onhow the applicant’s
complete and certify all of the following
sections. Please detail
disability(ies) impact their ability to board, navigate and
the accessible fixed route system. Please be as specific as possible
Applicant’s HIPAA Authorization:
I _________________________________authorize the healthcare provider completing this application to
release to the Washington Metropolitan Area Transit Authority (Metro) any protected health information about my disability in order to verify my eligibility for Metro Services for People with Disabilities. I also authorize the release of further information should it be needed for this application for a period of 60 days from the date of my signature on part A of this application.
____________________________________________________________ (Applicant’s name) is being referred for a brief
functional assessment to determine eligibility for Metro services for people with disabilities.
1.Name of Health Care Provider: (Please print)____________________________________________________
2.Phone: ( ) _______________________
3.License Number/State Issued: ___________________________
4.Street Address & Suite #: ________________________________________________________________________________
5.City, State, Zip: ____________________________________________________________________________________________
6.Specialization: ____________________________________________________________________________________________
7.Written Diagnosis (es) and ICD-9CM and/or DSM Code(s): ______________________________________
__________________________________________________________________________________________________________________
8.HYPERTENSION: Eligibility for service is determined by a functional assessment, which is
conducted by a certified/licensed therapist with the Transit Accessibility Center. Applicants may be required to walk/travel up to 1/2 mile. In order to ensure the safety ofe applicant’sthe applicant,restinga bloodB/P is pressure (B/P) reading is taken prior to starting the assessment. If th
Page 6 OF 9
160/100 or higher, the assessment will be suspended pending certification by the health care provider that the applicant can complete the assessment. If you are currently treating the applicant for hypertension and certify that he/she is cleared to complete the functional assessment, we may proceed without referring the applicant back to you for evaluation and certification.
9.Are you currently treating this applicant for Hypertension? No Yes
10.Applicant can complete the assessment as described above if B/P does not go above a reading of: ______________________
11.If applicant has a seizure disorder or epilepsy have they had a tonic-clonic seizure within the past 4 months?
No Yes N/A
12.Does the applicant require a Personal Care Attendant (PCA) when traveling on public transportation?
13. Does the applicant require any of the following mobility aids listed in question 14?
14.Check all that apply: Manual Wheelchair Support Cane Portable Oxygen
Power Wheelchair or Scooter CrutchesWalkerWhite Cane (visually impaired) Other: __________________
15. What is the expected duration of the disability? (Please initial appropriate box)
_____Short-Term: Conditions that last at least 90 days, but are likely to improve within one year.
____Long-Term: Conditions with absolutely little expectation of improvement
16. Does this applicant’s disability(ies) prevent him/her from independently using the accessible Metrobus and Metrorail system?
No Yes the disability or health condition impact the applicant’s ability to travel If yes, HOW does
independently from one location to another on the accessible Metrobus and Metrorail system?
Page 7 OF 9
17.If this applicant is currently on medication(s), will the side effects of this significantly reduce or hinder his/her ability to independently ride the accessible Metrobus and Metrorail system?
applicant’sIf you selectedabilityyestoforusethisthequestion,accessiblepleasefixedexplainroute bushowandtherailsidesystem:eff cts would hinder this
Based on the applicant’sENVIRONMENTALdisability(ies),ISSUESpleaseTHATtell usAFFECTif followingTHEenvironmentalAPPLICANT factors affect his/her ability to ride Metro’s accessible bus and rail system.
18.Would extremes in temperature affect this applicant’s ability to ride the accessible Metrobus or Metrorail?
If yes, please explain the effect and the extent of the limitation(s)
19. Would ice and/or snow affect this applicant’s ability to ride accessible Metrobus or Metrorail system?
If yes please explain the effect and the extent of the limitation(s)
20. Would poor air quality affect this applicant’s ability to ride Metrobus or Metrorail? Yes No If yes please explain the effect and the extent of the limitation(s). NOTE: If applicant suffers from Asthma, please indicate if the applicant has been on systemic medication for the immediate past 6 months OR has been required to use fast acting inhalers for three or more episodes per week for the immediate past six months
Page 8 OF 9
21.In your medical opinion what other factors related to the applicant’s disability(ies) affect his/her ability to ride the accessible Metrobus or Metrorail?
HEALTH CARE PROVIDER SIGNATURE PAGE
I certify that I have completed the questions in Part B and that the information provided is correct.
Original Signature of Physician/Healthcare Provider: ______________________________________________
(Note: Must be original hand signature, not signature stamp)
Printed Name_________________________________________________________Date: _____________________
False certification may be reported to the licensing agency under District of Columbia Code Annotated,
Section 2-3305.15, Code of Virginia 54. 1-2915, or Maryland Health Occupations Code Annotated 14-404 or appropriate code for state of license. Metro reservesn, (2) makethe rightthe finalto: (1)determinationv ify the validityon anofapplicant’sthe licenseeligibilityof the health care provider providing the certificatio
for MetroThes rvicesADA requiresfor peopleMetrowith disabilities,to provideanotificationd (3) retainofa copyan applicant’sof this applicationeligibility. status within 21 NOTE:
days of submitting a completed application. If, for any reason, it takes longer than that to process the determination, the applicant will be eligible to use MetroAccess until Metro completes the eligibility process. This is called "presumptive eligibility." If 21 days have passed since Metro received the completed application the applicant will be automatically granted eligibility for MetroAccess until the review process is completed.
Page 9 OF 9
Completing the Metro Access Application form is an important step for those seeking paratransit services. The process requires collaboration with a healthcare provider and ensures that all necessary information is accurately submitted. Follow these steps to successfully fill out the application.
What is the MetroAccess Application form?
The MetroAccess Application form is a document required for individuals with disabilities who wish to apply for door-to-door paratransit services. This service is designed for those who cannot use regular Metrobus and Metrorail services due to their disabilities.
How do I apply for MetroAccess services?
To apply, follow these steps:
Who can complete Part B of the application?
Part B must be completed by a healthcare provider who holds active licensure in the relevant area. Acceptable providers include:
What happens after I submit my application?
Once your application is submitted, Metro will evaluate your eligibility based on how your disability affects your ability to use accessible public transportation. You will be contacted to schedule an assessment appointment.
What should I bring to the assessment appointment?
Bring the original signed application, any mobility aids you use, and any required documentation. It is also advisable to bring a support person if needed. Children should not accompany you unless they are the applicant.
What if I need to cancel my appointment?
You must provide at least 24 hours' notice to cancel your appointment, except in emergencies. If you miss or cancel two appointments, you will need to complete a new application and wait 120 days to reapply.
How do I contact the Metro Transit Accessibility Center for more information?
You can reach the Metro Transit Accessibility Center at (202) 962-2700 and select option 5. TTY users can call (202) 962-2033. You may also email eligibility@wmata.com for additional questions.
When applying for MetroAccess services, individuals often make common mistakes that can delay the process or lead to application rejection. Understanding these pitfalls can help ensure a smoother experience.
One frequent error is failing to complete all required sections of the application. Many applicants overlook specific details, such as providing their full name, contact information, or emergency contact. Incomplete applications will be returned without processing, causing unnecessary delays. It's crucial to double-check that every section is filled out accurately before submission.
Another mistake involves not obtaining the necessary signatures from healthcare providers. Part B of the application must be completed by a qualified professional who certifies the applicant's disability. Some individuals mistakenly assume that they can complete this section themselves or neglect to ensure that the provider has signed it. Without the required signature, the application cannot be processed.
Applicants also often misinterpret the submission guidelines. The application must be submitted in person; mailing or faxing is not allowed. This requirement is frequently overlooked, leading to frustration when applications are returned. It’s essential to follow the instructions closely and bring the application to the Metro Transit Accessibility Center on the day of the appointment.
Another common oversight is not adhering to the timeline for submission. Applications that are older than 60 days from the date of the healthcare provider's signature will not be accepted. Applicants sometimes forget to call for a pre-assessment interview within this timeframe, resulting in the need to start the application process over again. Staying mindful of these deadlines is critical.
Lastly, some individuals fail to bring necessary documentation to their appointment. MetroAccess requires applicants to bring their completed original application and any mobility aids they use. Not having these items on the day of the assessment can lead to rescheduling, further complicating the process. Preparing all required materials ahead of time can help avoid this issue.
When applying for MetroAccess services, several important forms and documents may accompany the MetroAccess Application form. Each of these documents serves a unique purpose in ensuring that applicants receive the necessary support and assistance. Below is a brief overview of these forms:
Each of these documents plays a vital role in the application process for MetroAccess services. Ensuring that they are completed accurately and submitted alongside the main application can significantly enhance the chances of receiving the necessary transportation assistance. If you have any questions about these forms, reaching out to the Metro Transit Accessibility Center can provide clarity and support.
When filling out the Metro Access Application form, there are several important dos and don'ts to keep in mind. These guidelines will help ensure that your application is processed smoothly and efficiently.
By following these guidelines, you can help facilitate a smoother application process for Metro Access services.
When it comes to the Metro Access Application form, several misconceptions can lead to confusion. Here are six common misunderstandings, along with clarifications to help you navigate the process more easily.
Many people believe they can mail or fax their application. However, the instructions clearly state that you must bring the completed application to the Metro Transit Accessibility Center in person.
Some applicants think that financial status will impact their eligibility for MetroAccess. In reality, eligibility is based solely on how a disability affects your ability to use regular public transportation, not on financial need.
It is a common belief that individuals can complete the application independently. However, you and a licensed healthcare provider must fill out specific parts of the application to certify your disability.
Many assume they can bring friends or family members to the assessment. The policy states that only the applicant should attend unless the child is the applicant. This is to ensure a focused evaluation process.
Some individuals may think that a completed application is enough, but it is essential to provide an original signature. Applications without a signature will be returned without processing.
Many applicants mistakenly believe that submitting a copy or scan is acceptable. The Metro Transit Accessibility Center requires the original, completed application, as copies will not be accepted.
Filling out and utilizing the Metro Access Application form can be a straightforward process if you follow these key takeaways: