The Mv 145A form is an application for a Person with Disability Parking Placard. This form allows eligible individuals to request a parking placard that provides special parking privileges. If you need to fill out this form, please click the button below.
The MV-145A form is an essential document for individuals seeking a parking placard designated for persons with disabilities in Pennsylvania. This application enables eligible individuals, including severely disabled veterans, to request original, temporary, or renewal placards without incurring any fees. It requires detailed personal information about the applicant, including their name, address, and date of birth, along with the necessary certifications from a licensed healthcare provider or police officer. The form also allows for changes, such as updating an address or name, and provides guidance on how to replace lost or stolen placards. Importantly, the MV-145A outlines specific eligibility criteria, detailing the medical conditions that qualify for the placard. These conditions range from visual impairments to severe mobility limitations. Understanding the requirements and completing the form accurately is crucial for ensuring that individuals receive the parking privileges they need to navigate their daily lives more easily.
MV-145A (6-25)
PERSON WITH DISABILITY PARKING PLACARD APPLICATION NO FEE REQUIRED SEE REVERSE SIDE FOR INSTRUCTIONS AND ELIGIBILITY REQUIREMENTS
(The space above is for Department use only)
Bureau of Motor Vehicles • P.O. Box 68268 • Harrisburg, PA 17106-8268
CHECK ( 4) APPROPRIATE BLOCKS BELOW
qORIGINAL REQUEST - q Permanent Placard q Severely Disabled Veteran q Temporary Placard
qRENEWAL REQUEST - (For Permanent Placards Only)
q REPLACEMENT REQUEST - q PLACARD q ID CARD q Defaced q Lost q Stolen q Never Received PREVIOUS PLACARD # ______________________
qCHANGE OF ADDRESS - Complete Sections A and E.
qCHANGE OF NAME - Complete Sections A and E. Check here to indicate reason for change of name: q Marriage q Divorce q Other: ______________________
APERSON WITH DISABILITY INFORMATION - LIST NAME AND ADDRESS OF PERSON WITH DISABILITY - NOTE: If listing an out-of-state address, you must also complete and attach Form MV-8.
Last Name (or Full Business Name)
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
or Bus. ID#
Street Address
City
State
Zip Code
Email Address
NOTE: If you are the parent or adult charged by law with the natural parent’s rights, duties and responsibilities acting on behalf of a minor child (under 18) in place of the child’s natural parents (person in
loco-parentis), you must complete the information below. In addition, a parent, including an adoptive or foster parent who has custody care or control of the child or adult child or a spouse may sign on
behalf of the child, adult child or spouse (applicant) provided the applicant meets eligibility requirements (1) through (8).
Name of Parent, Person in Loco Parentis or Spouse
Relationship to Applicant
CERTIFICATION FROM A HEALTH CARE PROVIDER LICENSED OR CERTIFIED IN PA OR A CONTIGUOUS STATE (NEW YORK, NEW JERSEY, DELAWARE, MARYLAND, WEST VIRGINIA OR
B
OHIO). THIS SECTION MUST BE COMPLETED IN FULL. HEALTH CARE PROVIDERS MAY ONLY CERTIFY DISABILITIES WITHIN THEIR SCOPE OF PRACTICE. WARNING: Altering or forging a
document issued by the Department, such as a disabled person parking placard, or possessing, using or displaying such a document knowing it to have been altered, forged or counterfeited,
is a misdemeanor of the first degree pursuant to the Vehicle Code, 75 Pa.C.S. Section 7122, punishable by a fine of not more than $10,000 or imprisonment of not more than five years, or both.
I hereby certify that the person with the disability listed above is under my care and has the following condition listed on the reverse side of this
UNCORRECTED
application under “Eligibility Requirements”: _______________
(NOTE: Only those conditions listed on the reverse side of this application qualify
R
20/
List Reason Code # Here
an applicant for a person with disability placard.)
L
NOTE: If reason code #1 is listed above, please indicate the individual's visual acuity by completing the chart to the right:
If reason code #4 is listed above, please indicate the type of device used: ________________________________________________
CORRECTED
Temporary placards are only issued for a period of time not to exceed six months. If the applicant requires additional time after the expiration of
the placard issued, the applicant must be recertified by a health care provider.
Health Care Provider’s Printed Name
Health Care Provider’s Signature
Medical License No.
Office Street Address
Telephone Number
(
)
C
CERTIFICATION BY POLICE OFFICER - Police officer may only certify that the applicant does not have full use of a leg or both legs, or is blind.
NOTE: If Section B above is completed, please skip this Section and go on to Section E.
This is to certify that the person with disability listed above has the condition listed and is entitled to the use and privileges of the person with disability
parking placard.
q is blind, OR does not have full use of a leg or both legs as evidenced by the use of a: q wheelchair
q walker
q crutches
q cane/quad cane
q other prescribed device
Officer’s Printed Name
Officer’s Signature
Badge Number
D
CERTIFICATION FROM U.S. DEPARTMENT OF VETERANS AFFAIRS REGIONAL OFFICE ADMINISTRATOR (PHILADELPHIA OR PITTSBURGH)
OR SERVICE UNIT IN WHICH THE VETERAN SERVED OR A LEGIBLE PHOTOCOPY OF THE APPLICANT'S LETTER OF PROMULGATION,
AWARDS LETTER, SINGLE NOTIFICATION, OR SUMMARY OF BENEFITS LETTER.
q
This is to certify that the veteran listed above with VA number ___________________________, has a 100% service-connected disability or has the
following service connected disability reason code number _______, listed on the reverse side of this application under “Eligibility Requirements.”
NOTE: If reason code #4 is listed, please indicate the type of device used: __________________________.
Authorized Printed Name and Title: ____________________________________________ Authorized Signature: ____________________________________________
In lieu of the U.S. Department of Veterans Affairs Regional Office Administrator certification, I have attached a legible photocopy of my Letter of
Promulgation, Awards Letter, Single Notification Letter, or Summary of Benefits Letter that indicates I have a 100% service-connected disability.
E
UNSWORN DECLARATION AND APPLICANT SIGNATURE - Person with disability, natural parent or other authorized person listed in Section A must sign below.
I/We declare under penalty of perjury under the law of the Commonwealth of Pennsylvania, that the foregoing is true and correct, and that application was made for the above product or that the items as indicated were never received in the mail. Furthermore, I/we state that I/we have read and signed this application after its completion, and I/we swear or affirm that the statements made herein are true and correct, and that any statement made on or pursuant to this application is subject to the penalties of 18 Pa.C.S. Section 4904 (relating to unsworn falsification), which include criminal prosecution and a term of imprisonment, the maximum of which may be one year [18 Pa.C.S. 4904(b)], or up to two years[18 Pa.C.S. 4904(a)]. In addition to any other penalty, a person convicted under this section shall be sentenced to pay a fine of at least $1,000 [18 Pa.C.S. 4904(d)].
Signed on the _____ day of _______________, ___________________ at ________________________________________, _________________________.
(county or other location, and state)
(country)
Printed Name of Person with Disability
Person with Disability/Loco Parentis Signature
THIS APPLICATION MAY BE DUPLICATED
INSTRUCTIONS
1.Permanent Placard - Complete Sections A, B or C (NOT BOTH) and E. NOTE: Individuals should list their PA Driver’s License (PA DL) or Photo ID# in the space provided. Businesses should list their Business ID# (Bus. ID) where indicated (i.e. E.I.N.).
2.Severely Disabled Veteran Placard - Complete Sections A, D and E.
3.Temporary Placard - Complete Sections A, B and E. NOTE: Only licensed health care providers* may certify disabilities for temporary placards. Temporary placards may be issued for a period up to six months and may not be extended for an additional period of time. When additional time is needed, a new application must be completed and certified by a health care provider. In addition, please list your previous placard number.
4.Renewal Request - Complete Sections A and E.
5.Replacement Request - Indicate if applying for a replacement placard or ID card. Please check reason for replacement; Lost, Stolen, Defaced or Never Received. List your previous placard number and complete Sections A and E. NOTE: If product was not received within 90 days, please check the "Never Received" box or if product was not received for over 90 days please check the "Lost" box.
6.Change of Address - Complete Sections A and E.
7.Change of Name - Complete Sections A and E. Check the block on the front of this application to indicate reason for change of name.
*Health Care Provider is defined as a physician, chiropractor, optometrist, podiatrist, physician assistant, or a certified registered nurse practitioner licensed or certified in Pennsylvania or a contiguous state. Health care providers may only certify disabilities within their scope of practice.
NOTE: Customers with a permanent placard have the option to renew their placard, request a replacement placard or change the address their placard online at https://www.placard.penndot.pa.gov/PlacardWeb/public/external/placardLogin.xhtml or scan the QR code on the front of this application.
Placard Type
Eligibility Requirements
Qualifying Vehicles
Benefits
Person with Disability Placard
“Reason Codes”
Applicant:
(1)is blind.
(2)does not have full use of an arm or both arms.
(3)cannot walk 200 feet without stopping to rest.
(4)cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair or other assistive device.
(5)is restricted by lung disease to such an extent that the person’s forced (respiratory) expiratory volume for one second, when measured by spirometry, is less than one liter or the arterial oxygen tension is less than 60 MM/HG on room air at rest.
(6)uses portable oxygen.
(7)has a cardiac condition to the extent that the person’s functional limitations are classified in severity as Class III or Class IV according to the standards set by the American Heart Association.
(8)is severely limited in their ability to walk due to an arthritic, neurological or orthopedic condition.
NOTE: If you are the parent or adult charged by law with the natural parent’s rights, duties, and responsibilities, acting on behalf of a minor child (under 18) in place of the child’s natural parents (person in loco-parentis), complete the appropriate information on the front side of this application.
In addition, a parent, including an adoptive or foster parent who has custody, care, or control of the child or adult child or a spouse, may sign on behalf of the child, adult child, or spouse (applicant) provided the person with disability meets eligibility requirements (1) through (8).
(1)The placard is required to be displayed when the vehicle is parked in areas designated for use by persons with disability only and must not be displayed when the vehicle is being operated on the highway.
NOTE: Organizations that operate a passenger vehicle to transport persons with disabilities must supply the Department with the following:
a)A notarized statement of how the placard will be used and the type of services that will be provided.
b)The weekly or monthly number of hours that the services are provided.
c)The make of the vehicle(s), including the title number, vehicle identification number and registration plate number. The vehicle(s) must be titled in the name of the organization and must be a passenger vehicle.
d)The number of placards required: (Organizations may not be issued more than eight placards in the organization’s name.)
(1)Parking permitted in spaces designated for disabled persons and for 60 minutes in excess of legal parking period except where local ordinances or police regulations provide for the accommodation
of heavy traffic during morning, afternoon or evening hours.
(2)Upon request of a person with disability, local authorities may erect on the highway as close as possible to the person’s residence a sign(s) indicating that the place is reserved for the person with disability, that no one else may park there unless a person with disability plate or placard is displayed and that any unauthorized person parking there will be subject to a fine.
Severely
Disabled
Veteran
Placard
(1)100% service-connected disability certified by the U.S. Department of Veterans Affairs (Pittsburgh or Philadelphia) or service unit in which the veteran served or as shown on the applicant’s Letter of Promulgation, Awards Letter, Single Notification Letter, or Summary of Benefits Letter.
(2)Same disabilities as listed above for Person with Disability Placard but must be service-connected.
Same as 1 and 2 above for Person with Disability Placard.
Same as above for Person with Disability Placard.
Use of Person with Disability and Severely Disabled Veteran Placards:
. Parking in a designated persons with disability parking space is only permitted with this parking placard when the vehicle is being used for the transportation of the person for which the parking placard was issued.
. Any vehicle lawfully displaying a parking placard will qualify for parking in areas designated only for use by persons with a disability. NOTE: This parking placard can not be used to park where parking is prohibited.
Send completed application to: PennDOT, Bureau of Motor Vehicles, P.O. Box 68268, Harrisburg, PA 17106-8268
Visit us at www.pa.gov/dmv or call us at 717-412-5300. TTY callers — please dial 711 to reach us.
To complete the MV-145A form, follow these instructions carefully. Ensure that all required sections are filled out accurately to avoid delays in processing your application. Once completed, submit the form to the appropriate address provided at the end of these steps.
What is the MV-145A form?
The MV-145A form is an application for a Person with Disability Parking Placard in Pennsylvania. This form allows individuals with disabilities to request a parking placard that provides access to designated parking spaces. It can be used for original requests, renewals, replacements, and changes of address or name.
Who is eligible to apply for a disability parking placard?
Eligibility for a disability parking placard includes individuals who meet certain medical criteria. These criteria cover various conditions, such as being blind, having limited use of limbs, or having severe respiratory or cardiac conditions. A healthcare provider must certify the applicant's disability on the form.
Is there a fee to apply for the MV-145A form?
No, there is no fee required to apply for a disability parking placard using the MV-145A form. This application is provided at no cost to eligible individuals.
How long is a temporary placard valid?
A temporary placard is valid for up to six months. If additional time is needed after the expiration, the applicant must be recertified by a healthcare provider and submit a new application.
What should I do if my placard is lost or stolen?
If your placard is lost or stolen, you can request a replacement by completing the MV-145A form. Indicate the reason for replacement and provide your previous placard number if available. This helps ensure that your request is processed efficiently.
Can I apply for a placard on behalf of someone else?
Yes, you can apply on behalf of another person if you are their parent, guardian, or spouse. You must complete the appropriate sections of the form and certify that the individual meets the eligibility requirements.
What information is needed from a healthcare provider?
A healthcare provider must complete a section of the form certifying the applicant's disability. This includes providing their name, signature, medical license number, and office contact information. They must certify that the disability falls within their scope of practice.
Where should I send the completed MV-145A form?
Once you have completed the MV-145A form, send it to the Bureau of Motor Vehicles at the following address: P.O. Box 68268, Harrisburg, PA 17106-8268. Ensure that all required sections are filled out to avoid delays in processing your application.
Filling out the MV-145A form can be straightforward, but many applicants make common mistakes that can delay processing or lead to rejections. One frequent error is neglecting to check the appropriate box for the type of placard being requested. Whether it’s for a permanent, temporary, or renewal request, failing to select the correct option can cause significant delays.
Another mistake involves incomplete personal information. Applicants must provide the full name, address, and identification numbers, such as the PA Driver’s License or Business ID. Omitting any of these details can result in the application being returned for correction. Additionally, using an out-of-state address without attaching Form MV-8 is another common oversight that can hinder the application process.
Some individuals fail to obtain the necessary certification from a health care provider. This section must be filled out completely by a licensed professional who can verify the applicant's disability. Incomplete or incorrect information in this section can lead to disqualification. Furthermore, if the applicant is a minor, the form must include information about the parent or guardian acting on their behalf, which is often overlooked.
Applicants sometimes forget to sign the form. The signature of the person with a disability, or their authorized representative, is crucial for validating the application. Without this signature, the application cannot be processed. Additionally, not dating the application can also lead to complications, as the date is essential for record-keeping purposes.
Another common error is failing to indicate the reason for a name change or not providing the previous placard number when applying for a replacement. This information is vital for the DMV to track the applicant’s history and ensure that the correct changes are made. Similarly, not checking the box for the reason for a replacement can lead to unnecessary confusion.
Some applicants may misinterpret the instructions regarding notarization. While notarization is not required for many sections, applicants sometimes mistakenly believe it is necessary and delay their submission as a result. Understanding which sections require notarization is important for timely processing.
Lastly, applicants should be careful when providing contact information. Listing an incorrect phone number or email can prevent the DMV from reaching out for any clarifications or additional information needed to process the application. Ensuring that all contact details are accurate is essential for a smooth application experience.
The MV-145A form is essential for applying for a person with a disability parking placard. However, several other forms and documents may accompany it during the application process. Each document serves a specific purpose and helps ensure that the application is complete and accurate.
Collecting these documents can streamline the application process for a disability parking placard. Ensuring all necessary paperwork is in order will help avoid delays and improve the chances of approval.
The MV-145A form serves as an application for a person with a disability parking placard in Pennsylvania. Several other documents share similarities with this form, particularly in their purpose and the information they require. Below is a list of nine documents that are comparable to the MV-145A form, highlighting their similarities:
Understanding these documents can simplify the process of applying for various benefits and privileges related to disability and vehicle registration. Each form plays a crucial role in ensuring that individuals receive the accommodations they need.
When filling out the MV-145A form, it is important to follow certain guidelines to ensure a smooth application process. Here are six key dos and don'ts:
Following these guidelines can help avoid delays and ensure that your application is processed efficiently.
Understanding the MV 145A form, which is the application for a person with a disability parking placard in Pennsylvania, can be challenging. Here are some common misconceptions about this form:
Clearing up these misconceptions can help applicants navigate the process more smoothly and ensure they receive the benefits they need.
When completing the MV-145A form for a Person with Disability Parking Placard, consider the following key takeaways: