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Blank Application Access Ride PDF Form

The Application Access Ride form is a crucial document for individuals seeking to utilize the MTA New York City Transit’s paratransit service, Access-A-Ride. This service offers door-to-door transportation for those who cannot use public transit due to physical or mental disabilities. Completing this application accurately is essential for determining eligibility, so please ensure you fill it out thoroughly before your scheduled evaluation.

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Article Guide

The Application Access Ride form is a crucial document for individuals seeking access to MTA New York City Transit’s paratransit service, known as Access-A-Ride. This service is designed for those who cannot use public transit due to physical or mental disabilities. The form serves multiple purposes, including new applications and recertifications, and requires the applicant to provide personal information, including their name, address, and contact details. A photograph taken within the last three years is also necessary for the identification card. It is important to complete the form accurately, as any incomplete submissions may result in the need to reschedule evaluations. The application process involves attending an in-person evaluation at a designated center, where further documentation may be requested to verify eligibility. The form also emphasizes the confidentiality of the information provided, which is used solely to determine eligibility and any special assistance needed. Applicants must understand that their Access-A-Ride card will expire five years from the date of issuance, and they must notify the transit authority if their need for paratransit services changes. Clear instructions are provided for those who may need assistance completing the form, ensuring that the process is accessible to everyone.

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ACCESS-A-RIDE SERVICE APPLICATION

❑ New Application

❑ Recertification: ID Number ____________________________

MTA New York City Transit’s paratransit service, Access-A-Ride, provides door-to-door transportation within New York City on an advance reservation basis to persons who, because of a physical or mental disability, are unable to use public transit buses or subways.

INSTRUCTIONS

You must complete this application and bring it with you to the scheduled evaluation at the offices of the professional certifier selected by NYC Transit listed in the cover letter. Please give the completed application and any supporting documents to the professional certifier.

If a question does not apply to you, clearly mark N/A in the space provided. If you have any questions while completing this application, please call 877-337-2017 and when the recorded message begins press “1” for English and “1” for Eligibility. If you are unable to complete the form yourself, it can be completed by someone you choose to assist you. It may take up to 3 weeks to process your application.

One (1) photograph taken within the last three years must be submitted with this application for use on your identification card. Please see the box below for required size. The photograph must have a solid background and show a full view of your face. Please write your name on the back of the photograph. If you do not bring

the photograph with you to the evaluation center, the application process cannot be completed.

All of the information you provide will be used solely for the purpose of determining your eligibility, and any special assistance you may need when using paratransit. The information that you furnish will be kept strictly confidential.

Once issued, an Access-A-Ride paratransit service card expires five (5) years from the date it was issued, unless otherwise indicated.

Do you need information in an alternate format?

Check one: ❑ Large Print	❑ Audio Tape	❑ Braille
❑ E-mail _________________________________			2"
Address
Your evaluation will not take place if you arrive at the evaluation
center with an incomplete application. You will have to
reschedule your evaluation and you may not be provided with

				1 1/2"
transportation for the rescheduled evaluation.
transportation for the rescheduled evaluation.

For External Certifier’s Use

Initials _________________________

Date ____________________________

For NYCT Office Use

Application #: ______________________

Date Entered: ______________________

By: ______________________________

AGREEMENT TO ELIGIBILITY TERMS AND CONDITIONS (ALL APPLICANTS MUST SIGN THIS AGREEMENT)

I understand that as a part of the application process I must attend an in-person evaluation at the offices of a professional certifier selected by NYC Transit.

I understand that MTA NYC Transit reserves the right to request additional proof of my disability or my inability to use public buses and subways.

I understand that my application will not be accepted at the evaluation center if it is not complete.

I affirm that all of the information that I provide on this application is true to the best of my knowledge. I understand that my application is subject to review and verification, including verification after my Access-A-Ride card has been issued, and that misrepresentation of any material information will lead to termination of my eligibility.

I agree to notify NYC Transit at 877-337-2017 if I no longer need paratransit service for any reason, including a change in my ability to use bus and subway service. I also understand that my failure to cooperate with a request for additional information to verify statements made on my application after my Access-A-Ride card has been issued will be grounds for suspension or termination of my eligibility for paratransit service. I further understand that my failure to adhere to the policies and procedures for using Access-A-Ride are also grounds for suspension or termination of my eligibility for paratransit service.

_____________________________________________	_____________________________________________
Applicant’s Signature	Date

If someone other than the applicant has completed this application, please provide the following information:

_____________________________________________	_____________________________________________
Name	Relationship to Applicant
_____________________________________________	_____________________________________________
Telephone Number	Date

REQUIRED IDENTIFICATION INFORMATION (PLEASE PRINT CLEARLY)

____________________________________ ____________________________________				___________
Last Name	First Name			M.I.
________________________________________________________			______________________________
Street Address			Apt. No.
_______________________________________________		_______	_______________________________
City/Borough		State	Zip Code

________________________________________________ and ____________________________________________

Cross Streets

___________-_____________-_____________________		__________-_____________-______________________
Home Telephone Number		Work Telephone Number
______________________________________________		__________-_____________-______________________
E-mail Address		Cell Phone Number
_________-__________-__________	Sex: ______	______
Date of Birth	Male	Female

If your mailing address is different from your home address, please complete the following:

(Otherwise leave blank)

____________________________________________________________		_____________________________
P.O. Box or Street Address		Apt. No.
______________________________________________________	________________		__________________
City/Borough	State		Zip Code

Person to Contact in Case of Emergency: (This section must be completed.)

____________________________	____________________________ _______
Last Name	First Name	M.I.
_____________-____________-__________		_____________-____________-__________
Home Telephone Number		Work Telephone Number

Relationship to Applicant: _______________________________________

APPLICATION FORM

1.How do you currently travel? (Check all that apply)

❑ Public Transit Bus ❑ Subway ❑ School Bus ❑ Walking ❑ Automobile

❑Access-A-Ride ❑ Commuter Railroad

❑ Ambulette

❑ Taxi/Car Service

❑ Other: ____________________________________________

2.Are you registered with the MTA Reduced-Fare program?

❑ Yes

❑ No

3.Do you have a MetroCard? (Check all that apply)

❑Yes, I use my MetroCard when traveling by bus

❑Yes, I use my MetroCard when traveling by subway

❑No, I don’t have a MetroCard

4.Is your disability:

❑ Permanent ❑ Temporary ❑ I don’t know

5.If temporary, please indicate how long you believe the temporary disability will continue.

❑2 months ❑ 3 months ❑ 6 months

❑Other (Specify): ___________________________________

6.Indicate which support device(s) you use when traveling or walking outside your home.

❑I do not require a support device

❑ Respirator/Oxygen Tank	❑ Walker	❑ Braces
❑ Support Cane	❑ Scooter*	❑ Crutches

❑Prosthesis

❑Service Animal (an animal that provides assistance)

❑Manual Wheelchair*

❑Motorized Wheelchair*

❑Other (Specify) ______________________________________________

*Access-A-Ride vehicles can only accommodate a wheelchair or scooter that is less than 33.5 inches in width and 51 inches in length and does not weigh more than 800 pounds when occupied.

7.If you have a service animal, indicate the tasks(s) your service animal performs for you.

❑Guides me (vision impairment)

❑Alerts me (hearing impairment)

❑Pulls me (manual wheelchair)

❑Carries items for me

❑Other (Specify): _____________________________

8.Have you received training to use public transit buses or subways?

❑ Yes

❑ No ❑ No, I would like training

❑I am in the training process

9.Would you be able to travel by bus or subway if Access-A-Ride took you from: (Check all that apply)

❑your home to a bus stop

❑the bus stop to your home

❑your destination back to the bus stop

❑your home to an accessible subway station

❑the accessible subway station to your home

❑your destination back to the accessible subway station

❑Not applicable

10.a. How far from your home is the nearest public transit bus stop?

❑ Less than 1 block ❑ 1 to 2 blocks ❑ 3 to 4 blocks ❑ 5 or more blocks

Identify location of public transit bus stop:

___________________________________________________________________________

b. How long does it take you to walk to the nearest public transit bus stop?

❑ Less than 5 minutes	❑ 5-10 minutes
❑ More than 10 minutes	❑ Not sure

11.On your own or using a support device, are you able to get to and from the public transit bus stop nearest your home?

❑ Yes

❑ No

❑Sometimes—describe the circumstances:

___________________________________________________________________________

12.On your own or using a support device, can you get on, ride, and get off a public transit bus when the “kneeler” is lowered (a kneeler is a device that lowers the front of the bus)?

❑ Yes

❑ No

❑ Sometimes—describe the circumstances: _______________________________________________________________________________

13.How often do you travel on public transit buses?

❑	Daily ❑ Weekly ❑ Monthly
❑	Occasionally ❑ Never

If you have used a public transit bus in the past, when did you stop?

____________ (Mo./Yr.)

Why did you stop traveling by public transit bus?

_________________________________________________________________________________________________________________

14.If you cannot walk up the steps on a bus or use the kneeler, are you able to use the bus lift? (Please note that persons who cannot climb the bus steps have the right to enter the bus by standing on the lift.)

❑ Yes ❑ No

❑ Sometimes ❑ Don’t Know

15.Are you able to identify and understand the destination and route number signs on public transit buses?

❑ Yes

❑ No

❑Only when the bus operator announces them

❑Sometimes—describe the circumstances: _______________________________________________________________

16.Are you able to determine when you have reached your destination to get off the public transit bus?

❑ Yes ❑ No

❑Only when the bus operator announces the stop

❑Sometimes—describe the circumstances:

______________________________________________________________________________________________________________________________________________________________________

17.a. How far from your home is the nearest subway station?

❑ Less than 1 block ❑ 1 to 2 blocks

❑3 to 4 blocks ❑ 5 or more blocks

Identify location of subway station:

_______________________________________________

b. How long does it take you to walk to the nearest subway station?

❑	Less than 5 minutes	❑ 5-10 minutes
❑	More than 10 minutes	❑ Not sure

18.On your own or using a support device, are you able to get to and from the subway station nearest your home?

❑ Yes

❑ No

❑ Sometimes—describe the circumstances:

_________________________________________________________________________________________________________

19.On your own or using a support device, can you ride on an escalator?

❑ Yes ❑ No

❑ Sometimes—describe the circumstances: _________________________________________________________________

20.On your own or using a support device, are you able to go to and from the station platform and the street entrance?

❑ Yes

❑ No

❑Sometimes—describe the circumstances: _____________________________________________

❑Only if equipped with an elevator

21.On your own or using a support device, how far can you travel on a level street? Please answer in city blocks.

❑	Less than 1 block	❑ 1 to 2 blocks
❑	3 to 4 blocks	❑ 5 or more blocks

22.On your own or using a support device, can you get on, ride and get off a subway train?

❑ Yes ❑ No

❑Sometimes—describe the circumstances: ________________________________________

23.Are you able to determine surfaces (platform, top or bottom of stairs) in a subway station?

❑ Yes ❑ No

❑ Sometimes—describe the circumstances: ______________________________________________________

24.Are you able to identify and understand the destination and subway line signs?

❑ Yes ❑ No

❑Sometimes—describe the circumstances:

_______________________________________________________

25.Are you able to determine when you have reached your destination to get off the subway?

❑ Yes ❑ No

❑Sometimes—describe the circumstances:

______________________________________________________

❑Only when the conductor announces the stop

26.How often do you travel using the subway?

❑Daily ❑ Weekly ❑ Monthly ❑ Occasionally

❑Not at All

If you have used the subway in the past, when did you stop using it?

___________(Mo./Yr.)

Why did you stop traveling by subway?

______________________________________________________________________________

27.a. Do you currently travel with a Personal Care Attendant (PCA), a person such as a home attendant who assists you regularly when you travel outside your home?

❑ Yes

❑ No

❑Sometimes—describe the circumstances:

__________________________________________________________________________________

❑I don’t have a Personal Care Attendant

b.If you do need the assistance of a PCA to travel, what kind of traveling assistance does the PCA provide and what specifically does the PCA do for you when he/she travels with you?

_____________________________________________________________________________________________________________

28.If you are unable to take some or all of your trips by public transit bus or subway, check off the reasons below. (Check all that apply)

❑Not applicable

❑I feel unsafe traveling by public transit bus

❑I do not like traveling by city buses

❑Distance to public transit bus is too long

❑I do not like traveling by subway

❑I feel unsafe traveling by subway

❑Distance to subway is too long

❑Subway station has no elevators

❑No curb cuts

❑No paved sidewalks

❑Inclement weather

❑Extreme cold

❑Hilly streets

❑Extreme heat

❑I cannot travel to an unfamiliar place

(The application continues on Page 9).

29.a. From the following list, please check off all disabilities or conditions that prevent you from boarding, riding or disembarking from public transit buses or subways.

Cardiovascular/Pulmonary				Neuromuscular
Angina			___	ALS/Lou Gehrig’s Disease		___
Arteriosclerosis/Atherosclerosis			___	Cerebral Palsy		___
Asthma			___	Charcot-Marie Tooth Syndrome		___
Bypass Surgery:	Date: _________________			Equilibrium		___
Chronic Obstructive Pulmonary Disease			___	Fibromyalgia		___
Congestive Heart Failure			___	Hemiplegia/Hemiparesis		___
Cystic Fibrosis			___	Multiple Sclerosis		___
Emphysema			___	Muscular Dystrophy		___
Heart Attack:	Date: _________________			Neuropathy		___
HTN/Hypertension			___	Paraplegia		___
Peripheral Vascular Disease			___	Parkinson’s Disease		___
Phlebitis			___	Polio		___
Thrombosis			___	Quadriplegia		___
Other: ___________________________________				Sciatica		___
				Spina Bifida		___
General Medical				Stroke/Cerebral Trauma:	Date: ___________
AIDS			___	TIA’s (Transient Ischemic Attack)		___
Atrophy			___	Other: ___________________________________________
Chemotherapy Treatment dates: _______________
_________________________________________				Orthopedic
Diabetes			___	Amputation: specify extremity (ies) __________
Edema			___	_________________________________________________
Epilepsy			___	Broken/Fracture: __________ Date: ___________
HIV			___	Degenerative Joint Disease		___
Lupus			___	Gout		___
Rheumatoid Arthritis			___	Hip Replacement		___
Kidney Dialysis			___	Knee Replacement		___
Radiation Treatment dates: ___________________				Osteoarthritis		___
________________________________________				Osteoporosis		___
Other: __________________________________				Scoliosis		___
				Spondylitis		___
Vision [Specify eye (s)]		One Eye	Both Eyes	Other: __________________________________
Cataracts		___	___
Cortical Blindness		___	___	Cognitive/Psychological
Glaucoma (all types)		___	___	Alzheimer’s Disease		___
Macular Degeneration		___	___	ADD/Attention Deficit Disorder		___
Retinal Detachment		___	___	Autism		___
Legally Blind		___	___	Dementia		___
Totally Blind		___	___	Head Trauma		___
Other: ________________________________				Mental Retardation		___
				Panic Disorder		___
				Schizophrenia		___
				Other: __________________________________

Toll free from area codes 212, 646, 718, 347, 516, 631, 914, 845

(Press “1” for English and “1” for Eligibility when the recorded message begins.) From all other area codes

b. For each disability or condition checked on previous page, please describe how it prevents you from boarding, riding or disembarking from public transit buses or subways. You may also include medical documentation to support your disability.

_________________________________________________________________________________________________________________________

c. Bring a copy of medical documentation that verifies your transportation related disability to the in-person assessment.

❑CHECK HERE IF YOU ARE NOT BRINGING MEDICAL DOCUMENTATION TO THE IN-PERSON ASSESSMENT.

30.From your residence, what are the addresses of your three (3) most frequent destinations?

			How Often Do You Travel
			To This Location (Specify)?
Destination Address	Cross Streets	Borough	Daily	Wkly	Mthly

1.


2.


3.

If you have any questions, please contact Access-A-Ride Customer Information between 9 AM and 5 PM, Monday through Friday.

877-337-2017

718-393-4999

Customers who are deaf call through the relay.

PLEASE REMEMBER THAT YOU MUST:

■Submit one (1) photograph measuring 2" x 11/2" that has been taken within the last three (3) years.

■Complete and sign the Agreement section.

■Complete the application answering every question, and bring it with you when you go to the evaluation center.

10	134_10__14pt_MA

➤ PDF File

Form Specifications

Fact Name	Description
Eligibility Requirements	The Access-A-Ride application is designed for individuals with physical or mental disabilities who cannot use public transit. Applicants must attend an in-person evaluation to determine their eligibility.
Confidentiality Assurance	All information provided in the application is kept strictly confidential. It is used solely for assessing eligibility and any special assistance needed.
Processing Time	After submitting the application, it may take up to three weeks to process. Applicants must ensure their application is complete to avoid delays.
Expiration of Service Card	Once issued, the Access-A-Ride paratransit service card is valid for five years. It is important to renew it before the expiration date to continue receiving services.

Application Access Ride: Usage Guidelines

Completing the Application Access Ride form is a crucial step in securing transportation services tailored to your needs. After you fill out the form, you will need to bring it to your scheduled evaluation with a professional certifier. Make sure to provide any required documents and a recent photograph, as these are essential for the processing of your application.

Begin by indicating whether this is a New Application or Recertification. If it is a recertification, write your ID number in the space provided.
Fill in your required identification information clearly. This includes your last name, first name, middle initial, address, city, state, zip code, and contact numbers.
Specify your preferred format for receiving information, if applicable, by checking one of the options: Large Print, Audio Tape, Braille, or E-mail.
Sign the Agreement to Eligibility Terms and Conditions section, affirming that you understand the requirements and agree to comply with them.
Complete the Application Form by answering all questions regarding your travel habits, disability status, and ability to use public transit. Make sure to check all that apply.
If you have a service animal, indicate the tasks it performs for you in the appropriate section.
Provide information about your ability to travel to and from public transit bus stops, including distance and time taken to walk.
Answer questions about your experience with public transit, including how often you travel and any challenges you face.
Attach a recent photograph of yourself that meets the specified requirements. Ensure your name is written on the back of the photo.
Review the completed application for accuracy and completeness. Make sure all necessary sections are filled out, and mark any non-applicable questions with "N/A."

Once the form is filled out, gather any additional documents you may need, and prepare to present everything at your evaluation appointment. Keep in mind that an incomplete application may lead to delays in processing your request for transportation services.

Your Questions, Answered

What is the Application Access Ride form used for?

The Application Access Ride form is used to apply for the MTA New York City Transit’s Access-A-Ride service. This service provides door-to-door transportation for individuals who cannot use public transit due to a physical or mental disability. By completing this form, you are taking the first step toward accessing this important transportation option within New York City.

How long does it take to process the application?

Once you submit your completed application, it may take up to three weeks for processing. During this time, the information you provided will be reviewed to determine your eligibility for Access-A-Ride services. It's important to ensure that your application is complete to avoid delays.

What should I bring to the evaluation appointment?

When you attend your scheduled evaluation, you must bring your completed application along with any supporting documents. Additionally, you need to provide a recent photograph of yourself that meets specific requirements. This photo will be used for your identification card. If you arrive without the necessary items, your evaluation may need to be rescheduled.

What happens if my application is incomplete?

If your application is incomplete when you arrive at the evaluation center, the evaluation cannot take place. You will have to reschedule your appointment, and you may not receive transportation for this new date. To avoid this, double-check that all sections of the application are filled out and that you have all required documents before your visit.

Common mistakes

Incomplete Information: Many applicants fail to fill out all required sections of the form. Leaving blanks can lead to delays or even rejection of the application. It is crucial to provide complete answers for every question.
Missing Signature: Some individuals forget to sign the application. Without a signature, the application cannot be processed. Ensure that the applicant signs the agreement to eligibility terms and conditions before submission.
Not Including a Photograph: A recent photograph is mandatory for the application. Applicants often forget to attach this photograph, which can halt the process. Remember to include a photo taken within the last three years with a solid background.
Failure to Mark N/A: If a question does not apply, some people leave it blank instead of marking it as N/A. This can create confusion during the evaluation process. Clearly indicate N/A for any questions that do not pertain to you.

Documents used along the form

The Application Access Ride form is an essential document for individuals seeking paratransit services in New York City. Along with this application, several other forms and documents may be required to ensure a smooth application process. Below is a list of these documents, each described briefly for clarity.

Eligibility Verification Form: This form is used to provide additional proof of disability or inability to use public transportation. It may require medical documentation or other relevant information.
Photo Identification: A government-issued ID is often required to verify the applicant's identity. This could include a driver's license, state ID, or passport.
Medical Certification: A document from a healthcare provider confirming the applicant's disability status. This certification helps support the application for paratransit services.
Emergency Contact Information Form: This form collects details about a person to contact in case of emergencies during transportation. It is crucial for ensuring safety and communication.
Service Animal Documentation: If the applicant uses a service animal, documentation may be needed to confirm the animal's training and the tasks it performs for the individual.
Consent for Release of Information: This document allows the paratransit service to obtain necessary information from healthcare providers or other relevant sources to support the application.
Recertification Application: For individuals whose Access-A-Ride service is expiring, this form is necessary to renew eligibility. It typically requires updated information and documentation.

Gathering these documents in advance can facilitate a more efficient application process. It is important to ensure that all forms are completed accurately and submitted on time to avoid delays in receiving paratransit services.

Similar forms

Disability Certification Form: This document is often required to verify an individual's disability status. Like the Application Access Ride form, it collects personal information and may necessitate an in-person evaluation to confirm eligibility for services.
Medical Release Form: Similar to the Application Access Ride form, this document allows healthcare providers to share medical information with relevant agencies. Both forms require signatures and may involve the submission of supporting documents to establish eligibility for assistance.
Transportation Needs Assessment: This form evaluates an individual's specific transportation requirements. It parallels the Application Access Ride form by gathering detailed information about mobility challenges and travel preferences, which helps determine suitable transportation options.
Paratransit Eligibility Application: This document serves a similar purpose by assessing an individual's qualifications for paratransit services. Both applications require personal information and may involve a review process to validate the applicant's claims regarding their ability to use public transit.
Service Animal Registration Form: This form is used to register service animals that assist individuals with disabilities. It shares similarities with the Application Access Ride form in that it requires detailed information about the individual and the specific tasks the service animal performs.
Reduced-Fare MetroCard Application: Like the Application Access Ride form, this application is designed to assess eligibility for discounted transit fares based on disability status. Both forms require personal information and may necessitate proof of disability to qualify for the program.

Dos and Don'ts

When completing the Application Access Ride form, it is essential to approach the process with care and attention to detail. Below is a list of things you should and shouldn't do to ensure a smooth application experience.

Do ensure all sections of the application are filled out completely. Incomplete forms may lead to delays or the need to reschedule your evaluation.
Do provide a recent photograph. Remember to bring a photograph that meets the specified requirements, as the application cannot be processed without it.
Do mark any questions that do not apply to you as N/A. This helps clarify your responses and avoids confusion.
Do ask for help if needed. If you find it challenging to complete the form, seek assistance from someone you trust.

Don't forget to sign the application. Your signature is necessary to affirm that the information you provided is true.
Don't submit the application without reviewing it first. Take a moment to double-check for any errors or missing information.
Don't bring the application without the required identification documents. Ensure you have all necessary documents ready for the evaluation.
Don't hesitate to contact the support line for assistance. If you have questions while filling out the form, reach out for help.

Misconceptions

Misunderstandings about the Application Access Ride form can lead to confusion and delays in obtaining necessary transportation services. Here are some common misconceptions clarified:

Misconception 1: The form can be submitted without a photograph.

Many believe that a photograph is optional. In reality, a recent photograph is a required part of the application. Without it, the process cannot be completed.

Misconception 2: The application can be filled out at the evaluation center.

Some individuals think they can complete the application at the evaluation site. However, the form must be fully completed beforehand to avoid rescheduling.

Misconception 3: Anyone can complete the application for the applicant.

While it is true that someone may assist, the applicant must ensure that the information provided is accurate and truthful.

Misconception 4: The application process is instantaneous.

Many expect immediate results. However, processing can take up to three weeks, so it's important to apply well in advance of needing services.

Misconception 5: All disabilities qualify for Access-A-Ride.

Not all disabilities meet the eligibility criteria. The service is specifically for individuals who cannot use public transit due to their disability.

Misconception 6: Providing incomplete information won’t affect the application.

Some may think minor omissions are acceptable. Incomplete applications will lead to delays or even a requirement to reschedule the evaluation.

Misconception 7: The application is only about physical disabilities.

While physical disabilities are a focus, mental disabilities also qualify for Access-A-Ride services. It's essential to be honest about all limitations.

Misconception 8: The Access-A-Ride card lasts indefinitely.

Many assume that once they have the card, it is permanent. In fact, the card expires every five years and requires recertification.

Misconception 9: Providing personal information is unnecessary.

Some applicants may feel hesitant to share personal details. However, all information is crucial for determining eligibility and ensuring appropriate services.

Key takeaways

Here are key takeaways regarding the Application Access Ride form:

The Access-A-Ride service is designed for individuals unable to use public transit due to physical or mental disabilities.
Complete the application before attending the evaluation at the designated professional certifier's office.
If a question does not apply to you, indicate "N/A" in the space provided.
It is essential to submit a recent photograph with your application; without it, the process cannot proceed.
All information provided will be kept confidential and used only to determine eligibility and any special assistance needed.
Expect processing of your application to take up to three weeks.
Applications must be complete; arriving with an incomplete form will require rescheduling your evaluation.
Access-A-Ride cards expire five years after issuance, unless stated otherwise.
Notify NYC Transit promptly if you no longer require paratransit service for any reason.