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The BFS 108 Michigan form is a crucial document for individuals seeking a disability parking placard in the state of Michigan. This application process is designed to ensure that those with qualifying disabilities can access parking spaces that accommodate their needs. The form is divided into several parts, each serving a specific purpose. Part 1 requires applicants to provide personal information and authorize the release of medical information. This is essential for verifying eligibility. Part 2 focuses on medical eligibility, where a licensed healthcare professional must confirm the applicant's condition that limits their mobility. For those who qualify, Part 3 addresses the potential for free parking, contingent on additional medical criteria. Organizations that provide transportation services for disabled individuals can complete Part 4, allowing them to request placards for their vehicles. It’s important to note that the application must be filled out accurately, as any false statements can lead to serious penalties. Once completed, the form can be submitted at any Secretary of State branch office or mailed to the appropriate address. Understanding the requirements and process outlined in the BFS 108 form is vital for those in need of accessible parking options.

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MICHIGAN DEPARTMENT OF STATE

Disability Parking Placard Application

Directions:

Office Use Only:

Expiration

Date:

Placard

Number:

Applicants please complete and sign Part 1. Your physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant must complete Part 2 and the certification on the bottom of this page. If you also qualify for free parking, your physician, chiropractor, optometrist, nurse practitioner, physician’s assistant, or physical therapist must also complete Part 3. Organizations applying for parking placards to provide transportation services for disabled persons complete Part 4. Completed applications may be presented at any Secretary of State branch office or mailed to the address on the reverse side of this form. (Application cannot be processed without signed release of information and physician’s certification.)

Part 1: Release of Information and Signature

I am applying for a disability parking placard as provided in Public Act 300 of 1949. I authorize the release of the medical information described below to the Michigan Department of State. I certify the information is true and realize by making a false statement on this application I am subject to the penalties described on the reverse side of this form.

 

PLEASE PRINT OR TYPE INFORMATION REQUESTED

 

Print Form

Clear Form

 

Asterisks (*) indicate required fields.

 

 

 

 

 

 

 

 

 

 

 

 

Name (First, Middle, Last)*

 

Date of Birth*

Michigan Driver’s License or State ID Card #*

 

 

 

 

 

 

 

Street Address*

 

County*

 

Disability Plate Number (if any)*

 

 

 

 

 

 

City, State, Zip*

 

Daytime Phone Number*

Last Parking Permit Number

 

 

(

)

 

 

 

Signature of Disabled Person*

 

Today’s Date*

Are you a Michigan resident?*

X

 

 

 

 

YES

NO

Signature of Representative (If presented by representative)*

 

Representative’s Driver’s License Number*

X

 

 

 

 

 

 

Part 2: Medical Eligibility Standards and Physician’s Determination

The Michigan Vehicle Code [MCL 257.19a] states that a disabled person be determined by a licensed physician, physician’s assistant, chiropractor, nurse practitioner, physical therapist, or optometrist identifying one or more of the following characteristics which affect your patient’s ability to walk.

Circle all letters that apply*

Right Eye:

 

Left Eye:

 

Both Eyes:

Visual field (in degrees):

a) Blindness. Corrected acuity level:

20/

 

20/

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b)An inability to walk more than 200 feet without having to stop and rest. Please provide the diagnosis for this ambulatory disability:

____________________________________________________________________________________________________________________

c)Patient must use a wheelchair, walker, crutch, brace, or other ambulatory aid to walk. Describe:

d)Patient has a lung disease from which the forced expiratory volume for one second, when measured by spirometry, is less than one liter, or from which the arterial oxygen tension is less than 60mm/hg of room air at rest.

e)Patient has a cardiovascular condition which measures between 3 and 4 on the New York Heart Classification Scale, or which renders the patient incapable of meeting a minimum standard for cardiovascular health established by the American Heart Association and approved by the Michigan Department of Health and Human Services.

f)Patient has an arthritic, neurological, or orthopedic condition that severely limits ability to walk. Describe:

g)Patient has persistent reliance upon an oxygen source other than ordinary air.

Physician’s Certification

A parking placard will be issued solely on the physician’s evaluation

 

 

 

 

 

 

 

 

Patient’s condition is*:

Permanent

Temporary

If temporary, estimated duration:

 

months (maximum 6 months)

 

 

 

 

 

Physician’s Name*

 

 

Medical Specialty*

Office Telephone*

 

 

 

 

 

 

 

Street Address*

 

 

City, State, Zip*

 

Office Fax*

 

 

 

 

 

 

 

 

 

I certify the person listed above is eligible for a disability placard as provided in Public Act 300 of 1949. I also understand that making a false statement to obtain a disability parking placard is a misdemeanor and may result in fines, imprisonment, or both.

Medical License Number**

Physician’s Signature*

Date*

 

X

 

**If the medical license was issued in a state other than Michigan, the Physician/Physical Therapist must submit a copy of their medical license.

NOTE: If the individual listed above is also eligible for free parking, Part 3 on the reverse side of this application must also be completed.

BFS-108 (10/19/2023)

Page 1

Part 3: Free Parking Application and Physician’s Certification

(Complete Parts 1, 2, and 3)

The free parking application is completed only when the applicant qualifies for free parking. To qualify, your patient must be a Michigan licensed driver, have an ambulatory disability described in Part 2, and have one of the following conditions. Economic need is not a consideration.

Circle all letters that apply:

a)The patient cannot insert coins or tokens in a parking meter or cannot accept a ticket from a parking lot machine due to a lack of fine motor control of both hands.

b)The patient cannot reach above their head to a height of 42 inches from the ground, due to a lack of finger, hand, or upper extremity strength or mobility.

c)The patient cannot approach a parking meter due to use of a wheelchair or other ambulatory device.

d)The patient cannot walk more than twenty feet due to an orthopedic, cardiovascular, or lung condition in which the degree of debilitation is so severe that it almost completely impedes the patient’s ability to walk. (A condition requiring applicant to rest after walking twenty feet when not using a wheelchair or other ambulatory device.)

I certify the person listed on the front of this application is also eligible for free parking as provided in state law [MCL 257.675]. I understand that making a false statement to obtain a free parking sticker is a misdemeanor and may result in fines, imprisonment, or both.

Physician’s signature: X

 

 

 

 

 

Date

 

 

 

 

(Physician / Chiropractor / Physician’s Assistant / Optometrist / Nurse Practitioner / Physical Therapist)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 4: Organization Request for Disability Parking Placards

 

 

 

 

 

 

 

 

PLEASE PRINT OR TYPE INFORMATION REQUESTED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Organization

 

 

FEIN

County

 

Telephone Number

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

City, State, Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe the transportation services your organization provides to persons with disabilities:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of disability placards you are requesting:

 

 

 

(No more than one per vehicle used to transport clients.)

 

 

 

I am applying for a disability parking placard as provided in Public Act 300 of 1949 and certify the above information is true.

 

 

 

 

 

 

 

Signature of Organization Officer

 

Printed Name of Organization Officer

 

 

 

Date

X

 

 

 

 

 

 

 

 

 

 

Organization Officer’s Driver’s License Number

 

Position (Title) Within Organization

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note: If the organization ceases to provide specialized services to disabled persons, the parking placard must be returned to the Secretary of State for cancellation.

Penalties

Michigan Vehicle Code Section 257.676 prohibits:

•Using a disability parking placard to park in a designated parking space unless the disabled person is driving or being transported.

•Altering, modifying, or selling a disability parking placard or free parking sticker.

•Copying or forging, or using a copied or forged disability parking placard or free parking sticker.

•Making a false statement to obtain a disability parking placard or free parking sticker or committing a deception or fraud on a medical statement attesting to a disability.

•Knowingly using or displaying a disability parking placard that has been canceled by the Secretary of State.

A violation is a misdemeanor and punishable by a fine up to $500 or imprisonment for up to 30 days, or both. A law enforcement officer may immediately confiscate a disability parking placard for improper use.

Return completed applications to any Secretary of State branch office or mail to:

Michigan Department of State

 

Internal Services Section

 

PO Box 30764

 

Lansing, MI 48918

If you have any questions regarding disability parking placards, please call the Department of State Information Center at 1-888-767-6424.

The personally identifiable information collected on this form will be used by MDOS to complete the requested transaction. MDOS limits the amount of personally identifiable information to only that information which is relevant and necessary to complete your transaction. Please be aware that under the Federal Driver’s Privacy Protection Act, 18 U.S.C. 2751, et seq. and the Michigan Driver’s Protection law, MCL 257.208c, your personal information may be provided to third parties without additional prior notice or consent when permitted or required by law. As a public body, MDOS is subject to the Michigan Freedom of Information Act (FOIA), MCL 15.231 et seq., and information such as a name or address may be disclosed in response to a FOIA request pursuant to law.

Authority granted under Public Act 300 of 1949, as amended.

BFS-108 (10/19/2023)

Page 2
➤ PDF File

Form Specifications

Fact Name Description
Purpose The BFS 108 Michigan form is used to apply for a disability parking placard, allowing individuals with qualifying disabilities to park in designated spaces.
Governing Law This form is governed by Public Act 300 of 1949 and the Michigan Vehicle Code (MCL 257.675).
Eligibility Requirements Applicants must provide medical certification from a licensed healthcare provider confirming their disability, which affects their ability to walk.
Application Submission Completed applications can be submitted at any Secretary of State branch office or mailed to the designated address provided on the form.
Penalties for Misuse Misuse of a disability parking placard can lead to a misdemeanor charge, resulting in fines up to $500 or imprisonment for up to 30 days.

Bfs 108 Michigan: Usage Guidelines

Filling out the Bfs 108 Michigan form is a straightforward process, but it requires careful attention to detail. After completing the form, applicants will need to submit it either in person at a Secretary of State branch office or by mailing it to the designated address. Ensure all required sections are filled out accurately to avoid delays in processing.

  1. Part 1: Release of Information and Signature
    • Write your full name (First, Middle, Last).
    • Enter your date of birth.
    • Provide your Michigan driver's license or ID card number.
    • Fill in your street address, city, state, and zip code.
    • Indicate your county.
    • If applicable, enter your disability plate number.
    • Provide your daytime phone number.
    • Enter your last parking permit number.
    • Answer the questions about having a CDL endorsement and medical waiver.
    • Confirm if you are a Michigan resident by checking the appropriate box.
    • Sign and date the application. If a representative is submitting on your behalf, they must also sign and provide their driver's license number.
  2. Part 2: Medical Eligibility Standards and Physician’s Determination
    • Have your physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant complete this section.
    • Circle all relevant characteristics that apply to your condition.
    • Provide a diagnosis for your ambulatory disability if applicable.
    • Indicate if your condition is permanent or temporary, and if temporary, provide the estimated duration.
    • Your physician must sign and date this section, and include their medical license number.
  3. Part 3: Free Parking Application and Physician’s Certification
    • This section is only for applicants who qualify for free parking.
    • Your physician must circle all applicable conditions that apply to your ability to park.
    • Have your physician sign and date this section as well.
  4. Part 4: Organization Request for Disability Parking Placards
    • If you are applying on behalf of an organization, provide the organization's name, county, and telephone number.
    • Fill in the street address, city, state, and zip code of the organization.
    • Describe the transportation services your organization provides to persons with disabilities.
    • Indicate the number of disability placards you are requesting (maximum of one per vehicle).
    • Have an officer of the organization sign and date this section, and provide their driver’s license number and position.
  5. Submission
    • Review the completed form for accuracy.
    • Submit the form in person at any Michigan Department of State branch office or mail it to the specified address.

Your Questions, Answered

What is the BFS 108 Michigan form used for?

The BFS 108 Michigan form is an application for a disability parking placard. This form allows individuals with disabilities to request a placard that grants them access to designated parking spaces, ensuring they have easier access to facilities and services. The form must be completed by both the applicant and a qualified medical professional who can certify the applicant's disability.

Who can complete the medical certification section of the form?

The medical certification section of the BFS 108 form must be completed by a licensed physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant. This professional must assess the applicant's condition and confirm that it meets the eligibility criteria outlined in the form.

What information do I need to provide in Part 1 of the form?

In Part 1, you need to provide personal details such as your name, date of birth, Michigan driver's license or ID card number, street address, county, city, state, and zip code. Additionally, you must indicate whether you have a commercial driver's license (CDL) and if you have a medical waiver. You must also sign the form to authorize the release of your medical information and certify that the information provided is accurate.

What conditions qualify for a disability parking placard?

Eligibility for a disability parking placard includes various conditions that affect an individual's ability to walk. These may include blindness, an inability to walk more than 200 feet without resting, reliance on ambulatory aids like wheelchairs or walkers, certain lung diseases, cardiovascular conditions, and severe orthopedic or neurological conditions. The medical professional will need to identify and certify these conditions on the form.

Can I apply for free parking in addition to the disability placard?

Yes, if you qualify for a disability parking placard, you may also be eligible for free parking. To apply for free parking, your medical professional must complete Part 3 of the form, which requires additional information about your ability to use parking meters and your mobility limitations. Economic need is not a factor in this determination.

What happens if I provide false information on the form?

Providing false information on the BFS 108 form is a serious offense. It is considered a misdemeanor and can result in fines, imprisonment, or both. The form clearly states that making a false statement to obtain a disability parking placard or free parking sticker is punishable by law. It is crucial to ensure that all information provided is accurate and truthful.

How do I submit the completed BFS 108 form?

You can submit the completed BFS 108 form in two ways. You may present it in person at any Secretary of State branch office in Michigan. Alternatively, you can mail it to the Out-of-State Resident Services Unit at the address provided on the form. Ensure that all required signatures and certifications are included to avoid delays in processing.

What should organizations know when applying for disability parking placards?

Organizations that provide transportation services for individuals with disabilities can apply for disability parking placards by completing Part 4 of the BFS 108 form. The organization must describe the services it provides and indicate the number of placards requested. Each vehicle used for transportation can receive only one placard. If the organization ceases to provide these services, it must return the placards to the Secretary of State for cancellation.

What penalties exist for misuse of a disability parking placard?

Misuse of a disability parking placard can lead to significant penalties. The Michigan Vehicle Code prohibits using a placard unless the disabled person is present in the vehicle. Altering or selling a placard, as well as using a forged placard, are also illegal. Violations can result in fines up to $500, imprisonment for up to 30 days, or both. Law enforcement officers have the authority to confiscate placards that are being used improperly.

Common mistakes

  1. Failing to sign the application. A signature is required to validate the information provided.

  2. Not completing all necessary parts of the form. Each section must be filled out as applicable, including Parts 1, 2, and 3 if qualifying for free parking.

  3. Leaving out essential personal information. Missing details such as name, date of birth, or address can lead to delays in processing.

  4. Not obtaining the required medical certification. A physician's signature and evaluation are mandatory for the application to be processed.

  5. Using incorrect or outdated medical information. Ensure that the diagnosis and medical conditions listed are current and accurately reflect the applicant's situation.

  6. Failing to provide a valid medical license number. This is crucial if the physician is licensed in a state other than Michigan.

  7. Not attaching necessary documentation. If applicable, include a copy of any medical waivers or additional certifications required.

  8. Neglecting to verify residency. Confirm that the applicant is a Michigan resident, as this is a requirement for eligibility.

  9. Overlooking the penalties for false information. Applicants should be aware that providing inaccurate details can lead to serious legal consequences.

Documents used along the form

The BFS 108 form is a crucial document for individuals seeking a disability parking placard in Michigan. Along with this form, several other documents are often required or useful in the application process. Below is a list of these related documents, each with a brief description.

  • Physician’s Statement: This document is completed by a licensed medical professional. It certifies the applicant’s medical condition and eligibility for a disability placard based on specific criteria outlined in the law.
  • Proof of Residency: Applicants may need to provide documentation that confirms their Michigan residency. This can include utility bills, bank statements, or any official correspondence with the applicant's name and address.
  • Identification: A valid Michigan driver’s license or state ID is often required. This serves to verify the identity of the applicant and ensure that the placard is issued to the correct individual.
  • Free Parking Application: If eligible, this form is filled out to request a free parking sticker. It requires additional medical certification to confirm that the applicant meets specific criteria for free parking.
  • Organization Request Form: For organizations applying for disability parking placards, this document details the services provided to disabled individuals and the number of placards requested.
  • Release of Information Form: This form allows medical professionals to share necessary medical information with the Michigan Department of State, ensuring compliance with privacy regulations while facilitating the application process.

Each of these documents plays a vital role in the overall application process for a disability parking placard in Michigan. Ensuring that all forms are accurately completed and submitted can significantly streamline the approval process.

Similar forms

  • Form DS-11: Application for a U.S. Passport - Like the Bfs 108, this form requires personal information and a certification from a qualified individual, ensuring eligibility for a specific benefit, in this case, a passport.
  • Form I-485: Application to Register Permanent Residence or Adjust Status - Similar in that it gathers personal details and requires a medical examination, confirming the applicant's eligibility for permanent residency.
  • Form SSA-827: Authorization to Disclose Information to the Social Security Administration - This document also involves the release of medical information, requiring a signature from the applicant, akin to the release of information in the Bfs 108.
  • Form N-400: Application for Naturalization - Like the Bfs 108, this form collects personal data and requires verification of eligibility, ensuring applicants meet specific criteria.
  • Form 1040: U.S. Individual Income Tax Return - This form requires personal and financial information, similar to the Bfs 108, where accurate information is crucial for processing.
  • Form W-4: Employee's Withholding Certificate - Just as the Bfs 108 requires information for eligibility, this form collects data to determine tax withholding, requiring the employee's signature.
  • Form 1-130: Petition for Alien Relative - This document also necessitates personal information and a declaration of eligibility, similar to the requirements outlined in the Bfs 108.
  • Form I-20: Certificate of Eligibility for Nonimmigrant Student Status - Similar to the Bfs 108, this form requires verification from an educational institution regarding the applicant's eligibility for a student visa.
  • Form CMS-1500: Health Insurance Claim Form - This form collects medical information and requires a physician's signature, paralleling the medical certification needed in the Bfs 108.
  • Form 4506-T: Request for Transcript of Tax Return - Like the Bfs 108, this document requires the applicant's information and a signature to authorize the release of personal tax information.

Dos and Don'ts

When filling out the BFS 108 Michigan form for a disability parking placard, it’s important to follow certain guidelines. Here’s a list of things you should and shouldn’t do:

  • Do read the entire form carefully before starting.
  • Do ensure all personal information is accurate and complete.
  • Do have your physician complete Part 2 and sign it.
  • Do provide a clear diagnosis for your disability.
  • Do sign the application yourself if you are the applicant.
  • Don't leave any sections blank unless instructed.
  • Don't forge signatures or provide false information.
  • Don't forget to include any necessary attachments, like a medical waiver if applicable.
  • Don't submit the form without checking for errors.
  • Don't assume your application is complete without a physician’s certification.

By following these guidelines, you can help ensure a smooth application process for your disability parking placard.

Misconceptions

Misconceptions about the Bfs 108 Michigan form can lead to confusion for applicants. Here are some common misunderstandings:

  • Only physicians can complete the form. Many healthcare professionals, including nurse practitioners and optometrists, are authorized to certify the application.
  • All applicants automatically qualify for free parking. Free parking is only available if specific conditions are met, including the inability to use a parking meter due to a disability.
  • The placard is permanent once issued. Placards can be temporary or permanent, depending on the individual’s medical condition as determined by their healthcare provider.
  • You can apply without a physician's signature. The application cannot be processed without a signed certification from a qualified medical professional.
  • Only individuals with visible disabilities can apply. Many disabilities are not visible, yet they still qualify for a disability parking placard.
  • It’s acceptable to use someone else's placard. Using a placard that is not issued to you is illegal and can result in serious penalties.
  • Once you receive a placard, you can use it indefinitely. If your condition improves or changes, you may need to reapply or return the placard.
  • Applications can only be submitted in person. Completed applications can also be mailed to the designated address.
  • Misrepresenting information on the application has no consequences. Providing false information can lead to fines, imprisonment, or both.

Understanding these misconceptions can help ensure a smoother application process and compliance with the law.

Key takeaways

Filling out the Bfs 108 Michigan form is an essential step for those seeking a disability parking placard. Here are some key takeaways to ensure a smooth application process:

  • Complete Part 1: As the applicant, you must fill out and sign Part 1 of the form, which includes personal information and a release of medical information.
  • Medical Certification Required: A licensed healthcare provider must complete Part 2, confirming your eligibility based on specific medical criteria.
  • Free Parking Eligibility: If you qualify for free parking, ensure your healthcare provider completes Part 3 of the form as well.
  • Organizational Applications: Organizations applying for placards must fill out Part 4, detailing the transportation services they provide for disabled individuals.
  • Submission Options: You can submit your completed application at any Secretary of State branch office or mail it to the designated address on the form.
  • Accuracy is Crucial: Ensure all information is accurate. A false statement can lead to serious penalties, including fines or imprisonment.
  • Understand the Penalties: Familiarize yourself with the penalties for misuse of the placard, including fines up to $500 and potential jail time.
  • Keep Copies: It's wise to keep copies of your completed application and any supporting documents for your records.
  • Ask Questions: If you're unsure about any part of the process, don't hesitate to call the provided helpline for assistance.

By following these guidelines, you can navigate the application process more effectively and ensure that you receive the support you need.