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The Illinois Placard form serves as a crucial tool for individuals with disabilities, enabling them to access designated parking spaces that accommodate their needs. This form is essential for both new applicants and those seeking to renew their existing placards. It is important to note that if a placard has been lost, stolen, or damaged, a replacement form must be utilized instead. The placard is issued for either temporary or permanent disabilities, with specific certification requirements from a medical professional. The form requires detailed information, including the applicant's personal details, and mandates signatures from both the applicant and, if applicable, a parent or legal guardian. Additionally, there are provisions for meter-exempt parking, which allows certain individuals to park without the constraints of time limits. Each section of the form must be meticulously completed, as any incomplete submissions may delay the processing of the application. Moreover, applicants must understand the legal implications of misusing the placard, as violations can lead to significant penalties. Therefore, familiarity with the Illinois Placard form not only aids in securing necessary parking privileges but also emphasizes the importance of adhering to the regulations that govern its use.

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State of Illinois Secretary of State 501 S. 2nd Street Springfield, IL 62756

NNEW APPLICANT

NRENEWAL

*If your valid placard was lost/stolen/damaged,

use replacement form VSD 415,

available online at cyberdriveillinois.com or visit your local Secretary of State facility.

Persons with Disabilities Certification for Parking Placard

*This form is valid for three months from your physician’s signature date for a Temporary Placard and six months for a Permanent Placard.

NOTE TO DISABILITY LICENSE PLATE OWNERS: If you have a disability license plate, you MUST complete the form and renew your placard.

DIRECTIONS: Both sides of this document must be signed and completed fully. All fields are required.

Applicants complete Part 1. If the applicant is a MINOR, then Parent/Guardian(s) MUST also complete Part 2. The applicant’s medical profes- sional MUST complete Part 3. If the applicant is applying for meter-exempt parking, his/her medical professional MUST also complete Part 4.

Part 1: Applicant Information (MUST have a valid Illinois driver’s license and/or ID card)

I hereby certify that I meet the definition of a person with a disability as provided in 625 ILCS 5/1-159.1, and I certify that my physical condition entitles me to the issuance of a Persons with Disabilities Parking Placard. By affixing my signature below, I understand that the parking placard may not be used unless I am the driver or passenger of the vehicle.

*If a military veteran, please provide a copy of your DD214 showing proof of service.

 

 

 

 

 

 

 

 

Disability Parking Placard # (if any)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full Name of Person with Disability (If Minor, complete Part 2 also.)

 

 

 

 

 

Male/Female

 

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Valid Illinois Driver’s License or ID Card # of Applicant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Illinois Address

Apt/Unit #

City

 

 

 

 

 

IL

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address if Different from Above

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

Email Address

 

 

 

 

Military Veteran? Yes / No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Person with Disability

 

 

 

 

 

 

 

Today’s Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 2: For Parent or Legal Guardian (MUST have a valid Illinois driver’s license and/or ID card)

I hereby certify that the above applicant is a minor and I have primary responsibility for his/her transportation. By affixing my signature below, I understand that the disability placard is issued to the person with disability and may not be used unless I am transporting the disabled person in the vehicle.

Name of Parent or Legal Guardian

 

 

Relationship to Person with Disability

 

 

 

 

 

 

 

Valid Illinois Driver’s License or ID Card #

 

 

 

 

 

 

 

 

 

 

 

 

 

Illinois Address

Apt/Unit #

City

 

 

IL

ZIP

 

 

 

 

 

 

 

Telephone Number

Email Address

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Parent or Legal Guardian

 

 

 

Today’s Date

 

 

 

 

 

 

 

Warning: Any misuse of the disability parking placard/plates or making a false application may result in the revocation of the placard, a 12- month suspension or revocation of your driver’s license, and a fine of up to $1,000.

Temporary Disabled Parking Placard Applications — May be taken to any Secretary of State facility or mailed in. Permanent Disabled Parking Placard Applications — MUST be mailed to the following address:

Secretary of State, Persons with Disabilities Placard Unit, 501 S. 2nd Street, Room 541, Springfield, IL 62756.

*If you have a permanent disability placard and would like a Persons with Disabilities License Plate, please visit your local Secretary of State facility to apply. You will need your permanent placard number and current plate number or VIN.

Please complete Page 2 to ensure timely processing.

Printed by authority of the State of Illinois. July 2021 — 1 — VSD 62.28

Part 3: Medical Eligibility Standards and Medical Professional Certification

As the medical professional(s) executing this document and verifying the nature of the applicant’s disability, I understand that making a false representation of a person’s disability for the purposes of obtaining any type of disabled parking placard may result in suspension or revocation of my license and a fine of up to $1,000. As a licensed physician, advanced practiced nurse, optometrist, chiropractor or physician’s assistant, I certify the applicant has a condition that constitutes him/her as a person with disabilities.

Length of Disability: (Check one)

NTemporary Disability; the duration of this disability is ________________________(maximum 6 months)

NPermanent Disability

NMeter-Exempt Disability (Must complete and sign Part 4 also.)

Check all that apply: (MUST check at least one):

NIs restricted by a lung disease to such a degree that the person’s forced (respiratory) expiratory volume (FEV) for 1 second, when measured by spirometry, is less than 1 liter.

NUses a portable oxygen device.

NHas Class III or Class IV cardiac condition according to the standards set by the American Heart Association.

NCannot walk without the use of or assistance from a wheelchair, a walker, a crutch, a brace, a prosthetic device, or another person.

NIs severely limited in the ability to walk due to an arthritic, neurological, oncological, or orthopedic condition.

NCannot walk 200 feet without stopping to rest because of one of the above five conditions.

Check all that apply: (MUST check at least one diagnosis):

 

 

N Amputation of extremity(s) _________________________

N Arthritis of the ______________________________________

N Spina Bifida

N Osteoarthritis of the

_________________________________

N Multiple Sclerosis

N Chronic Pain due to

_________________________________

N Quadriplegia/Paraplegia

N Legally Blind with limited mobility

NCerebral Palsy

NOther Diagnosis: _________________________________________________________________________________________

If none of the above conditions apply, list the medical condition that impacts the person’s mobility.

Medical Professional’s Printed Name

Specialty

 

 

 

 

Office Address

City, State, ZIP

 

 

 

 

Medical Professional’s Signature

State Professional License Number (NOT NPI#)

Today’s Date

 

 

 

Signature of Collaborating/ Supervising Physician (if signed above by resident/assistant)

Supervising State Professional License Number

 

 

 

 

Part 4: Medical Eligibility for Meter-Exempt Parking

The meter-exempt parking certification must be completed only when the applicant qualifies. To qualify, the applicant MUST have a VALID Illinois driver’s license, have an ambulatory disability described in Part 3, and also have one of the following conditions listed below.

Economic need is not a consideration for meter-exempt parking.

The applicant is eligible for meter-exempt parking as provided by statue due to the following PERMANENT medical condition or disability:

Check all that apply:

NCannot manage, manipulate or insert coins, or obtain tickets in parking meters/ticket machines due to lack of fine motor control of BOTH hands.

NCannot reach above his/her head to a height of 42 inches from the ground due to a lack of finger, hand or upper-extremity strength or mobility.

NCannot approach a parking meter due to his/her use of a wheelchair or other device for mobility.

NCannot walk more than 20 feet due to an orthopedic, neurological, cardiovascular or lung condition in which the degree of debilitation is so severe that it almost completely impedes the ability to walk.

NMissing a hand(s) or arm(s) or has permanently lost the use of a hand or arm.

NPatient is under 18 years of age and incapable of driving.

Medical Professional’s Signature

State Professional License Number (NOT NPI#)

Today’s Date

Signature of Collaborating/ Supervising Physician (if signed above by resident/assistant)

Supervising State Professional License Number

FOR SECRETARY OF STATE OFFICE USE ONLY

Parking Placard Number: ________________________________

Expiration Date: ______________________________________

Issued By: ___________________________________________

Issue Date: __________________________________________
➤ PDF File

Form Specifications

Fact Name Details
Governing Law The Illinois Placard form is governed by 625 ILCS 5/1-159.1.
Application Types Applicants can apply for a new placard, renew an existing one, or request a replacement if lost, stolen, or damaged.
Temporary vs. Permanent A temporary placard is valid for three months, while a permanent placard is valid for six months.
Minor Applicants Minors must have a parent or guardian complete Part 2 of the form.
Medical Certification A medical professional must complete Part 3 to certify the applicant's disability.
Meter-Exempt Parking For meter-exempt parking, additional certification in Part 4 is required from a medical professional.
Misuse Consequences Misuse of the placard can lead to revocation, license suspension, and fines up to $1,000.

Illinois Placard: Usage Guidelines

To complete the Illinois Placard form, you will need to gather the necessary information and signatures from both the applicant and the medical professional. This process ensures that all required sections are filled out accurately.

  1. Obtain the Illinois Placard form from the Secretary of State's website or your local facility.
  2. Fill out Part 1: Applicant Information. Include the following:
    • Disability Parking Placard number (if applicable).
    • Full name of the person with a disability.
    • Gender and date of birth.
    • Valid Illinois driver’s license or ID card number.
    • Illinois address, including apartment or unit number, city, and ZIP code.
    • Mailing address if different from above.
    • Telephone number and email address.
    • Indicate if the applicant is a military veteran.
    • Sign and date the form.
  3. If the applicant is a minor, have the parent or legal guardian complete Part 2. This includes:
    • Name of the parent or legal guardian.
    • Relationship to the person with a disability.
    • Valid Illinois driver’s license or ID card number.
    • Illinois address, including apartment or unit number, city, and ZIP code.
    • Telephone number and email address.
    • Sign and date the form.
  4. Have a medical professional complete Part 3: Medical Eligibility Standards. They must:
    • Certify the applicant’s disability.
    • Indicate the length of the disability.
    • Check all applicable conditions and diagnoses.
    • Provide their printed name, specialty, office address, and signature.
    • Include their state professional license number.
    • If applicable, have a supervising physician sign and provide their license number.
  5. If applying for meter-exempt parking, the medical professional must also complete Part 4. They should:
    • Check all applicable conditions for meter-exempt parking.
    • Sign and provide their state professional license number.
    • Include the supervising physician's signature and license number if required.
  6. Review the entire form to ensure all fields are completed and signatures are obtained.
  7. Submit the form:
    • For temporary disabled parking placard applications, you can take it to any Secretary of State facility or mail it in.
    • For permanent disabled parking placard applications, mail it to the Secretary of State, Persons with Disabilities Placard Unit, 501 S. 2nd Street, Room 541, Springfield, IL 62756.

Your Questions, Answered

What is the Illinois Placard form used for?

The Illinois Placard form is used to apply for a Persons with Disabilities Parking Placard. This placard allows individuals with disabilities to park in designated spaces, providing easier access to buildings and facilities. The form is necessary for both new applicants and those seeking to renew their existing placards.

Who is eligible to apply for a Persons with Disabilities Parking Placard?

Individuals who meet the definition of a person with a disability as outlined in Illinois law are eligible to apply. This includes those with temporary or permanent disabilities that significantly impair their mobility. If the applicant is a minor, a parent or legal guardian must also sign the application.

What information is required to complete the application?

The application requires detailed information, including the applicant’s full name, date of birth, address, and valid Illinois driver’s license or ID card number. Additionally, a medical professional must certify the applicant's disability, providing their signature and license number. If applicable, military veterans should include proof of service.

How long is the Placard valid?

A temporary placard is valid for three months from the date of the medical professional's signature. In contrast, a permanent placard is valid for six months. It is essential to renew the placard before it expires to maintain eligibility for accessible parking.

What should I do if my placard is lost, stolen, or damaged?

If your valid placard is lost, stolen, or damaged, you must complete the replacement form VSD 415. This form is available online at cyberdriveillinois.com or can be obtained at your local Secretary of State facility.

Where should I submit my application for a permanent placard?

Applications for a permanent disabled parking placard must be mailed to the following address: Secretary of State, Persons with Disabilities Placard Unit, 501 S. 2nd Street, Room 541, Springfield, IL 62756. Temporary placard applications can be submitted in person at any Secretary of State facility or mailed in.

What are the consequences of misusing the placard?

Misuse of the disability parking placard or making a false application can result in severe penalties. These may include revocation of the placard, a 12-month suspension or revocation of the driver’s license, and fines of up to $1,000. It is crucial to use the placard only as intended and to provide accurate information on the application.

Common mistakes

  1. Incomplete Information: Failing to fill out all required fields can lead to delays or rejection of the application. Ensure that every section is completed, including personal details and medical professional information.

  2. Missing Signatures: Both the applicant and the medical professional must sign the form. Omitting a signature can result in the application being deemed invalid.

  3. Incorrect Medical Certification: The medical professional must accurately complete Part 3. If the information does not clearly establish the applicant's disability, the application may be denied.

  4. Failure to Submit Correctly: Temporary placard applications can be submitted in person or by mail, while permanent placard applications must be mailed to a specific address. Make sure to follow the correct submission guidelines.

  5. Not Renewing on Time: Both new applicants and those renewing must pay attention to expiration dates. Renewing too late can result in a lapse in parking privileges.

Documents used along the form

The Illinois Placard form is essential for individuals with disabilities seeking parking accommodations. In addition to this form, several other documents may be necessary for a complete application process. Below is a list of related forms and documents often used in conjunction with the Illinois Placard form.

  • VSD 415 Replacement Form: This form is used when a valid placard is lost, stolen, or damaged. It can be obtained online or at a local Secretary of State facility.
  • DD214 Form: Military veterans must provide this document as proof of service when applying for a disability placard.
  • Medical Professional Certification: This section of the placard application must be completed by a licensed medical professional to verify the applicant’s disability.
  • Minor’s Guardian Form: If the applicant is a minor, a parent or legal guardian must complete this section, confirming their responsibility for the minor's transportation.
  • Meter-Exempt Parking Certification: This part of the application is required for those seeking meter-exempt parking. It must be filled out by a medical professional if applicable.

Understanding these forms can streamline the application process and ensure compliance with state regulations. Having the necessary documents ready can help applicants avoid delays and facilitate a smoother experience when obtaining a parking placard.

Similar forms

The Illinois Placard form shares similarities with several other documents used for disability-related certifications and applications. Below are four documents that have comparable functions or purposes:

  • ADA Paratransit Application: This document is used to request paratransit services under the Americans with Disabilities Act. Like the Illinois Placard form, it requires medical verification of the applicant's disability and is aimed at ensuring accessible transportation for individuals with mobility challenges.
  • State Disability License Plate Application: This application allows individuals with disabilities to obtain specialized license plates for their vehicles. Similar to the Placard form, it necessitates proof of disability from a medical professional and aims to provide parking privileges for individuals with mobility impairments.
  • Social Security Administration Disability Benefits Application: This application is used to request disability benefits from the Social Security Administration. Both forms require detailed information about the applicant's disability and medical condition, emphasizing the need for proper documentation to validate the claim.
  • Veterans Affairs Disability Compensation Claim Form: This form is used by veterans to claim compensation for service-connected disabilities. Like the Illinois Placard form, it requires medical documentation and verification of the applicant's disability status, aiming to provide necessary support for individuals with disabilities.

Dos and Don'ts

When filling out the Illinois Placard form, there are key steps to follow to ensure a smooth application process. Here’s a list of what you should and shouldn't do:

  • Do read the entire form carefully before starting.
  • Do provide accurate information in all required fields.
  • Do ensure that both the applicant and, if applicable, the parent or guardian sign the form.
  • Do check for any additional documentation needed, such as proof of military service.
  • Do submit the application to the correct address based on whether it’s for a temporary or permanent placard.
  • Don't leave any fields blank; all sections must be completed.
  • Don't use the placard unless you are the driver or passenger of the vehicle.
  • Don't forget to have your medical professional complete the necessary sections.
  • Don't submit false information, as this can lead to serious consequences.
  • Don't wait until the last minute to apply; processing can take time.

Misconceptions

  • Misconception 1: Only individuals with severe disabilities can apply for the Illinois Placard.

    • This is not true. The Illinois Placard is available for a range of disabilities, including temporary conditions. The key is that the applicant must have a medical professional certify their condition. Even those with mild to moderate disabilities may qualify, depending on their mobility limitations.

  • Misconception 2: Once you receive a placard, you never need to renew it.

    • Many people believe that obtaining a placard is a one-time process. In reality, placards must be renewed periodically. Temporary placards are valid for three months, while permanent ones need renewal every few years. Keeping track of expiration dates is essential to maintain parking privileges.

  • Misconception 3: You can use the placard for anyone, regardless of whether they are in the vehicle.

    • This misconception can lead to serious consequences. The placard is issued specifically for the individual with a disability. It may only be used when that person is a passenger or driver in the vehicle. Misusing the placard can result in fines and even revocation of driving privileges.

  • Misconception 4: The application process is overly complicated and time-consuming.

    • While the form does require several steps, many find it straightforward once they understand the requirements. The process involves completing specific sections, obtaining medical certification, and submitting the form either in person or by mail. With careful attention to detail, applicants can navigate the process smoothly.

Key takeaways

  • Complete all required fields: Ensure that both sides of the Illinois Placard form are filled out completely. All fields are mandatory.
  • Eligibility verification: The applicant must have a valid Illinois driver’s license or ID card. This is essential for processing the application.
  • Minor applicants: If the applicant is a minor, a parent or legal guardian must also fill out the designated section of the form.
  • Medical professional’s role: A licensed medical professional must certify the applicant's disability. Their signature is necessary for the application to be valid.
  • Temporary vs. permanent placards: Temporary placards are valid for three months, while permanent placards are valid for six months from the physician's signature date.
  • Meter-exempt parking: If applying for meter-exempt parking, the medical professional must complete an additional section of the form to confirm eligibility.
  • Submission guidelines: Temporary placard applications can be submitted in person or by mail, while permanent placard applications must be mailed to the specified address in Springfield.