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Content Overview

The Texas Vi 4 form serves as a crucial application for individuals seeking a medical exemption for window tint on their vehicles. This form is specifically designed for those who require darker window tinting due to medical conditions that necessitate additional protection from sunlight. Applicants must provide personal information, including their name, driver’s license number, and contact details, as well as details about the vehicle or vehicles for which the exemption is sought. The form also requires the name and contact information of a physician, optometrist, or ophthalmologist who can substantiate the medical need for the exemption. Importantly, applicants must certify the accuracy of their information and understand the legal implications of providing false statements. To complete the application process, individuals must submit the Vi 4 form along with supporting documentation, such as a letter from a physician or an original prescription, both of which must be dated within the past year. Once submitted, applicants can expect a processing period of up to 15 working days before receiving an exemption certificate, if approved. This structured approach ensures that those in need of medical exemptions can navigate the requirements efficiently while adhering to state regulations.

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Texas Department of Public Safety
Regulatory Services Division
www.dps.texas.gov
VEHICLE INSPECTION
WINDOW TINT
APPLICATION FOR WINDOW TINT MEDICAL EXEMPTION
MUST USE MOST CURRENT FORM
FORM MUST BE TYPED
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Applicant / Legal Guardian’s Signature
Date
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Letter, on physician letterhead, signed by the physician, indicating the medical reason for the exemption.
An original prescription including the applicant’s name, physician’s signature and indicating the medical reason for the exemption.
Letters and prescriptions must be dated within one year of exemption request. If the exemption is approved, an exemption letter will be sent
to the applicant listed above.
SUBMIT completed form with required documentation:
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Contact Us, select “Vehicle Inspection” and complete the online form.
http://www.txdps.state.tx.us/rsd/contact/default.aspx
 to (512) 424-2774
 Texas Department of Public Safety
Regulatory Services Division, Compliance & Enforcement Service
Window Tint Medical Exemption
P. O. Box 4087
Austin, Texas 78773-0543
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VI-4 (Rev. 3/16)
APPLICANT (PLEASE USE NAME AS IT APPEARS ON DRIVER LICENSE)
Name DL # State Expiration
Patient Name
(IF DIFFERENT FROM APPLICANT)
Relationship to Applicant
FOR DPS USE ONLY
Residence
Address
City State County ZIP
Mailing
Address
City State County ZIP
Date of Birth Home Phone Cell Phone
Email Business Phone Other Phone
VEHICLE INFORMATION
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VIN Year Make Model
Vehicle #2
VIN Year Make Model
Vehicle #3
VIN Year Make Model
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Name License #
Address City State Zip
Email Phone Fax

Form Specifications

Fact Name Detail
Governing Law The Texas Vi 4 form is governed by Texas Transportation Code, Section 547.613, which addresses window tint regulations and medical exemptions.
Form Purpose This form is used to apply for a medical exemption from the state's vehicle window tint regulations.
Eligibility Requirements Applicants must provide a letter or prescription from a licensed physician, optometrist, or ophthalmologist to justify the medical need for the exemption.
Submission Methods Completed forms can be submitted online, via fax, or by mail to the Texas Department of Public Safety.
Processing Time Applicants should allow up to 15 working days for their application to be processed and for the exemption certificate to be received.
Signature Requirement The applicant or legal guardian must sign the form, certifying that all information provided is accurate and true under penalty of perjury.
Form Update The Texas Vi 4 form must be the most current version, as indicated by the revision date on the form (Rev. 3/16).

Texas Vi 4: Usage Guidelines

After completing the Texas Vi 4 form, you will need to submit it along with the required documentation. Ensure that all information is accurate to avoid delays in processing. The next steps involve choosing your submission method, whether online, by fax, or by mail.

  1. Download the Texas Vi 4 form from the Texas Department of Public Safety website.
  2. Type your name as it appears on your driver’s license in the "Applicant" section.
  3. Enter your driver’s license number, state, and expiration date.
  4. Provide the patient’s name and their relationship to you if it differs from your own.
  5. Fill in your residential address, including city, state, county, and ZIP code.
  6. Complete the mailing address section if it is different from your residential address.
  7. Input your date of birth, email address, and phone numbers (home, cell, business, and other).
  8. For each vehicle, provide the VIN, year, make, and model in the vehicle information section. You can list up to three vehicles.
  9. Enter the name, address, email, license number, city, state, ZIP code, phone, and fax number of your physician, optometrist, or ophthalmologist.
  10. Read the certification statement carefully. By signing, you affirm that all information is true and correct.
  11. Sign and date the application as the applicant or legal guardian.
  12. Gather the required documentation: a letter from your physician on letterhead or an original prescription that indicates the medical reason for the exemption.
  13. Ensure that the letter or prescription is dated within one year of your exemption request.
  14. Choose your submission method: online, fax, or mail. Follow the instructions for your chosen method.

Your Questions, Answered

What is the Texas Vi 4 form?

The Texas Vi 4 form is an application for a medical exemption from window tint regulations in Texas. It allows individuals with specific medical conditions to request permission for darker window tinting on their vehicles. This form must be filled out accurately and submitted to the Texas Department of Public Safety (DPS) for consideration.

Who needs to fill out the Vi 4 form?

Individuals who have a medical condition that requires them to have darker window tinting in their vehicles should complete the Vi 4 form. This includes patients who have conditions that make them sensitive to sunlight or heat. The form must be filled out by the applicant or their legal guardian.

What information is required on the form?

The form requires personal information such as the applicant's name, driver's license number, date of birth, and contact details. It also asks for vehicle information, including the vehicle identification number (VIN), year, make, and model of each vehicle for which the exemption is requested. Additionally, the form must include details about the physician or optometrist providing the medical justification.

What kind of medical documentation is needed?

To support the application, you must include one of the following documents: a letter on the physician's letterhead that states the medical reason for the exemption, or an original prescription that includes the applicant’s name, physician’s signature, and the medical reason. These documents must be dated within one year of the exemption request.

How do I submit the Vi 4 form?

You can submit the completed form and required documentation in several ways. You may send it via secured email through the DPS website, fax it to (512) 424-2774, or mail it to the Texas Department of Public Safety at the address provided on the form. Choose the method that is most convenient for you.

How long does it take to process the application?

Once submitted, you should allow up to 15 working days for the Texas Department of Public Safety to process your application. If approved, you will receive an exemption letter sent to the applicant listed on the form.

What happens if my application is denied?

If your application for a medical exemption is denied, you will not receive the exemption letter. You may contact the Texas Department of Public Safety for clarification on the reasons for the denial and to discuss any potential next steps.

Can I appeal a denial of my exemption request?

While the Texas Vi 4 form does not specifically outline an appeal process, you can reach out to the Texas Department of Public Safety for guidance. They may provide options or additional steps you can take if you believe your application was unjustly denied.

Is there a fee associated with the Vi 4 form?

There is no fee for submitting the Texas Vi 4 form. However, you may incur costs if you need to obtain medical documentation from your physician or if you choose to send the form via certified mail.

Common mistakes

  1. Not using the most current version of the Texas Vi 4 form. Always check for updates on the Texas Department of Public Safety website.

  2. Failing to type the application. Handwritten forms may not be accepted.

  3. Providing incorrect or incomplete personal information. Ensure that the name matches exactly as it appears on the driver's license.

  4. Omitting the relationship to the applicant if the patient’s name is different from the applicant. This information is necessary for processing.

  5. Not including all vehicle information. Each vehicle must have its VIN, year, make, and model listed.

  6. Forgetting to include the physician's information. The form must have the physician’s name, address, and license number.

  7. Neglecting to attach the required documentation. This includes a letter from the physician or an original prescription.

  8. Not signing and dating the application. The applicant or legal guardian must certify the information is true and correct.

Documents used along the form

The Texas Vi 4 form is specifically designed for individuals seeking a medical exemption for window tint on their vehicles. To support the application process, several other forms and documents may be necessary. Each of these documents serves a distinct purpose and is integral to ensuring compliance with Texas regulations.

  • Physician's Letter: This document, written on official letterhead, must be signed by a physician. It should detail the medical reason for requesting the window tint exemption. The letter must be dated within one year of the exemption request.
  • Prescription: An original prescription from a licensed medical professional is required if it specifies the applicant's name and the medical reason for the exemption. Like the physician's letter, it must also be dated within the last year.
  • Vehicle Registration: A copy of the vehicle registration is often needed to verify ownership and ensure that the application is associated with the correct vehicle.
  • Proof of Identity: A valid driver's license or another form of government-issued identification is required to confirm the identity of the applicant and their relationship to the vehicle owner.
  • Application for Vehicle Inspection: This form may be required to document that the vehicle has undergone a proper inspection, especially if the exemption is being sought for a new vehicle.
  • Affidavit of Ownership: In cases where the applicant is not the registered owner of the vehicle, an affidavit may be needed to establish ownership and the applicant's right to request the exemption.
  • Medical Records Release: This document allows the physician to share relevant medical information with the Department of Public Safety if necessary for the exemption request.
  • Exemption Certificate: If the application is approved, this certificate will be issued to the applicant. It serves as official documentation of the granted exemption for window tint.

Gathering these documents can streamline the application process for a medical exemption. Ensuring that all required forms are complete and accurate will help facilitate a timely review by the Texas Department of Public Safety.

Similar forms

The Texas Vi 4 form is used to apply for a medical exemption for window tinting on vehicles. Several other documents serve similar purposes in different contexts. Here are ten documents that share similarities with the Texas Vi 4 form:

  • Medical Exemption Form (California) - This form allows individuals to request exemptions from certain regulations based on medical conditions, similar to how the Texas Vi 4 form requests an exemption for window tint.
  • Vehicle Registration Application - Like the Texas Vi 4 form, this application collects personal and vehicle information, ensuring compliance with state regulations.
  • ADA Accommodation Request Form - This document is used to request accommodations for disabilities, paralleling the medical basis for exemptions in the Texas Vi 4 form.
  • Driver’s License Application - Both forms require personal identification details and certification of accuracy, reinforcing the importance of truthful information.
  • Medical Certification for Disability Parking - This certification serves a similar function by allowing individuals with medical needs to obtain special parking privileges.
  • Application for Special License Plates - This application often includes a medical rationale for special plates, akin to the justification required in the Texas Vi 4 form.
  • Request for Exemption from Emissions Testing - This document allows individuals to seek exemptions based on specific criteria, similar to the medical exemptions in the Texas Vi 4.
  • Health Insurance Claim Form - Both forms require detailed personal and medical information to support a request, emphasizing the need for accurate documentation.
  • Application for Temporary Disability Benefits - This application seeks benefits based on medical conditions, paralleling the medical justification needed for the window tint exemption.
  • Vehicle Title Application - Similar to the Texas Vi 4 form, this application requires vehicle information and personal details to establish ownership and compliance.

Each of these documents shares common elements with the Texas Vi 4 form, primarily in their requirement for personal information, medical justification, and the need for accurate and truthful submissions.

Dos and Don'ts

When filling out the Texas Vi 4 form for a window tint medical exemption, it's important to follow certain guidelines to ensure your application is processed smoothly. Here’s a helpful list of things to do and avoid:

  • Do use the most current version of the form.
  • Do type your information clearly to avoid any confusion.
  • Do include all required information about yourself and the vehicle(s).
  • Do provide accurate details about your physician, including their contact information.
  • Do attach the necessary documentation, such as a letter from your physician or an original prescription.
  • Do sign and date the application to confirm the information is true.
  • Do submit your application via the recommended methods: online, fax, or mail.
  • Don't forget to check that all information is complete before submission.
  • Don't use hand-written text; it should be typed to ensure legibility.
  • Don't submit documents that are older than one year from the date of your exemption request.
  • Don't omit your contact information, as it is essential for communication regarding your application.
  • Don't submit your application without the required physician documentation.
  • Don't assume your application will be processed immediately; allow up to 15 working days.
  • Don't provide false information, as this can lead to serious legal consequences.

By following these guidelines, you can help ensure that your application for a window tint medical exemption is completed correctly and efficiently.

Misconceptions

Misconceptions about the Texas Vi 4 form can lead to confusion and delays in obtaining window tint medical exemptions. Here are ten common misconceptions clarified:

  1. Anyone can apply for a window tint exemption. Only individuals with a medical condition that necessitates the exemption can apply.
  2. The form can be handwritten. The Texas Vi 4 form must be typed to ensure clarity and legibility.
  3. All doctors can sign the form. Only licensed physicians, optometrists, or ophthalmologists can provide the necessary documentation for the exemption.
  4. There is no need for supporting documents. A letter from a physician or an original prescription is required to accompany the application.
  5. The exemption is granted automatically. Each application is reviewed, and approval is not guaranteed.
  6. Exemption letters are sent immediately. Applicants should allow up to 15 working days for processing and approval.
  7. Expired documents are acceptable. All supporting documents must be dated within one year of the exemption request.
  8. Faxing is the only submission method. Applications can also be submitted online or by mail.
  9. Only one vehicle can be listed. The form allows for multiple vehicles to be included, up to three.
  10. The applicant’s signature is optional. The applicant or legal guardian must sign the form to certify the information is accurate.

Understanding these misconceptions helps ensure a smoother application process for those seeking medical exemptions for window tinting in Texas.

Key takeaways

Here are some key takeaways about filling out and using the Texas Vi 4 form:

  • Use the Most Current Form: Always ensure you are using the latest version of the Texas Vi 4 form, available on the Texas Department of Public Safety website.
  • Type Your Information: The form must be filled out using a computer. Handwritten submissions are not accepted.
  • Provide Accurate Personal Information: Include your name, driver's license number, and other personal details exactly as they appear on your ID.
  • List All Vehicles: You can include information for up to three vehicles on the form. Make sure to provide the VIN, year, make, and model for each.
  • Include Medical Documentation: Attach a letter from your physician or an original prescription that outlines the medical reason for your exemption request.
  • Signature Required: The applicant or legal guardian must sign the form, certifying that all information is true and accurate.
  • Submission Options: You can submit the completed form online, via fax, or by mail. Choose the method that works best for you.
  • Processing Time: Expect up to 15 working days for your application to be processed and for you to receive your exemption certificate.