Fill in a Valid Metro Mobility Application Template

The Metro Mobility Application form is a crucial document designed for individuals seeking paratransit services under the Americans with Disabilities Act (ADA). This application consists of two essential components: the Certification Questionnaire and the Professional Verification Form, both of which must be completed and submitted together. To begin the process, applicants are encouraged to fill out the form by clicking the button below.

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The Metro Mobility Application form is a crucial document for individuals seeking paratransit services under the Americans with Disabilities Act (ADA). This application consists of two main components: the Certification Questionnaire Form and the Professional Verification Form. Each part plays an essential role in determining eligibility for the service. The Certification Questionnaire must be completed by the applicant or an advocate, ensuring that all sections are filled out accurately. It requires personal information, including contact details and specifics about the applicant's mobility challenges. The second part, the Professional Verification Form, must be filled out by a qualified professional familiar with the applicant's condition. This could include doctors, therapists, or social workers, among others. Both forms must be submitted together to avoid delays in processing. Additionally, applicants may need to undergo an in-person assessment if further information is required. It is important to ensure that both forms are signed and complete, as any missing information could result in the application being returned. Understanding the steps involved in completing the Metro Mobility Application can streamline the process and facilitate access to necessary transportation services.

Metro Mobility Application Example

APPLICATION INSTRUCTIONS

All applicants must submit a complete application which includes BOTH FORMS

(1)The Certiication Questionnaire Form

(2)The Professional Veriication Form

STEP 1 COMPLETE THE CERTIFICATION QUESTIONNAIRE

The Certiication Questionnaire should be illed out by

the applicant or the applicant’s advocate. The form must be illed out in its entirety. It should be signed by the applicant or the applicant’s guardian and anyone who assisted the applicant in completing the application.

CERTIFICATION

QUESTIONNAIRE

Americans with Disabilities Act (ADA) | Paratransit Eligibility

1.	See application Instructions	We do not
2.	If you have additional questions call Metro Mobility	accePt
	Customer Service at (651) 602-1111 voice, (651) 221-9886 TTY.	aPPlications
3. This form is incomplete if it is NOT ACCOMPANIED BY COMPLETED		by fax
	PROFESSIONAL VERIFICATION.

This application and future written information are available in large print. Does large print better suit your needs?

PART 1 APPLICANT DATAPlease Print or tyPe

Name: ______________________________________________________________________________________

STEP 2 COMPLETE THE PROFESSIONAL VERIFICATION FORM

The Professional Veriication Form must be completed by one of the following professionals who are familiar with the applicant’s condition:

•Physicians or Psychiatrists

•Occupational Therapists

•Psychologists

•Physical Therapists

•Licensed Independent Social Workers (LISW, LICSW)

•Recreational Therapists

•Speech/Language Pathologists

•Certiied Orientation and Mobility Specialists

•Registered Nurses (RN)

•Doctors of Chiropractic (DC)

ELIGIBILITY APPLICATION

PROFESSIONAL VERIFICATION

Americans with Disabilities Act (ADA)

1.	Complete and sign the “Authorization to Release Information”.	We do not
2.	Send to your designated professional.	accePt
3.	Wait for the professional to return this form to you.	aPPlications
	Check back with your professional if you don’t receive your information.	by fax

4.This form is incomplete if it is NOT ACCOMPANIED BY COMPLETED CERTIFICATION QUESTIONNAIRE.

SECTION A RELEASE INFORMATION		Please Print or tyPe
AUTHORIZATION TO


(WHEN COMPLETE SEND TO THE PROFESSIONAL YOU NAMED)
Applicant’s Name: First	Middle Initial	Last
Birth Date:______/______/______

Applicant’s Address: ________________________________________________ Apt.#:____________________

City: ___________________________________________ State:_____________ Zip Code: ________________

Applicant’s Telephone Number (

) ______________________________

I authorize the following professional to release to the MMSC speciic information as requested. It is my understanding that the information released will be used solely to determine my ADA paratransit eligibility. I understand that I may revoke this authorization at any time. Unless revoked, this form will allow that professional listed below to release information described for six months after the date appearing below.

Name of Professional: _______________________________________________ Title:_____________________

Applicant’s Signature: ____________________________________________ Date: ______/______/______

Guardian’s signature required if the applicant is not his/her own guardian,

Guardian’s Signature:_____________________________________________ Date: ______/______/______

To complete the Professional Veriication Form

1.Complete and sign the Authorization to Release Information.

2.Send the Professional Veriication Form to your designated professional.

3.Wait for your professional to return the Professional Veriication Form to you. Check back with your professional if you have not received the form back in a timely manner.

STEP 3 SUBMIT BOTH FORMS TOGETHER

Submit both the Certiication Questionnaire and the Professional Veriication Form in the same envelope to

Metro Mobility Service Center

390 N. Robert Street

Saint Paul, MN 55101-1805

WE DO NOT ACCEPT APPLICATIONS BY FAX OR E-MAIL	See additional info on back

STEP 4 IN-PERSON ASSESSMENT

Usually the forms provide Metro Mobility Staff with all of the information needed to make a determination on eligibility. Sometimes however more information is needed. When this happens an applicant may be asked to come in for an “in-person assessment.”

This assessment may include:

•A conversation about the applicant’s current mobility. The Metro Mobility evaluator will talk with you about how you currently get around.

•A pretend bus trip on the computer. This standardized test is designed to measure a person’s cognitive ability to use regular ixed-route transit. (Functional Assessment of Cognitive Transit Skills or FACTS for short.)

•A walk outside or through the skyway. This will help determine things such as physical ability to get to the regular ixed-route bus as well as memory and landmark recognition.

•A standard walking and balance test. This standardized test measures a person’s risk of falling. (Tinetti Gait and Balance Test.)

PLEASE NOTE THAT APPLICANTS WHO NEED TO COME IN FOR IN-PERSON ASSESSMENTS WILL STILL HAVE THEIR APPLICATIONS PROCESSED WITHIN 21 CALENDAR DAYS.

COMMON ISSUES

In order to make a determination within 21 calendar days the Metro Mobility Service Center must have a complete application. There are several things which may cause an application to be incomplete. By double checking these things PRIOR to submitting your application you may avoid delays in processing.

1.One of the forms is missing. Your application must contain both the Certiication Questionnaire and the Professional Veriication. Please ensure both are submitted in the same envelope.

2.One of the forms is not signed. Both the Certiication Questionnaire and the Professional Veriication must be signed. If either the applicant or the professional forgets to sign the form it is considered incomplete.

3.The professional credentials are missing. Professionals must include their titles and credentials when signing the Professional Veriication.

Jane Doe X (Incomplete) Jane Doe M.D.

(Complete) Jane Doe R.N.

(Complete)

AN INCOMPLETE APPLICATION WILL BE RETURNED TO THE APPLICANT ONE (1) TIME. IF IT IS SUBMITTED A SECOND TIME AND IS STILL INCOMPLETE IT WILL BE HELD FOR 60 DAYS BY THE METRO MOBILITY SERVICE CENTER BEFOREIT IS DISCARDED.

APPLICATIONS MUST BE PROCESSED WITHIN 21 CALENDAR DAYS. IF YOUR PROPERLY COMPLETED AND SUBMITTED APPLICATION IS NOT PROCESSED WITHIN 21 DAYS, YOU WILL BE GRANTED PRESUMPTIVE ELIGIBILITY FOR METRO MOBILITY SERVICE UNTIL YOUR APPLICATION IS PROCESSED.

Questions? Please call 651-602-1111

CERTIFICATION

QUESTIONNAIRE

Americans with Disabilities Act (ADA) | Paratransit Eligibility

1.See application Instructions

2.If you have additional questions call Metro Mobility

Customer Service at (651) 602-1111 voice, (651) 221-9886 TTY.

3.This form is incomplete if it is NOT ACCOMPANIED BY COMPLETED PROFESSIONAL VERIFICATION.

WE DO NOT ACCEPT APPLICATIONS BY FAX

This application and future written information are available in large print. Does large print better suit your needs?

PART 1 APPLICANT DATA

PLEASE PRINT OR TYPE

Name: ______________________________________________________________________________________

FirstMiddle InitialLast

Street Address: ____________________________________________________ Apt.#:____________________

City: ______________________________________________________________ Zip Code: ________________

Day Telephone: (	) ________________________ Evening Telephone: (	) ________________
Email Address: _____________________________________________________
I prefer communication via email: ____Yes ____No
Birth Date:______/______/______
Do you have a Minnesota state ID card or Minnesota driver’s license?		Yes	No

ID # ______________________________ License # ______________________ Expiration Year: __________

Mailing Address (if different from above)

Street Address: ____________________________________________________ Apt.#: __________________

City: ______________________________________________________________ Zip Code: ______________

Emergency Contact Person

Name: _____________________________________________________________________________________

First	Middle Initial	Last
Day Telephone: (	) _______________________ Evening Telephone: (	) _______________

1.Are you able to travel in an automobile? ____Yes ____No

2.If you use a wheelchair or scooter:

Is it more than 30 inches wide? ____Yes ____No

Is it more than 48 inches long? ____Yes ____No

Is the combined weight of device and occupant more than 600 pounds? ____Yes ____No

3. Which of the following assistive devices, if any, do you use? (Please check all that apply.)

Cane	Manual Wheelchair	Boarding Chair	Prosthesis
White Cane	Powered Wheelchair	Service Animal	Communication Aid
Walker	Powered Scooter/	Portable Oxygen	Other (please describe):
Crutches	Cart	Transfer Board

If you selected Wheelchair or Scooter, would you prefer/need to use the device while riding in Metro Mobility Vehicles? ____Yes ____No ____Sometimes

4.Does your health condition/disability require you to use Metro Mobility service:

Seasonally (Nov. - Apr.)

Permanently	Temporarily
If temporarily, for how long?	Week(s)	Month(s)

5.Does your health condition/disability change from day to day in ways that occasionally disrupts your ability to use regular-route city bus service? ____Yes ____No

If yes, please explain: ______________________________________________________________________

6.When using Metro Mobility service, does your health condition/disability require you to travel with someone to assist and/or supervise you? ____Yes ____No

PART 2 QUESTIONS ABOUT USING

REGULAR-ROUTE PUBLIC TRANSIT

Complete Part 2 even if you are unable to use regular-route city bus service. This information will assist us in determining how your disability/health condition affects your ability to use regular-route city bus

service.

7. Do you now independently use regular-route city buses? ____Yes ____No ____Sometimes

If “Yes” or “Sometimes,” how many times?

per week

per month per year

Which of the following best describes how you use regular-route city buses?

To travel to and from one destination only

To travel to and from a few destinations

To travel to and from many different destinations

Explain what prevents you from independently using regular-route city bus.

8. Have you ever had training to use the regular-route city buses? ____Yes ____No

9. Using a mobility aid or on your own, how far are you able to travel without the assistance of

another person?	3 blocks	6 blocks
	9 blocks or more	less than 3 blocks

10.I can wait for a regular-route city bus (check all that apply):

Only if there is a bench or shelter

Up to 15 minutes

More than 15 minutes

11.Please check all the categories below as they relate to your ability to use regular-route city buses:

	I am:	Yes	No	Sometimes
A.	Able to tolerate very hot or very cold weather
B.	Able to recognize destinations, bus stops, or landmarks
C.	Able to tolerate air pollution (smog, fumes, perfume)
D.	Free from night blindness
E.	Able to recognize printed information
F.	Able	to hear and process spoken words or auditory information
G.	Able to communicate needs
H.	Able to follow directions

I.Able to deal with unexpected situations or changes in routine

(example: bus detours)...................................................................

J.Able to safely and effectively travel through crowded and/or

complex facilities............................................................................

K. Able to recognize changes in terrain..................................................

L.Able to travel independently along sidewalks and other

pedestrian ways ..............................................................................

M. Able to cross streets independently...................................................

N. Able to ind the correct bus stop .......................................................

O. Able to identify the correct bus..........................................................

P. Able to get on and off a bus using the lift if necessary......................

Q. Able to deposit fare into the fare box or show bus pass ...................

R.Able to get to a seat/wheelchair position and remain seated

during a bus trip ..............................................................................

S. Familiar with what to do if I miss my bus...........................................

If you checked “No” or “Sometimes” to any of the items in question 11, please explain:

More Space Provided On The Next Page

PART 3 APPLICANT SIGNATURE

The information provided on this form is private data and is used to determine ADA paratransit eligibility. The ability to determine your eligibility is based on receiving all of the information requested on this form. All medical or locational information pertaining to application for or users of ADA paratransit service is private. Any other information cannot be released to anyone else, unless the applicant or user authorizes the release in writing. If you are determined ADA paratransit eligible, information about your eligibility status will be entered into a database maintained by the Minnesota Department of Public Safety, Driver and Vehicle Services Division. This information could be used by Drivers License Division of the Depart- ment of Public Safety to (1) Reexamine your driving ability or, (2) Demand that you surrender your license if a severe disabling condition has developed since the current license was issued.

I certify that all information on this application form is accurate. I understand that misinformation or misrepresentation of facts will be cause for disqualiication or rejection of my ADA eligibility. I also understand that additional information relating to my health condition or disability may be required to determine eligibility. This information may be obtained through an in-person assessment or by requesting information from a professional who understands my health condition or disability. Additional information will be required only when the information provided on the application form does not clearly determine ADA paratransit eligibility.

Applicant’s Signature:_____________________________________________ Date:______/______/______

*If the applicant is not his/her own guardian, the following information about the guardian is required:

Guardian’s Name: (please print) _______________________________________________________________________________

	First	Middle Initial	Last
Day Phone: (	) ______________________________________________________

Guardian’s Signature: _____________________________________________ Date:______/______/______

*If someone other than the applicant or the applicant’s guardian is preparing this form, please provide the following information about the preparer:

Name: (please print) _________________________________________________________________________________________

	First	Middle Initial	Last
Day Phone: (	) ______________________________________________________

Preparer’s Signature:______________________________________________ Date:______/______/______

ELIGIBILITY APPLICATION PROFESSIONAL VERIFICATION

Americans with Disabilities Act (ADA)

1.Complete and sign the “Authorization to Release Information”.

2.Send to your designated professional.

3.Wait for the professional to return this form to you.

Check back with your professional if you don’t receive your information.

4.This form is incomplete if it is NOT ACCOMPANIED BY COMPLETED CERTIFICATION QUESTIONNAIRE.

WE DO NOT ACCEPT APPLICATIONS BY FAX

AUTHORIZATION TO		PLEASE PRINT OR TYPE
SECTION A RELEASE INFORMATION		PLEASE PRINT OR TYPE
SECTION A RELEASE INFORMATION

(WHEN COMPLETE SEND TO THE PROFESSIONAL YOU NAMED)

Applicant’s Name: First	Middle Initial	Last
Birth Date:______/______/______

Applicant’s Address: ________________________________________________ Apt.#:____________________

City: ___________________________________________ State:_____________ Zip Code: ________________

Applicant’s Telephone Number (

) ______________________________

Name of Professional: _______________________________________________ Title:_____________________

Applicant’s Signature: ____________________________________________ Date: ______/______/______

Guardian’s signature required if the applicant is not his/her own guardian,

Guardian’s Signature:_____________________________________________ Date: ______/______/______

SECTION B METRO MOBILITY PROFESSIONAL VERIFICATION FORM

Dear Health Care Professional:

You are being asked to provide information regarding this individual’s disability. The Federal Law is very speciic about ADA para-transit eligibility. The law restricts eligibility to individuals who,

1.as a result of their disability, cannot board, ride, or disembark from a regular ixed route bus or light rail car or

2.have a speciic impairment-related condition which prevents them from getting to or from a bus stop.

PLEASE NOTE: This does not include persons who ind it dificult or uncomfortable to get to and

from bus stops. In providing information you should consider only the presence of a disability or health condition and not the applicant’s age or economic status.

THIS SECTION MUST BE FILLED OUT FOR ALL APPLICANTS

GENERAL INFORMATION

•Describe the diagnosed disability you are currently treating this individual for: _____________________

____________________________________________________________________________________________

• Describe any other health conditions or disabilities with which this individual is diagnosed:__________

____________________________________________________________________________________________

•Date of onset ____/____/____

•Date of last visit ____/____/____

•How long have you worked with the individual? Since ____/____/____

•Is disability temporary ________ or permanent ________ ?

If permanent is disability progressive? ____Yes ____No

If temporary please give best estimate of rate of recovery. ___________________________________

• Is therapy part of treatment? ____Yes ____No If yes, give brief description ______________________

____________________________________________________________________________________________

• Do temperature extremes affect the individual?

(Ex. Heat index of more than 85 degrees or wind chill less than 10 degrees) ____Yes ____No

If yes, how so? _________________________________________________________________________

• Please list all medications. _____________________________	____________________________
_____________________________	____________________________
_____________________________	____________________________

•Is this individual compliant with taking medications? ____Yes ____No

•Does the individual currently uses regular route public transportation? ____Yes ____No ____Not Sure

•Is the individual’s judgment impaired ____Yes ____No

•Is behavioral inhibition impaired? ____Yes ____No

•Can the individual walk? ____Yes ____No

• Does the individual use a mobility aid? ____Yes ____No Please list ____________________________

____________________________________________________________________________________________

•How long has individual been using the device(s)? _____________________________________________

____________________________________________________________________________________________

• How far can the individual travel without the assistance of another person?

3 blocks

6 blocks

9 blocks or more

less than 3 blocks

•With treatment/therapy will this distance increase? ____Yes ____No

•Please indicate the expected distance after treatment/therapy:

3 blocks

6 blocks

9 blocks or more

less than 3 blocks

•Give best estimate of length of time required to achieve this improvement. _______________________

____________________________________________________________________________________________

PLEASE COMPLETE ONLY THOSE SECTIONS THAT APPLY TO THIS INDIVIDUAL

NEUROLOGICAL IMPAIRMENT/HEAD INJURY

• Does the individual experience seizures? ____Yes ____No Date of last seizure ______/______/______

•Please give no. of seizures ________ and frequency ____________________________________________

•What type(s) of seizures does patient experience_______________________________________________

•Does individual experience auras? ____Yes ____No

•Is the individual’s judgment impaired? ____Yes ____No

•Is behavioral inhibition impaired? ____Yes ____No

•Does judgment and inhibition impairment prevent the individual from independently traveling outside the home or immediate environment? ____Yes ____No

•When traveling independently does the individual have the ability to: (check all that apply)


Get help if lost	Recognize & avoid danger		Cross streets safely
Follow written directions		Communicate needs	Process information

Understand and follow schedule to get places on time

• Is there history of Brain Injury ____Yes ____No. Date of injury______/______/______

VISUAL IMPAIRMENT

•Please provide visual acuity measurements and visual ield readings for both eyes. OS: __________________________ OD: ________________________________

•Does the individual require any accommodations, adaptations, low vision aids, etc? Please list:

____________________________________________________________________________________________

• How does the individual’s visual impairment affect their ability to move about in the environment?

____________________________________________________________________________________________

• Has the individual received any orientation & mobility (O&M) training? ____Yes ____No

3	Questions? Please call 651-602-1111

• Does the individual experience any of the following:
Auditory hallucinations	Visual hallucinations	Delusions	Disassociation

•Does this prevent the individual from being oriented to person, place, and time? ____Yes ____No

•Is the individual currently being treated for any of the following:

Anxiety	Depression	Panic attacks	Schizophrenia
Other: _____________________

•For anxiety panic attacks please indicate on average the frequency and length of panic attacks. Per day________ Per week________ Per month________ Per year________

Approx. duration: ________

•What technique(s) and/or skills is the individual utilizing to assist in coping with the above issue(s)?

Visualization	Relaxation techniques	Positive self-talk	Aroma therapy
Other:______________________

•Are these techniques effective in reducing symptoms? ____Yes ____No

•Is there a history of Electroconvulsive Therapy (ECT)? ____Yes ____No ____Unknown

COGNITIVE/MENTAL IMPAIRMENTS

Please list IQ score and GAF score if known. IQ = ___________ GAF = ___________

•Please describe the functional limitations caused by this impairment?

___________________________________________________________________________________________

•Is the individual’s judgment impaired? ____Yes ____No

•If yes, please describe to what extent or give an example.______________________________________

_________________________________________________________________________________________

• Is the individual able to live independently? ____Yes ____No

Additional Comments: ____________________________________________________________________

___________________________________________________________________________________________

MMSC Staff will make the inal determination of the applicant’s eligibility

Doctor/Health Care Professional Signature: _________________________________________________

PLEASE RETURN FORM TO APPLICANT PLEASE PRINT so that we may contact you if needed Name of Professional: ______________________________________________ Date: ______/______/______

Title: _______________________________________________________________________________________

Street Address:______________________________________________________________________________

City: _____________________________________ State: ________ Zip Code: _________________________

Telephone Number: (

) ____________________________ Fax: (

) _____________________

Click for Metro Mobility Application File

File Breakdown

Fact Name	Detail
Application Components	Applicants must submit both the Certification Questionnaire Form and the Professional Verification Form for their application to be complete.
Professional Verification Requirement	The Professional Verification Form must be completed by a qualified professional familiar with the applicant’s condition, such as a physician, occupational therapist, or psychologist.
Submission Guidelines	Both forms must be submitted together in the same envelope to the Metro Mobility Service Center. Applications are not accepted by fax or email.
Governing Law	This application process is governed by the Americans with Disabilities Act (ADA), which ensures accessibility and non-discrimination for individuals with disabilities.

Guide to Using Metro Mobility Application

Completing the Metro Mobility Application form is a crucial step toward accessing necessary transportation services. To ensure your application is processed efficiently, follow these steps carefully. It’s important to provide accurate information and submit all required documents together.

Complete the Certification Questionnaire: Fill out the Certification Questionnaire form completely. If you need assistance, an advocate can help. Make sure it is signed by both the applicant and anyone who assisted in completing it.
Gather Professional Verification: Obtain the Professional Verification Form. This form must be filled out by a qualified professional familiar with the applicant’s condition, such as a physician or therapist.
Authorization to Release Information: Complete and sign the “Authorization to Release Information” section on the Professional Verification Form. This allows the designated professional to share necessary information with Metro Mobility.
Send the Professional Verification Form: Submit the completed Professional Verification Form to your chosen professional. Make sure to follow up to ensure they return the form to you promptly.
Check for Completeness: Before submitting, verify that both forms are fully completed and signed. Ensure that professional credentials are included on the Professional Verification Form.
Submit Both Forms Together: Place both the Certification Questionnaire and the Professional Verification Form in the same envelope. Send them to the Metro Mobility Service Center at 390 N. Robert Street, Saint Paul, MN 55101-1805. Remember, applications cannot be sent by fax or email.

Once your application is submitted, Metro Mobility will review it. If additional information is needed, you may be asked to attend an in-person assessment. This assessment helps determine your eligibility and may include various evaluations related to your mobility. Be proactive and ensure your application is complete to avoid any delays.

Get Answers on Metro Mobility Application

What forms do I need to submit with my Metro Mobility application?

All applicants must submit a complete application that includes two forms: the Certification Questionnaire Form and the Professional Verification Form. Both forms must be filled out entirely and submitted together in the same envelope.

Who should complete the Certification Questionnaire Form?

The Certification Questionnaire should be completed by the applicant or their advocate. It is essential that the form is filled out completely and signed by the applicant or their guardian, as well as anyone who assisted in the application process.

What is the purpose of the Professional Verification Form?

The Professional Verification Form must be completed by a qualified professional who is familiar with the applicant's condition. This includes physicians, occupational therapists, and other licensed professionals. Their input helps determine the applicant's eligibility for Metro Mobility services.

What happens if I do not submit both forms?

If either the Certification Questionnaire or the Professional Verification Form is missing, the application will be considered incomplete. An incomplete application will be returned to the applicant once. If it is submitted again and remains incomplete, it will be held for 60 days before being discarded.

Can I submit my application by fax or email?

No, applications cannot be submitted by fax or email. All documents must be mailed to the Metro Mobility Service Center in a single envelope.

What if I need assistance filling out the application?

If you require assistance, you can have an advocate help you complete the forms. It is crucial that the application is filled out accurately and completely to avoid delays.

What is the in-person assessment, and when is it required?

An in-person assessment may be required if additional information is needed to determine eligibility. This assessment could involve discussions about your mobility, a simulated bus trip, or physical tests. Applicants will still have their applications processed within 21 calendar days even if an assessment is needed.

How long does it take to process my application?

Metro Mobility aims to process applications within 21 calendar days. If your properly completed application is not processed in this timeframe, you will be granted presumptive eligibility for services until your application is processed.

What should I do if I have questions about the application process?

If you have additional questions, you can contact Metro Mobility Customer Service at (651) 602-1111 for voice assistance or (651) 221-9886 for TTY support. They can provide guidance on the application process.

What if my health condition changes after I submit my application?

If your health condition or disability changes after submitting your application, it is advisable to inform Metro Mobility as soon as possible. This information may affect your eligibility and the services you require.

Common mistakes

Filling out the Metro Mobility Application form can be a straightforward process, but it’s easy to make mistakes that could delay your eligibility determination. Here are nine common pitfalls to avoid when completing this important application.

First, many applicants forget to submit both required forms: the Certification Questionnaire and the Professional Verification Form. It is crucial to remember that both forms must be included in the same envelope. An application missing either form is considered incomplete and will not be processed.

Another frequent error involves signatures. Both forms require signatures from the applicant and, if applicable, their guardian. If these signatures are missing, the application will be deemed incomplete. This simple oversight can lead to unnecessary delays.

Additionally, applicants often overlook the need for professional credentials on the Professional Verification Form. Professionals must clearly state their titles and credentials when signing the form. For example, a signature like "Jane Doe" is insufficient, while "Jane Doe, M.D." is complete. Missing credentials can lead to rejection of the application.

Some applicants also fail to complete the “Authorization to Release Information” section. This authorization is essential for the professional to share necessary information with Metro Mobility. Without it, the application cannot proceed.

Inaccurate information can also be a stumbling block. Providing incorrect details about the applicant's condition or mobility can lead to confusion and delays. It’s important to double-check all information for accuracy before submission.

Another mistake is neglecting to follow up with the designated professional. After sending the Professional Verification Form, it’s wise to check back with the professional to ensure they have completed and returned the form. Delays from the professional’s side can hold up the entire application process.

Some applicants may not realize the importance of answering all questions thoroughly. Leaving questions blank or providing vague answers can result in an incomplete application. Each question is designed to gather specific information that supports the applicant's case for eligibility.

Additionally, applicants sometimes forget to check the preferred method of communication. If you prefer to receive updates via email but fail to indicate this preference, you might miss important notifications regarding your application status.

Lastly, it’s crucial to remember that applications cannot be submitted via fax or email. Some applicants mistakenly believe they can send their forms electronically, which is not allowed. Always submit your application by mail to ensure it is received and processed correctly.

By being aware of these common mistakes, applicants can significantly improve their chances of a smooth and efficient application process. Taking the time to carefully review each section and ensuring all requirements are met can make a big difference.

Documents used along the form

The Metro Mobility Application process requires several key forms to ensure that applicants receive the assistance they need. Alongside the Metro Mobility Application form, there are other important documents that may be required. Each of these documents plays a crucial role in the eligibility determination process.

Certification Questionnaire Form: This form must be completed by the applicant or their advocate. It gathers personal information and assesses the applicant's ability to use regular public transit.
Professional Verification Form: A healthcare professional familiar with the applicant's condition must fill out this form. It confirms the applicant's eligibility based on their health status.
Authorization to Release Information: This document allows the designated professional to share specific information about the applicant with the Metro Mobility Service Center. It is essential for processing the Professional Verification Form.
Emergency Contact Form: This form provides contact details for someone who can be reached in case of an emergency. It ensures that help can be provided quickly if needed during transit.
In-Person Assessment Schedule: If additional information is required, applicants may need to attend an in-person assessment. This document outlines the details of the assessment process.
Transportation Needs Assessment: This form assesses the specific transportation needs of the applicant, including any mobility aids they may use and their ability to navigate public transit.
Service Agreement Form: Once approved, this document outlines the terms and conditions of using Metro Mobility services. It is important for understanding the rights and responsibilities of the service user.

Completing all necessary forms accurately and submitting them together will help streamline the application process. If you have any questions or need assistance, don't hesitate to reach out for support. Your eligibility for Metro Mobility services is important, and ensuring that all documentation is in order can make a significant difference in your experience.

Similar forms

Disability Benefits Application: Similar to the Metro Mobility Application, this document requires detailed personal information and verification of disability from a qualified professional. Both forms aim to establish eligibility for services based on specific criteria related to the applicant's condition.
Medicaid Application: Like the Metro Mobility Application, the Medicaid Application involves submitting personal data and supporting documentation. Both applications require verification of eligibility based on health-related needs and financial status.
Social Security Disability Insurance (SSDI) Application: This application shares similarities in that it requires comprehensive information about the applicant’s medical history and the impact of their disability on daily activities, much like the Metro Mobility Application.
Supplemental Nutrition Assistance Program (SNAP) Application: Both applications involve assessing the applicant's needs and circumstances. The SNAP application focuses on food security, while the Metro Mobility Application centers on transportation needs.
Housing Assistance Application: Similar to the Metro Mobility Application, this document requires detailed information about the applicant’s living situation and needs. Both applications aim to provide necessary support services based on individual circumstances.
Veterans Affairs Benefits Application: This document is comparable as it requires verification from healthcare professionals regarding the applicant's service-related disabilities, similar to the professional verification needed in the Metro Mobility Application.
Child Care Assistance Application: Like the Metro Mobility Application, this form collects information about the applicant's situation and needs. Both applications assess eligibility for support services based on specific criteria.
Public Assistance Application: This application is similar as it requires a thorough assessment of the applicant's financial and personal circumstances. Both documents aim to determine eligibility for public services based on individual needs.

Dos and Don'ts

When filling out the Metro Mobility Application form, there are several important dos and don'ts to keep in mind to ensure a smooth application process.

Do fill out both the Certification Questionnaire and the Professional Verification Form completely.
Do ensure that both forms are signed by the appropriate parties.
Do include the professional's credentials when submitting the Professional Verification Form.
Do submit both forms in the same envelope to avoid processing delays.
Don't forget to double-check for missing information before submission.
Don't submit applications by fax or email, as they will not be accepted.

Misconceptions

Here are five common misconceptions about the Metro Mobility Application form, along with explanations to clarify them:

Misconception 1: You can submit the application by fax or email.

This is not true. The Metro Mobility Service Center does not accept applications via fax or email. You must submit a complete application by mail.

Misconception 2: Only the applicant needs to sign the forms.

Both forms—the Certification Questionnaire and the Professional Verification—require signatures from the applicant and the professional completing the verification. If either signature is missing, the application will be considered incomplete.

Misconception 3: You can submit the forms separately.

Both the Certification Questionnaire and the Professional Verification Form must be submitted together in the same envelope. If one form is missing, the application will not be processed.

Misconception 4: You do not need to follow up with the professional after sending the form.

Misconception 5: An incomplete application will be processed eventually.

If your application is incomplete, it will be returned to you one time for corrections. If you resubmit it and it remains incomplete, it will be held for 60 days before being discarded. It’s crucial to ensure all information is complete before submission.

Key takeaways

Both the Certification Questionnaire and the Professional Verification Form must be completed and submitted together. Missing either form will result in an incomplete application.
The Certification Questionnaire should be filled out by the applicant or their advocate. It must be signed by the applicant or their guardian, as well as anyone who assisted in completing it.
The Professional Verification Form needs to be completed by a qualified professional familiar with the applicant’s condition. This includes various healthcare providers like physicians, therapists, and social workers.
After submitting the application, if additional information is needed, an in-person assessment may be required. This assessment can include discussions about mobility and standardized tests to evaluate cognitive and physical abilities.