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The Nassau Parking Application form is an essential document for residents of Nassau County seeking a handicapped parking permit. This application is designed specifically for individuals with severe disabilities that significantly impair their mobility. It consists of two main parts: personal information and medical certification. In the first section, applicants provide details such as their name, address, and contact information, along with their date of birth and gender. They must also indicate whether they possess a handicapped license plate. The second part requires a licensed New York State physician to certify the applicant's condition, detailing any physical impairments that justify the need for a permit. Important instructions accompany the form, emphasizing that it must be fully completed and signed, with no copies or faxes accepted. Additionally, it is crucial for applicants to include a self-addressed envelope for expedited processing. Understanding these key aspects is vital for ensuring a smooth application process and securing the necessary parking privileges.
Nassau Parking Application Example
PART I PERSONAL INFORMATION (To be completed by disabled person)
I hereby certify that the above statements are true and authorize the physician named to furnish any information requested by the
Nassau County Office for the Physically Challenged concerning the diagnosis, prognosis and treatment of my described condi-
tion. I further acknowledge that I have read and understand the conditions of this application and the Handicapped Parking
Permit, and shall observe and comply with same.
Date
SIGNATURE OF APPLICANT OR GUARDIAN
PART II MEDICAL CERTIFICATION INFORMATION (To be completed by a New York State licensed medical physician).
Name of Physician Phone #
Address
Physicians’s
Name of Patient NYS Practicing License #
Please Check and describe below applicable condition(s):
“Severely Disabled Person”. shall mean any person who has any one or more of the following impairments, disabilities or condi-
tions which are permanent in nature.
(a)_____ Has limited or no use of one or both lower limbs; (State disability and describe below:)
(b)_____ Has a Neuro-muscular dysfunction which severely limits mobility; (state disability and describe below)
(c)_____ Has a physical or mental impairment of condition which is other than those specified above, but is of such nature as
to impose unusual hardship in utilization of public transportation facilities and such condition is certified by a physician
duly licensed to practice medicine in this state as constituting an equal degree of disability (specifying the particular
condition) so as to prevent such person from getting around without great difficulty in accordance with subdivision two
of this section; or
(d)_____ A legally blind person
Please describe handicapped condition:
Temporary ?: _______ _______ Doctor must state walking device used ______________________
TEMPORARY DISABILITY: A temporarily disabled person is any person who is unable to ambulate without the aid of an assisting
device, such as a brace, cane, crutch, prosthetic device, wheelchair, walker or other assistive device. (temporary permits are
issued for periods of six months or less). New application required after that.
I am an MD licensed to practice in New York State, and in my professional opinion, I believe the applicant’s mobility
impairing condition does warrant a handicapped Parking Permit, according to the above New York State definition of
“SEVERELY DISABLED.” Yes________ No_________
Date: ___________________
SIGNATURE OF PHYSICIAN (No stamps accepted)(MD/DO/DPM/NP)
Permit No. _____________________ Date Issued ________________ Expiration Date _____________
Permanent Temporary
For Office Use Only
Name of Disabled Person_____________________________________________________________________________________
Address___________________________________________________________________________________________________
house number, street (NO P.O. Box) city zip code county state
Home Telephone_____________________________ Date of Birth ______________________ Male Female
Current Drivers License ID Number/Non Drivers License ID Number
Do not have Drivers License/Non Drivers License
HP4594 5/79/ Rev. 11/08
Do you have a handicapped license plate? No_________ Yes_________ If yes, License Plate No.___________
How long is
Permit needed?:
NASSAU COUNTY OFFICE FOR THE PHYSICALLY CHALLENGED STATE HANDICAPPED PARKING PERMIT APPLICATION
60 CHARLES LINDBERGH BOULEVARD, UNIONDALE, N.Y. 11553 (516) 227-7399
State Permanent diagnosis:
State temporary diagnosis:_________________________________________________________________________________
See Reverse Side
(please print ) last first middle initial
INSTRUCTIONS FOR APPLICATION
1. MUST BE A NASSAU COUNTY RESIDENT.
You are eligible for a permit if you are a resident of Nassau County who has one or more
servere disabilities that impair your mobility.
All applications must have a Nassau County street address (No Post Office Boxes).
2. All applications must be fully completed and properly executed.
All questions must be answered and Medical Certification MUST be completed by a
New York State Practicing Licensed
Medical Doctor. All Applications must be signed
not stamped.
***** NO CHIROPRACTOR *****
3. All permits are issued in the name of the person with the disability, therefore all
Information on application must pertain to the disababled applicant.
You do not have to be the driver . Children and non drivers can apply for a permit.
Application must be in the name of the person with the disability.
4. The Department of New York State Motor Vehicles requires the disabled person’s
New York State Drivers License Client ID number or on a NYS ID card to be on the permit.
Enclose a copy of disabled applicants ID (not the person driving them) with this
Completed application.
5. COPIES OR FAXES of Applications will result in immediate
denial.
6. To expedite the issuance of your permit upon approval, please enclose a self-addressed
(number 10 size) envolope.
7. Any
FALSE statement on the application by the applicant or by the doctor will result in
refusal to issue a permit.
File Breakdown
| Fact Name | Description |
|---|---|
| Governing Authority | The application is governed by New York State laws regarding handicapped parking permits. |
| Eligibility | Applicants must be residents of Nassau County and have one or more severe disabilities that impair mobility. |
| Application Requirement | All applications must be fully completed and signed by the disabled person or their guardian. |
| Medical Certification | A licensed New York State medical physician must complete the medical certification section of the application. |
| Identification Requirement | Applicants must provide their New York State Drivers License Client ID number or a NYS ID card number. |
| Permit Issuance | Permits are issued in the name of the person with the disability, not necessarily the driver. |
| False Statements | Any false information provided by the applicant or physician may lead to denial of the permit. |
| Temporary Permits | Temporary permits are available for individuals unable to ambulate without an assisting device for six months or less. |
| Submission Guidelines | Applications must be original; copies or faxes will result in immediate denial. |
Guide to Using Nassau Parking Application
Filling out the Nassau Parking Application form is an important step for those seeking a handicapped parking permit. This process requires careful attention to detail to ensure that all necessary information is accurately provided. Once you have completed the form, you will submit it for review, and upon approval, you will receive your permit.
- Obtain the Application: Download or pick up a copy of the Nassau Parking Application form.
- Complete Personal Information: Fill in your name, address, and contact details in Part I. Make sure to include your home telephone number and date of birth. Indicate your gender and whether you have a handicapped license plate.
- Provide License Information: If applicable, enter your license plate number and your driver's license or non-driver ID number. If you do not have either, check the appropriate box.
- Certify Your Information: Sign and date the application, certifying that all information is true and that you understand the conditions of the permit.
- Medical Certification: Have a licensed New York State physician complete Part II. They must provide their name, contact information, and license number, as well as certify your condition.
- Describe Your Condition: The physician must check the applicable conditions and provide a detailed description of your disability. If temporary, they should indicate the duration.
- Include Supporting Documents: Attach a copy of your New York State driver's license or ID card to the application.
- Review for Completeness: Ensure all sections are filled out and that both you and your physician have signed the application.
- Submit the Application: Send your completed application to the Nassau County Office for the Physically Challenged. Include a self-addressed envelope to expedite the process.
Get Answers on Nassau Parking Application
What is the Nassau Parking Application form used for?
The Nassau Parking Application form is used to apply for a handicapped parking permit in Nassau County, New York. This permit allows individuals with severe disabilities that impair their mobility to park in designated handicapped spaces, making it easier for them to access public and private facilities.
Who is eligible to apply for a handicapped parking permit?
To be eligible for a handicapped parking permit, you must be a resident of Nassau County and have one or more severe disabilities that significantly impair your ability to move around. The application must include a valid Nassau County street address; P.O. Boxes are not acceptable.
What information is required on the application?
The application requires personal information about the disabled person, including their name, address, date of birth, and contact information. Additionally, it requires medical certification from a licensed New York State physician who must verify the applicant's mobility impairing condition. All sections of the application must be fully completed and signed.
Can someone else apply on behalf of the disabled person?
No, the application must be completed in the name of the person with the disability. However, a guardian or caregiver can assist in filling out the form. It is crucial that all information pertains to the disabled applicant, not the person assisting them.
What happens if the application is not completed correctly?
If the application is not fully completed or if any required information is missing, it will be denied. Additionally, any false statements made by the applicant or the physician will result in refusal to issue a permit. It is essential to review the application carefully before submission.
Are copies or faxes of the application accepted?
No, copies or faxes of the application will lead to immediate denial. Only original, signed applications will be processed. Ensure that the application is submitted in its original form.
How can I expedite the processing of my application?
To expedite the issuance of your permit, enclose a self-addressed envelope (size number 10) with your completed application. This will facilitate faster communication regarding your permit status once it has been approved.
Is there a time limit for temporary permits?
Yes, temporary permits are issued for a maximum period of six months. If you require a permit beyond this duration, a new application must be submitted, along with updated medical certification. Ensure that your physician provides a clear statement regarding the temporary nature of your condition.
Common mistakes
Filling out the Nassau Parking Application form can be straightforward, but many applicants make common mistakes that can delay the process or even lead to denial. One frequent error is failing to provide a complete address. The application specifically requires a Nassau County street address, and using a P.O. Box will result in immediate rejection. Ensure that every part of the address, including house number, street, city, and zip code, is accurately filled out.
Another mistake involves the medical certification section. Applicants often overlook the requirement for a licensed medical physician to complete this part. Only physicians with a valid New York State license can certify the applicant’s condition. Submitting a certification from a chiropractor or failing to include the physician’s signature will lead to automatic denial. It is crucial to verify that the physician's name, contact information, and license number are clearly stated.
Inaccuracies in personal information also pose a problem. Many individuals mistakenly provide incorrect or outdated information, such as an old phone number or an incorrect driver's license ID number. This can create confusion and hinder communication with the Nassau County Office for the Physically Challenged. Double-checking all personal details before submission is essential to avoid these pitfalls.
Some applicants forget to answer all questions on the form. Each section must be fully completed, and leaving any question unanswered can lead to delays. This includes the medical certification section, where specific conditions must be described in detail. Providing comprehensive information helps the reviewing office make informed decisions.
Moreover, applicants often neglect to include required documentation, such as a copy of the disabled applicant's ID. This is a crucial component that must accompany the application. Failing to include this documentation can result in immediate denial, so it’s wise to gather all necessary materials before submitting the application.
Lastly, many individuals do not read the instructions carefully. The form explicitly states that any false statements made by the applicant or the physician will lead to refusal of the permit. Understanding the requirements and adhering to them is vital for a successful application. By avoiding these common mistakes, applicants can streamline the process and increase their chances of receiving a handicapped parking permit.
Documents used along the form
When applying for a handicapped parking permit in Nassau County, several additional forms and documents may be required to support your application. These documents help ensure that all necessary information is accurately provided and that the application is processed efficiently. Below is a list of forms commonly used alongside the Nassau Parking Application form.
- Proof of Residency: This document verifies that the applicant resides in Nassau County. It can include utility bills, lease agreements, or any official correspondence that displays the applicant's name and address.
- Physician's Statement: A detailed letter from the applicant's physician may be necessary. This letter should outline the medical condition and its impact on mobility, reinforcing the need for a handicapped parking permit.
- Driver's License Copy: A copy of the applicant’s New York State driver’s license or non-driver ID is typically required. This ensures that the permit is issued in the name of the individual with the disability.
- Vehicle Registration: A copy of the vehicle registration may be needed if the applicant plans to use the permit with a specific vehicle. This document confirms ownership and helps link the permit to the vehicle.
- Self-Addressed Envelope: Including a self-addressed envelope with the application can expedite the process. This envelope should be of the standard size to ensure that the permit can be mailed directly to the applicant.
- Application Fee: Depending on local regulations, a fee may be required when submitting the application. Check with the Nassau County Office for the Physically Challenged for current fee information.
Gathering these documents in advance can help streamline the application process and reduce delays. Ensure that all information is accurate and complete to facilitate a smooth approval for your handicapped parking permit.
Similar forms
The Nassau Parking Application form is similar to several other documents that serve various purposes related to disability and parking permits. Here are eight documents that share similarities with the Nassau Parking Application form:
- State Handicapped Parking Permit Application: This document allows individuals with disabilities to apply for a parking permit, requiring personal and medical information similar to the Nassau form.
- Disabled Veteran Parking Permit Application: Like the Nassau form, this application is designed for veterans with disabilities, asking for proof of service and medical certification.
- Temporary Disability Parking Permit Application: This form is for individuals with temporary disabilities, mirroring the structure of the Nassau application in gathering personal and medical details.
- Accessible Parking Permit Application: This document also focuses on providing parking access for those with mobility issues, requiring similar information about the applicant's condition.
- Medicaid Transportation Request Form: Individuals seeking transportation assistance due to disabilities fill out this form, which collects personal and medical information like the Nassau application.
- Social Security Disability Benefits Application: This application requires detailed personal and medical information to assess eligibility for benefits, akin to the information needed for a parking permit.
- Special Needs Registration Form: This document registers individuals with special needs for various services, asking for similar personal and medical details as the Nassau form.
- Accessible Housing Application: Those seeking accessible housing often fill out this application, which requests information about disabilities and needs, much like the Nassau Parking Application.
Dos and Don'ts
When filling out the Nassau Parking Application form, it is important to follow specific guidelines to ensure a smooth process. Below are four things you should and shouldn't do:
- Do provide a complete and accurate address. Ensure that it is a Nassau County street address and not a P.O. Box.
- Don't leave any questions unanswered. All sections of the application must be filled out completely.
- Do have a licensed medical doctor complete the medical certification section. This is crucial for the application to be valid.
- Don't submit copies or faxes of the application. Only original documents will be accepted to avoid immediate denial.
Misconceptions
Understanding the Nassau Parking Application form can be challenging, and several misconceptions often arise. Here are eight common misunderstandings, along with clarifications to help navigate the application process.
- Misconception 1: Only drivers can apply for a parking permit.
- Misconception 2: A chiropractor can complete the medical certification section.
- Misconception 3: You can submit a photocopy of the application.
- Misconception 4: You must have a permanent disability to qualify.
- Misconception 5: You can use a P.O. Box for your address.
- Misconception 6: The application can be signed by someone other than the disabled person.
- Misconception 7: The application does not need to include the disabled person's ID.
- Misconception 8: False statements on the application are not taken seriously.
This is not true. Any person with a qualifying disability can apply for a permit, regardless of whether they drive. Children and non-drivers are also eligible.
Only a licensed medical physician in New York State can complete this section. Chiropractors are not permitted to certify the application.
Submitting copies or faxes of the application will lead to immediate denial. The original, fully completed application is required.
Temporary disabilities also qualify for a permit. If a person is unable to ambulate without assistance for six months or less, they can apply for a temporary permit.
The application requires a physical street address in Nassau County. P.O. Boxes are not accepted.
The application must be signed by the disabled individual or their guardian. It cannot be signed by anyone else.
It is essential to include a copy of the disabled applicant's New York State Driver's License or ID card with the application.
Any false statement made by the applicant or the physician can lead to the refusal of the permit. Honesty is crucial when completing the application.
Key takeaways
Filling out the Nassau Parking Application form correctly is essential to obtaining a handicapped parking permit. Here are some key takeaways to keep in mind:
- Eligibility: You must be a resident of Nassau County with one or more severe disabilities that impair your mobility.
- Complete Information: Ensure that all sections of the application are fully completed and accurate. Missing information can lead to delays or denials.
- Medical Certification: A licensed New York State physician must complete the medical certification section. This cannot be done by a chiropractor.
- Signature Requirement: The application must be signed by the applicant or their guardian. Stamped signatures are not acceptable.
- Identification: Include a copy of the disabled applicant's New York State Driver's License or ID card with the application. This is crucial for processing.
- Original Submission: Do not submit copies or faxes of the application. Doing so will result in immediate denial.
- Self-Addressed Envelope: To expedite the process, include a self-addressed envelope for the return of your permit once approved.
- False Statements: Be aware that any false information provided on the application can lead to a refusal to issue a permit.
By following these guidelines, you can help ensure a smoother application process for your handicapped parking permit.