Form 3955 "Application for Driver Identification Visor Card" - Texas

What Is Form 3955?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2020;
  • The latest edition provided by the Texas Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 3955 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.

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Download Form 3955 "Application for Driver Identification Visor Card" - Texas

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Form 3955
October 2020-E
Office of Deaf and Hard of Hearing Services (ODHHS)
Application for Driver Identification Visor Card
The deaf or hard of hearing driver identification program is only for Texas residents who hold a valid, state-issued driver’s license.
Mail completed application to HHS ODHHS, P.O. Box 12904, Austin, Texas 78711.
Original signatures are required. Allow 20 business days for the application to be processed.
This application is valid until August 31, 2022.
Applicant Information
Applicant name
Number of vehicles that need visor cards
Visor card type (pick one):
Driver is deaf (uses sign language).
Driver has a hearing loss.
Address Field
City
County of Residence
ZIP Code
Mode
Date of Birth
Phone
Email
Voice
VP
Text
Signature is required by applicant if age 18 or older.
Applicant signature
Applicant printed name
Date
Signature is required by parent or legal guardian if applicant is younger than 18.
Parent’s or legal guardian’s signature
Printed name
Date
I want to be contacted by HHS ODHHS Access or Technology Specialists for additional community resources related to my
Yes
No
hearing loss or communication access needs.
Required Documentation
Required: Attach a copy of the front of your valid Texas driver’s license to this application.
• If your license shows restriction “S,” your application is complete and ready to mail.
• If your license does not show restriction “S,” a licensed physician, licensed audiologist, or licensed advanced practice registered nurse
(APRN) must complete and sign the section below to verify that you are deaf or hard of hearing and are likely to have difficulty
communicating in traffic stops.
Certification and Signature
I certify that the person named above has a hearing loss severe enough to possibly impede communication in some traffic stop situations.
Audiologist’s or physician’s or advanced practice registered nurse’s signature
Printed name
Date
License number
Phone
Email
For Office Use Only
Visor card number:
First application
Duplicate
Form 3955
October 2020-E
Office of Deaf and Hard of Hearing Services (ODHHS)
Application for Driver Identification Visor Card
The deaf or hard of hearing driver identification program is only for Texas residents who hold a valid, state-issued driver’s license.
Mail completed application to HHS ODHHS, P.O. Box 12904, Austin, Texas 78711.
Original signatures are required. Allow 20 business days for the application to be processed.
This application is valid until August 31, 2022.
Applicant Information
Applicant name
Number of vehicles that need visor cards
Visor card type (pick one):
Driver is deaf (uses sign language).
Driver has a hearing loss.
Address Field
City
County of Residence
ZIP Code
Mode
Date of Birth
Phone
Email
Voice
VP
Text
Signature is required by applicant if age 18 or older.
Applicant signature
Applicant printed name
Date
Signature is required by parent or legal guardian if applicant is younger than 18.
Parent’s or legal guardian’s signature
Printed name
Date
I want to be contacted by HHS ODHHS Access or Technology Specialists for additional community resources related to my
Yes
No
hearing loss or communication access needs.
Required Documentation
Required: Attach a copy of the front of your valid Texas driver’s license to this application.
• If your license shows restriction “S,” your application is complete and ready to mail.
• If your license does not show restriction “S,” a licensed physician, licensed audiologist, or licensed advanced practice registered nurse
(APRN) must complete and sign the section below to verify that you are deaf or hard of hearing and are likely to have difficulty
communicating in traffic stops.
Certification and Signature
I certify that the person named above has a hearing loss severe enough to possibly impede communication in some traffic stop situations.
Audiologist’s or physician’s or advanced practice registered nurse’s signature
Printed name
Date
License number
Phone
Email
For Office Use Only
Visor card number:
First application
Duplicate