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"Application for a New York City Parking Permit for People With Disabilities" - New York City (Haitian Creole)
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6Enstriksyon ak Aplikasyon
Pèmi Idantifikasyon Pakin Espesyal Vil New York
(Ki rele tou Pèmi Pakin pou Andikap Vil la)
Pèmi Pakin pou Moun ak Andikap (Parking Permits for People with Disabilities, PPPD)
Bonjou,
Pou nou kapab sèvi kliyan nou yo pi byen, inite Pakin pou Moun ak Andikap (PPPD) nan Depatman Transpò Vil New
York (New York City Department of Transportation, DOT) te sanble yon lis kesyon moun poze souvan ak repons yo ki
kapab ede gide nouvo aplikan yo nan pwosesis aplikasyon an.
Kijan m ap fè konnen si mwen kalifye pou yon pèmi PPPD?
Si ou se yon rezidan oswa ou pa yon rezidan Vil la epi ou gen yon andikap pèmanan ki afekte mobilite ou anpil epi ou
bezwen itilize yon machin prive pou transpò, ou kapab kalifye. Tanpri note byen nou p ap ka mete yon plak machin
komèsyal, plak biznis k ap vann machin, oswa plak pou yon machin lokasyon sou yon pèmi pou PPPD.
Ki dokiman mwen dwe bay pou yon pèmi PPPD?
Aplikan yo dwe bay dokiman sa yo:
•
Yon lisans chofè eta a te ba ou, yon kat idantite ki pa pou chofè eta a te ba ou, oswa yon kat ID Minisipal NYC
(IDNYC). Tanpri asire ou non ak adrès ki sou aplikasyon ou a se menm ak adrès ki sou kat idantite ou a.
•
Yon aplikasyon sètifye ak dokiman medikal sipò (dat ki sou li pa plis pase yon (1) ane avan aplikasyon ou a)
ki pwouve andikap ou a yon Doktè Medikal (M.D.) oswa Doktè Osteyopati (D.O.) te ba ou epi yon doktè
Depatman Sante ak Sante Mantal Vil New York (Department of Health and Mental Hygiene, DOHMH) te nome
valide. .
Ki kalite enfòmasyon machin nan m ap bezwen bay?
Aplikan yo oblije bay yon kopi anrejistreman machin ki ajou ak valab pou chak plak machin ki pral anrejistre ak pèmi an
(li pa ka bay plis pase twa (3) plak). Tanpri pa voye foto viyèt nan vit devan yon machin. DOT pa p aksepte okenn
nimewo plak machin ki gen yon jijman pou vyolasyon pakin ki poko regle ak Depatman Finans Vil New York la
(Department of Finance, DOF). Pou jwenn plis enfòmasyon sou jijman pou vyolasyon pakin ki poko regle, tanpri ale sou
sitwèb DOF la nan nyc.gov/DOF. Tanpri note byen si ou gen plan enskri yon machin ou lwe, ou dwe mete yon kopi kontra
pou lwe machin sa a.
Kijan pou mwen soumèt aplikasyon mwen an?
•
Li aplikasyon an epi siyen li
•
Mete tout enfòmasyon yo mande sou fòm aplikasyon an
•
Voye fòm ou a pa lapòs bay:
NYC Department of Transportation
Permits & Customer Service (PPPD Unit)
nd
30-30 Thomson Avenue – 2
Floor
Long Island City, NY 11101-3045
Ou ka depoze aplikasyon ou a nan adrès sa a tou. Antre DOT la se sou 30th Place, tou pre 47th Avenue. Fenèt sèvis
kliyantèl la louvri ant 9:00 AM ak 4:30 PM.
NYC Department of Transportation
Permits & Customer Service-PPPD Unit
nd
30-30 Thomson Avenue, 2
Floor
th
th
(Antre nan 30
Place, tou pre 47
Avenue)
Long Island City, New York 11101-3045
(718) 433-3100, TTY (212) 504-4115 • nyc.gov/dot
City Instructions 4-2018 P.1
Enstriksyon ak Aplikasyon
Pèmi Idantifikasyon Pakin Espesyal Vil New York
(Ki rele tou Pèmi Pakin pou Andikap Vil la)
Pèmi Pakin pou Moun ak Andikap (Parking Permits for People with Disabilities, PPPD)
Bonjou,
Pou nou kapab sèvi kliyan nou yo pi byen, inite Pakin pou Moun ak Andikap (PPPD) nan Depatman Transpò Vil New
York (New York City Department of Transportation, DOT) te sanble yon lis kesyon moun poze souvan ak repons yo ki
kapab ede gide nouvo aplikan yo nan pwosesis aplikasyon an.
Kijan m ap fè konnen si mwen kalifye pou yon pèmi PPPD?
Si ou se yon rezidan oswa ou pa yon rezidan Vil la epi ou gen yon andikap pèmanan ki afekte mobilite ou anpil epi ou
bezwen itilize yon machin prive pou transpò, ou kapab kalifye. Tanpri note byen nou p ap ka mete yon plak machin
komèsyal, plak biznis k ap vann machin, oswa plak pou yon machin lokasyon sou yon pèmi pou PPPD.
Ki dokiman mwen dwe bay pou yon pèmi PPPD?
Aplikan yo dwe bay dokiman sa yo:
•
Yon lisans chofè eta a te ba ou, yon kat idantite ki pa pou chofè eta a te ba ou, oswa yon kat ID Minisipal NYC
(IDNYC). Tanpri asire ou non ak adrès ki sou aplikasyon ou a se menm ak adrès ki sou kat idantite ou a.
•
Yon aplikasyon sètifye ak dokiman medikal sipò (dat ki sou li pa plis pase yon (1) ane avan aplikasyon ou a)
ki pwouve andikap ou a yon Doktè Medikal (M.D.) oswa Doktè Osteyopati (D.O.) te ba ou epi yon doktè
Depatman Sante ak Sante Mantal Vil New York (Department of Health and Mental Hygiene, DOHMH) te nome
valide. .
Ki kalite enfòmasyon machin nan m ap bezwen bay?
Aplikan yo oblije bay yon kopi anrejistreman machin ki ajou ak valab pou chak plak machin ki pral anrejistre ak pèmi an
(li pa ka bay plis pase twa (3) plak). Tanpri pa voye foto viyèt nan vit devan yon machin. DOT pa p aksepte okenn
nimewo plak machin ki gen yon jijman pou vyolasyon pakin ki poko regle ak Depatman Finans Vil New York la
(Department of Finance, DOF). Pou jwenn plis enfòmasyon sou jijman pou vyolasyon pakin ki poko regle, tanpri ale sou
sitwèb DOF la nan nyc.gov/DOF. Tanpri note byen si ou gen plan enskri yon machin ou lwe, ou dwe mete yon kopi kontra
pou lwe machin sa a.
Kijan pou mwen soumèt aplikasyon mwen an?
•
Li aplikasyon an epi siyen li
•
Mete tout enfòmasyon yo mande sou fòm aplikasyon an
•
Voye fòm ou a pa lapòs bay:
NYC Department of Transportation
Permits & Customer Service (PPPD Unit)
nd
30-30 Thomson Avenue – 2
Floor
Long Island City, NY 11101-3045
Ou ka depoze aplikasyon ou a nan adrès sa a tou. Antre DOT la se sou 30th Place, tou pre 47th Avenue. Fenèt sèvis
kliyantèl la louvri ant 9:00 AM ak 4:30 PM.
NYC Department of Transportation
Permits & Customer Service-PPPD Unit
nd
30-30 Thomson Avenue, 2
Floor
th
th
(Antre nan 30
Place, tou pre 47
Avenue)
Long Island City, New York 11101-3045
(718) 433-3100, TTY (212) 504-4115 • nyc.gov/dot
City Instructions 4-2018 P.1
Tanpri note byen: Yon mari, madanm, patnè domestik jan li defini nan Kòd Administratif Vil New York 1-112(21), paran,
responsab legal, oswa lòt moun ki gen responsablite legal pou jere aktivite aplikan sa a gen pou li fè chak jou kapab
soumèt yon aplikasyon pou li. Tanpri note byen non ki sou aplikasyon an dwe parèt egzakteman menm jan ak non ki sou
dokiman idantite a. N ap retounen aplikasyon ki pa konplè yo.
Sa ki pral pase apre yo resevwa aplikasyon mwen an?
•
Inite PPP a pral egzaminen tout dokiman pou asire aplikasyon ou a konplè. Si yo konsidere aplikasyon an pa
konplè, y ap retounen enfòmasyon yo ak yon lèt ki dekri enfòmasyon ki manke ou bezwen bay yo.
•
Biwo PPPD a pral soumèt aplikasyon konplè ou yo bay Inite Medikal DOHMH la pou yo evalye. Si DOHMH
apwouve aplikasyon w lan, PPPD ap bay ou yon pèmi.
•
Si DOHMH refize aplikasyon w lan, y ap voye yon lèt ba ou pa lapòs ak yon eksplikasyon sou pwosesis pou fè
kontestasyon an.
•
Tanpri note byen tout pwosesis aplikasyon an ka pran jiska 90 jou.
N ap kenbe tout enfòmasyon ou soumèt ak aplikasyon an ak nenpòt dokiman medikal aplikan an soumèt apre bay
DOHMH konfidansyèl, epi se sèlman ak moun k ap patisipe nan pwosesis sètifikasyon ak/oswa pèmi an n ap pataje
enfòmasyon sa yo, nan mezi lalwa pèmèt oswa egzije sa.
Si w gen nenpòt kesyon konsènan aplikasyon sa a, ou ka rele Sèvis Kliyan nan:
(718) 433-3100, pou Aparèy Telekominikasyon pou Moun ki Soud (TTY) rele (212) 504-4115.
Nou apresye opòtinite pou sèvi ou epi nou remèsye ou pou koperasyon ou.
Rezidan New York yo ka jwenn yon Fòm Enskripsyon Elektè sou entènèt la nan: vote.nyc.ny.us oswa rele Komisyon Eleksyon
an: 212-868-3692 Nimewo telefòn: 866-VOTE-NYC. Ou pa oblije enskri pou vote pou resevwa sèvis gouvènman yo.
NYC Department of Transportation
Permits & Customer Service-PPPD Unit
nd
30-30 Thomson Avenue, 2
Floor
th
th
(Antre nan 30
Place, tou pre 47
Avenue)
Long Island City, New York 11101-3045
(718) 433-3100, TTY (212) 504-4115 • nyc.gov/dot
City Instructions 4-2018 P.2
Depatman Transpò Vil Nouyòk
PÈMI IDANTIFIKASYON PAKIN ESPESYAL VIL NEW YORK
PÈMI PAKIN POU MOUN AK ANDIKAP (PARKING PERMITS FOR PEOPLE
WITH DISABILITIES, PPPD)
Aplikasyon pou yon Pèmi Pakin pou Andikap VILLA
DOKIMAN IDANTITE: Tanpri mete yon lisans chofè Eta a te ba ou, yon kat idantite ki pa pou chofè eta a te ba ou;
oswa, ID Minisipal NYC (IDNYC).
ANSÈKLE YON SÈL Lisans Chofè
A. DOSYE PÈSONÈL *APLIKAN
NIMEWO DOKIMAN
AN
IDANTIFIKASYON
ID ki pa pou chofè
*moun ki gen andikap la
(ak Eta
IDNYC
#
a, si genyen)
Siyati
Prenon
Inisyal Dezyèm
Nimewo Sekirite Sosyal (Sèlman 4 dènye Chif Nesesè)
Prenon
Adrès Kay: Ri ak Nimewo Apatman
Sèks (ansèkle)
Wotè (an pye
Pwa
ak pous):
(an liv):
G
F
Vil
Eta
Kòd postal
Nimewo Telefòn Kay
Nimewo Telefòn Mobil
Dat Nesans
Adrès Imèl:
B. PLAK LISANS W ap bezwen soumèt yon kopi ajou anrejistreman machin pou chak nimewo plat lisans ki sou
lis la. N ap fè ou konnen yo pral verifye anrejistreman machin ou soumèt yo pou wè si yo pa gen vyolasyon pakin
ak Vil New York, epi nou p ap mete okenn plak machin ki gen jijman vyolasyon pakin ki poko regle sou pèmi ou
a. Se sèlman twa (3) plak lisans ou ka mete pou chak pèmi.
1.
2.
3.
C. DEKLARASYON
Mwen deklare enfòmasyon yo ki nan dokiman sa a se verite epi yo kòrèk daprè sa mwen konnen ak kwè, epi mwen pa te
fè esprè pou mwen bay manti oswa bay enfòmasyon mwen konnen ki se manti epi mwen rekonèt gen sanksyon Lwa
Penal New York § 210.45 pou moun ki bay manti. Mwen konprann yo pral pataje nenpòt enfòmasyon mwen bay la
sèlman ak moun k ap patisipe nan pwosesis pèmi an, nan mezi lalwa pèmèt oswa egzije sa.
DAT
SIYATI APLIKAN AN*
REMAK: Si dokiman idantite ou a endike ou "Pa ka Siyen", tanpri kite espas anwo a ki di "Siyati Aplikan" an vid epi
ranpli Seksyon D anba a. Si w ap bezwen sèvis yon entèprèt, tanpri presize nan ki lang:
___________________________________.
D. * Si aplikan an poko gen 18 tan, tanpri bay non ak nimewo telefòn paran, responsab legal, oswa lòt moun ki
gen responsablite legal pou jere aktivite li gen pou fè chak jou yo. Si aplikan an gen 18 tan epi li pa ka siyen
aplikasyon an, tanpri bay nimewo telefòn madanm, mari, patnè domestik, paran, responsab legal, oswa lòt moun
ki gen responsablite legal pou jere aktivite li gen pou fè chak jou yo.
Non
Telefòn
Relasyon
Siyati Reprezantan Chwazi
NYC Department of Transportation
Permits & Customer Service-PPPD Unit
zyèm
30-30 Thomson Avenue, 2
Etaj
th
th
(Antre nan 30
Place, tou pre 47
Avenue)
Long Island City, New York 11101-3045
(718) 433-3100, TTY (212) 504-4115 • nyc.gov/dot
City Instructions 4-2018 P.3
PAJ DOSYE MEDIKAL OU
REMAK: SÈLMAN DOKTÈ PÈSONÈL OU (M.D. oswa D.O.) GENDWA RANPLI FÒM SA A
E. DOSYE MEDIKAL AK ETA SANTE pou:
Non aplikan an jan li parèt sou Dosye Medikal yo (si li
Non Aplikan an (jan li parèt sou Lisans Chofè Eta a eta bay
diferan):
oswa Lisans ki pa pou chofè Eta a te bay; oswa IDNYC):
_____________________________________________
_____________________________________________
Dat Nesans Aplikan an _____-_____-__________
Non Aplikan
Tanpri bay dyagnostik medikal pasyan an nan moman an ak fason li afekte KAPASITE LI POU MACHE. Endike
BEZWEN LI OU APARÈY KI ASISTE nan moman an (si genyen). Tanpri bay nòt egzamen pi resan ki te fèt nan yon (1)
ane oswa mwens ak dokiman medikal sipò (tankou rapò X-Ray, rapò egzamen CT, rapò MRI, rapò EKG/Tèst Stress, rapò
PFT, rezilta EMG, ak rapò konsiltan) pou soumèt ak aplikasyon sa a.
Eksplike nan ki degre pwoblèm nan afekte kapasite li pou mache;
Dat dènye egzamen an:
Tanpri chwazi youn nan repons yo ki anba la a ki reprezante degre mobilite redwi a:
Mobilite redwi a: Tanporè Pèmanan
Nan opinyon ou, èske moun sa a gen yon andikap ki egzije pou li itilize yon machin prive pou transpò?
Wi
Non
Tanpri bay pasan ou dokiman medikal sipò tankou rapò X-Ray, rapò egzamen CT, rapò MRI, rapò EKG/Tèst Stress, rapò
PFT, rezilta EMG, ak rapò konsiltan (Nou p ap aksepte OKENN CD OSWA FIM MEDIKAL) pou soumèt ak aplikasyon sa a
pou yon doktè Vil la nome kapab evalye epi sètifye mobilite redwi aplikan an. L ap enpòtan pou ou ranpli enfòmasyon sa a yon
fason egzat epi ou reponn tout kesyon yo konplètman.
Sètifikasyon Aplikan Doktè Pèsonèl la:
Mwen konfime mwen te egzaminen aplikan non li endike anwo a pèsonèlman epi enfòmasyon yo ki prezante nan aplikasyon
sa a pa rapò ak andikap moun sa a egzat.
Depi ou siyen anba la a, sa vle di ou sètifye enfòmasyon w ap bay yo vrè ak konplè, epi ou konnen gen pinisyon pou nenpòt fo
deklarasyon ou bay selon seksyon 240.45 nan Lwa Penal Eta New York la. Answit, si ou ta bay nenpòt fo deklarasyon alekri, nou ka
pote plent pou ou nan Biwo Kondwit Medikal Pwofesyonèl Depaman sante Eta New York (NYS Department of Health Office of
Professional Medical Conduct)
SIYATI M.D oswa D.O.
# LISANS PWOFESYONÈL, ETA
oswa
(EKRI NON M.D
D.O. AK LÈT
DETACHE)
DAT
ADRÈS
NIMEWO TELEFÒN
NYC Department of Transportation
Permits & Customer Service-PPPD Unit
zyèm
30-30 Thomson Avenue, 2
Etaj
th
th
(Antre nan 30
Place, tou pre 47
Avenue)
Long Island City, New York 11101-3045
(718) 433-3100, TTY (212) 504-4115 • nyc.gov/dot
City Instructions 4-2018 P.4
Dokiman Medikal pou mete ak nouvo Pèmi Idantifikasyon Pakin Espesyal Vil
New York ou a (ki rele tou Pèmi Pakin pou Moun kk Andikap [Parking
Permits for People with Disabilities, PPPD])
Tanpri mande Doktè Medikal oswa Doktè Osteyopati ou po li ba ou:
1. Dokiman medikal sipò ki te fèt nan yon (1) ane oswa mwens avan aplikasyon ou an ki gen ladan tès/rapò
dyagnostik ak nòt egzamen medikal ki fasil pou li.
2. Nòt egzamen doktè ou yo dwe mansyone degre andikap ou a afekte mobilite ou. (Kapasite pou ou mache).
Lis anba a yo se egzanp dokiman sipò medikal selon pwoblèm medikal yo:
Kadyovaskilè: Nòt egzamen, Elektwokadyogram (EKG), Ekokadyogram, Tès Estrès (Stress Test) (rapò
sèlman), Doplè (Doppler), ak Anjyografi. Tanpri di kapasite pou mache, kanpe, pote, pouse, rale, ak leve.
Poumon: Nòt egzamen, egzamen tès fonksyon poumon (PFT), radyografi poumon (CXR), egzamen tomografi
sou òdinatè (CT), n ap bezwen yon rapò pou oksijèn siplemantè ki plis pase 12 zèdtan pa jou.
Doulè nan do / Atrit: Nòt egzamen Rematoloji, Òtopedik, Newoloji, rapò imajri rezonans manyetik (MRI),
Radyografi (X-Ray), elektwomyografi (EMG), rezime operasyon pasyan an fè deja, bezwen pou aparèy ki
asiste (baton, aparèy pou ede mache, sipò, chèz woulant, elatriye.
Dyagnostik Kansè: Nòt Kansè - eta pasyan an nan moman an, terapi l ap pran regilyèman - chimyoterapi,
radyasyon, elatriye, operasyon li fè deja.
Ensifizans Renal Kwonik: Dyaliz, grèf, done dènye laboratwa, prèv l ap resevwa tretman regilyèman nan
yon inite dyaliz.
Kondisyon konjenital (Paralezi serebral, Sendwòm Downs, elatriye): Nòt egzamen fizik, Òtopedik, newolojik,
oswa espesyalite apwopriye.
Pwoblèm Sante Mantal: Evalyasyon sikolojik, Nòt egzamen, rapò Pwogram Edikasyon endividyèl (IEP), ak /
oswa egzamen Newolojik.
Pwoblèm Newolojik (Estwok, Newopati, Paralizi ak Demans): Nòt egzamen ki pi resan, imajri rezonans
manyetik (MRI), elektwomyografi (EMG), bezwen pou asistans aparèy / swen lakay.
Si w gen nenpòt lòt kesyon konsènan dokiman medikal pou w voye ak aplikasyon ou a, tanpri rele Inite Sètifikasyon
Medikal Depatman Sante ak Sante Mantal (DOHMH) nan (347) 396-6552.
NYC Department of Transportation
Permits & Customer Service-PPPD Unit
zyèm
30-30 Thomson Avenue, 2
Etaj
th
th
(Antre nan 30
Place, tou pre 47
Avenue)
Long Island City, New York 11101-3045
(718) 433-3100, TTY (212) 504-4115 • nyc.gov/dot
City Instructions 4-2018 P.5
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- Form VSD 190, Application for Vehicle Transaction(s) Form VSD 190, Application for Vehicle Transaction(s)
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