Form BMV4826 "Application for Disability Placards" - Ohio

What Is Form BMV4826?

This is a legal form that was released by the Ohio Department of Public Safety - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2020;
  • The latest edition provided by the Ohio Department of Public Safety;
  • 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 printable version of Form BMV4826 by clicking the link below or browse more documents and templates provided by the Ohio Department of Public Safety.

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Download Form BMV4826 "Application for Disability Placards" - Ohio

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OHIO DEPARTMENT OF PUBLIC SAFETY
BMV OR DEPUTY USE ONLY
NOTE: A PRESCRIPTION
BUREAU OF MOTOR VEHICLES
PLACARD NUMBER
FROM YOUR HEALTH CARE
PROVIDER MUST BE
APPLICATION FOR DISABILITY PLACARDS
SUBMITTED WITH THIS
Ohio Revised Code (R.C.) 4503.44
ISSUE DATE
APPLICATION.
(Instructions are on page 2.)
SEE REVERSE SIDE FOR INSTRUCTIONS
R.C. 4503.44 allows an applicant to obtain one disability placard. A person with a disability that limits or impairs the ability to walk is
entitled to request one additional placard that may be issued at the discretion of the Registrar. Consideration will be given only if the
person applies separately for an additional placard and states the reason why the additional placard is necessary. Second placards
are issued for an additional fee of $5.00.
Please allow 10-15 business days for processing if form is submitted by mail.
INDICATE TYPE OF PLACARD REQUESTED
New Placard - $5.00
Temporary Placard - $5.00
Organization transporting people with disabilities - $5.00
Replacement - $5.00 because original was:
Damaged
Lost
Stolen
Additional Placard - $5.00, Please list the reason
.
Renewal - $5.00 (Do not apply more than 90 days prior to expiration date.)
Previous Placard Number
(Applies only to renewal or replacement.)
You may make a non-refundable donation to Opportunities for Ohioans with Disabilities (OOD) by checking the box below and
entering the amount you wish to donate. Add this to your total fees due.
For more information, please visit https://ood.ohio.gov/wps/portal/gov/ood/about-us/resources/donations-to-ood.
I would like to donate $
to the Opportunities for Ohioans with Disabilities Agency.
TO BE COMPLETED BY APPLICANT
PLEASE PRINT OR TYPE
NAME OF PERSON WITH A DISABILITY
STREET ADDRESS
CITY
STATE
ZIP CODE
COUNTY
DL / ID / SSN OF PERSON WITH A DISABILITY
TELEPHONE NUMBER
SIGNATURE OF PERSON WITH A DISABILITY, NEXT OF KIN, OR CARE PROVIDER
DATE SIGNED
X
APPLICATION BY AN ORGANIZATION
This is to certify that we are a private organization or corporation or any governmental board, agency, department, division, or office,
that, as part of its business or program, transports people with disabilities (limited or impaired ability to walk) on a regular basis in a
motor vehicle that has not been altered for the purpose of providing it with special equipment for use by people with disabilities.
NAME OF AUTHORIZED AGENT / OFFICER
TITLE / POSITION
NAME OF ORGANIZATION
FEDERAL TAX ID / CHARTER NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
SERVICE PROVIDED FOR PEOPLE WITH DISABILITIES
SIGNATURE OF AUTHORIZED AGENT / OFFICER
DATE SIGNED
X
Warning: Knowingly making a false statement on this form constitutes falsification, a first degree misdemeanor punishable
by criminal fines and imprisonment, and also may result in civil liability (R.C. 2921.13).
BMV 4826 3/20 [760-0616] Page 1 of 2
RESTRICTED
OHIO DEPARTMENT OF PUBLIC SAFETY
BMV OR DEPUTY USE ONLY
NOTE: A PRESCRIPTION
BUREAU OF MOTOR VEHICLES
PLACARD NUMBER
FROM YOUR HEALTH CARE
PROVIDER MUST BE
APPLICATION FOR DISABILITY PLACARDS
SUBMITTED WITH THIS
Ohio Revised Code (R.C.) 4503.44
ISSUE DATE
APPLICATION.
(Instructions are on page 2.)
SEE REVERSE SIDE FOR INSTRUCTIONS
R.C. 4503.44 allows an applicant to obtain one disability placard. A person with a disability that limits or impairs the ability to walk is
entitled to request one additional placard that may be issued at the discretion of the Registrar. Consideration will be given only if the
person applies separately for an additional placard and states the reason why the additional placard is necessary. Second placards
are issued for an additional fee of $5.00.
Please allow 10-15 business days for processing if form is submitted by mail.
INDICATE TYPE OF PLACARD REQUESTED
New Placard - $5.00
Temporary Placard - $5.00
Organization transporting people with disabilities - $5.00
Replacement - $5.00 because original was:
Damaged
Lost
Stolen
Additional Placard - $5.00, Please list the reason
.
Renewal - $5.00 (Do not apply more than 90 days prior to expiration date.)
Previous Placard Number
(Applies only to renewal or replacement.)
You may make a non-refundable donation to Opportunities for Ohioans with Disabilities (OOD) by checking the box below and
entering the amount you wish to donate. Add this to your total fees due.
For more information, please visit https://ood.ohio.gov/wps/portal/gov/ood/about-us/resources/donations-to-ood.
I would like to donate $
to the Opportunities for Ohioans with Disabilities Agency.
TO BE COMPLETED BY APPLICANT
PLEASE PRINT OR TYPE
NAME OF PERSON WITH A DISABILITY
STREET ADDRESS
CITY
STATE
ZIP CODE
COUNTY
DL / ID / SSN OF PERSON WITH A DISABILITY
TELEPHONE NUMBER
SIGNATURE OF PERSON WITH A DISABILITY, NEXT OF KIN, OR CARE PROVIDER
DATE SIGNED
X
APPLICATION BY AN ORGANIZATION
This is to certify that we are a private organization or corporation or any governmental board, agency, department, division, or office,
that, as part of its business or program, transports people with disabilities (limited or impaired ability to walk) on a regular basis in a
motor vehicle that has not been altered for the purpose of providing it with special equipment for use by people with disabilities.
NAME OF AUTHORIZED AGENT / OFFICER
TITLE / POSITION
NAME OF ORGANIZATION
FEDERAL TAX ID / CHARTER NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
SERVICE PROVIDED FOR PEOPLE WITH DISABILITIES
SIGNATURE OF AUTHORIZED AGENT / OFFICER
DATE SIGNED
X
Warning: Knowingly making a false statement on this form constitutes falsification, a first degree misdemeanor punishable
by criminal fines and imprisonment, and also may result in civil liability (R.C. 2921.13).
BMV 4826 3/20 [760-0616] Page 1 of 2
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CERTIFICATION FOR PRESCRIPTION (R.C. 4503.44)
1.
Cannot walk two hundred feet without stopping to rest.
4.
Uses portable oxygen.
Has a cardiac condition to the extent that the person’s
2.
Cannot walk without the use of or assistance from a brace,
5.
cane, crutch, another person, prosthetic device, wheelchair
functional limitations are classified in severity as Class III or
or other assistive device.
Class IV according to standards set by the American Heart
3.
Is restricted by lung disease to such an extent that the
Association.
person’s forced (respiratory) expiratory volume for one
6.
Is severely limited in the ability to walk due to an arthritic,
second, when measured by spirometry, is less than one liter,
neurological, or orthopedic condition.
or the arterial oxygen tension is less than sixty millimeters of
7.
Is blind, legally blind, or severely visually impaired.
mercury on room air at rest.
THE PRESCRIPTION MUST STATE THE FOLLOWING INFORMATION
Original prescriptions required (copies are not accepted)
1. Name of the person with the disability.
4. How long the disability is expected to last. The health care
2. Indicate you are applying for a disability placard or similar
provider must specify an ending date, not to exceed five years,
wording.
or the prescription will be rejected. Placards expire on the date
3. The health care provider must sign and date the prescription.
specified by the health care provider.
Pursuant to R.C. 4503.44(A)(3), health care provider means
“a physician, physician assistant, advanced practice nurse,
optometrist, or chiropractor as defined in this section.”
INSTRUCTIONS
Note: Placard must be hung on the rear view mirror when the vehicle is parked (Ohio Administrative Code 4501:1-7-02).
Remove placard when driving.
APPLICATION REQUIREMENTS:
I.
TO OBTAIN A PLACARD FOR THE PERSON WITH A DISABILITY
A.
The application for the parking placard must be completed in the name of the person with a disability and signed.
B.
Proof of the disability must be submitted.
1.
Attach prescription.
2.
Prescription must state the name of the person with the disability, and that it is written for a disability placard, state how
long the disability is expected to last and must be signed and dated by the health care provider.
C. To apply for a replacement or one additional placard, complete the top portion of this application. A new prescription is not
required for replacements or additional placards. Replacement and additional placards expire the same date as the initial
placard regardless of issue date.
D. Processing fees are $5.00 per placard. Make checks payable to, Ohio Treasurer of State. Limit two placards per person.
E.
Take completed application and fee(s) to any local Deputy Registrar agency or mail to the Ohio Bureau of Motor Vehicles,
Attn.: Ohio Bureau of Motor Vehicles, Registration Support Services, P.O. Box 16521, Columbus, Ohio 43216-6521. For
questions or concerns regarding the application process, call (614) 752-7518.
II. TO OBTAIN A PLACARD FOR AN ORGANIZATION
A.
An organization may obtain a parking placard if it transports individuals with disabilities on a regular basis in a motor vehicle
that has not been altered for the purpose of providing it with special equipment for use by people with disabilities.
1.
The bottom portion of the front of this application must be completed in the name of the organization, signed by an officer.
2.
You may obtain up to two placards per application.
3.
If your placard has been lost, stolen, or damaged, complete the bottom portion of this application. List your previous
placard number and check the reason for replacement. A replacement placard will expire on the same date as your
original placard.
4.
Processing fees are $5.00 per placard. Make checks payable to, Ohio Treasurer of State.
B.
Take completed application and fee(s) to any local Deputy Registrar agency or mail to the Ohio Bureau of Motor Vehicles,
Attn.: Ohio Bureau of Motor Vehicles, Registration Support Services, P.O. Box 16521, Columbus, Ohio 43216-6521. For
questions or concerns regarding the application process, call (614) 752-7518.
FINES AND PENALTIES
In accordance with R.C. 4511.69, no person shall stop, stand, or park a motor vehicle at special clearly marked parking locations
provided in or on privately owned parking lots, parking garages, or parking areas designated for people with disabilities without the
vehicle being operated by or transporting such person and displaying a disability placard or special license plates. Whoever viol ates
this section is guilty of a misdemeanor. The fine is at least $250.00, but not more than $500.00, is not punishable with imprisonment,
and is not a criminal offense.
In accordance with R.C. 4731.481 and 4734.161, no health care provider shall furnish a prescription to a person to enable the person
to obtain a disability placard or special license plates if they do not meet the criteria in R.C. 4503.44. Nor shall any health care provider
provide the person with a prescription misrepresenting the expected length of disability. These offenses are misdemeanors of the first
degree and are punishable by imprisonment of not more than six months, a fine of not more than $1,000, or both, and sanctions by the
State Medical Board, the Chiropractic Examining Board or the Board of Nursing respectively.
In accordance with R.C. 4503.44, no person or organization shall misrepresent themselves as eligible for a disability placard or special
license plates if they are not eligible according to the guidelines of this section. The penalty for this offense is confiscation of the
placard or license plates and the revocation of privileges to obtain a disability placard or special license plates.
BMV 4826 3/20 [760-0616] Page 2 of 2
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