Arkansas Form 10 336, officially the Physician's Certification for Disabled Person, is the required medical certification for persons with disabilities seeking disability license plates or a handicap parking placard in Arkansas. The form is issued by the Arkansas Department of Finance and Administration, Motor Vehicle Division.
To qualify for disability license plates or a handicap parking permit in Arkansas, an individual must have a physician certify that they meet at least one of the following conditions:
- The person cannot walk 200 feet without stopping to rest.
- The person cannot walk without a brace, cane, crutch, prosthetic device, or assistance from another person.
- The person has severe lung disease with a forced expiratory volume of less than one liter per second.
- The person uses a portable oxygen device.
- The person has a cardiac condition classified as Class III or IV by the American Heart Association.
- The person has severely limited use of one or both legs due to an orthopedic, neurological, or cardiovascular condition.
- The person is legally blind.
The certifying physician, physiatrist, or advanced practice registered nurse must be currently licensed in Arkansas. The practitioner must have personally examined the patient and confirmed that the disability meets qualifying criteria. Required information includes the physician's Arkansas license number, the examination date, and a description of the qualifying condition.
The physician must indicate whether the disability is permanent or temporary. For temporary disabilities, the expected duration must be included. Temporary disability plates or placards may be issued for periods up to six months. Permanent disability license plates are available for individuals with long-term qualifying conditions.
Once the physician completes and signs the ar 10 336 certification, the applicant submits it to their nearest Arkansas Revenue Office along with vehicle registration and any required fees. For a new handicap parking placard, you can also use the handicapped parking permit application available on FormsPal. For existing placard holders, the renew handicap placard form covers the renewal process.
Organizations applying for disability license plates for vehicles used to transport persons with disabilities must submit a separate organizational application along with the physician certification. Contact the Arkansas DFA Motor Vehicle Division for details on organizational requirements.
What is Arkansas Form 10 336 used for?
Arkansas Form 10 336 is the Physician's Certification for Disabled Person. Physicians complete it to certify a patient's qualifying disability when that person applies for a disability license plate or handicap parking placard in Arkansas.
Who can certify the Arkansas 10 336 form?
A licensed physician, physiatrist, or advanced practice registered nurse currently licensed in Arkansas can certify the form. The certifying practitioner must have personally examined the patient and confirmed the qualifying disability.
What is the difference between a temporary and permanent certification?
A permanent certification applies to individuals with long-term qualifying conditions. A temporary certification covers disabilities expected to resolve within six months. The physician notes the expected duration on the certification form. Temporary disability plates or placards are issued for the period specified by the physician.
Where do I submit the completed form?
Submit the completed ar 10 336 certification at your nearest Arkansas Revenue Office, along with your vehicle registration and applicable fees. For additional disability-related documentation, the disability questionnaire template may help organize information before your visit.
| Question | Answer |
|---|---|
| Form Name | Arkansas Form 10-336 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 29 |
| Avg. time to fill out | 6 min 22 sec |
| Other names | 10 336 form, form 10 336 arkansas, 10 336, arkansas handicap parking permit |