Dmv Need Form PDF Details

In the bustling state of California, where the car is often king, the Department of Motor Vehicles (DMV) provides an avenue for individuals facing specific hardship conditions to apply for a Critical Need Restriction through the Application for Critical Need Restriction form. This detailed application, aimed primarily at drivers under 21 years of age who have faced license suspension due to Preliminary Alcohol Screening or other chemical test failures, necessitates a thorough submission process to the Driver Safety Actions Unit in Sacramento. The form addresses a variety of scenarios in which the applicant can demonstrate an essential need for restricted driving privileges, including but not limited to, commuting for education, work, or addressing family health issues. It emphasizes the importance of detailed documentation, including alternative transportation assessments and personal affidavits, to justify the critical need for a restricted license. Cost considerations are not overlooked, as approved applicants must pay a reissue fee alongside providing an SR-22 insurance proof. Furthermore, to ensure a comprehensive review, the application mandates input from relevant professionals and authorities, like physicians and school principals, thus underpinning the multisectoral approach required for approval. Ultimately, the DMV's stringent criteria ensure that only genuine cases of hardship receive consideration, a testament to the balance between public safety and individual necessity.

QuestionAnswer
Form NameDmv Need Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdmv real id, restriction applicant, california dmv need online, real id california application form

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STATE OF CALIFORNIA

DEPARTMENT OF MOTOR VEHICLES®

A Public Service Agency

APPLICATION FOR CRITICAL NEED RESTRICTION

[Section 13353.8(a) VC]

Submit COMPLETED application to the Driver Safety Actions Unit, 2570 24th Street, M/S J256, Sacramento, CA 95818, Telephone: (916) 657-6452. DMV approval is required prior to issuance of a restricted license. If approved, a $100 reissue fee must be paid and a California Insurance Proof Certiicate (SR-22) must be submitted to the department prior to issuance of a restricted license; proof of inancial responsibility must be maintained for three (3) years. Do not present in person at any DMV ield office. ATTACH SEPARATE SHEET IF MORE SPACE IS NEEDED. Incomplete information may delay the issuance of this license. Application can only be approved if driver is legally present in California and speciic HARDSHIP conditions are shown to exist. ALL other transportation must be inadequate. Action taken by the department must be pursuant to § 13353.2 & 13388 of the Vehicle Code AND applicant must have been under 21 years of age at the time of arrest/detainment and have submitted to a Preliminary Alcohol Screening test, or other chemical test, as requested by a peace officer. A 30 day mandatory suspension is required prior to issuance of a hardship license.

SECTION 1 — STATEMENT OF FACTS BY APPLICANT (OR PARENTS, IF UNDER 18 YEARS OF AGE)

CHECK ONE OR MORE OF THE FOLLOWING REASONS FOR APPLICATION AND COMPLETE THE CORRESPONDING SECTION(S): A, B, C, OR D

A.

For Family Illness

B.

To and From School

C.

To and From Work

D.

For Family Enterprise

APPLICANT’S FULL NAME

DL NUMBER

DATE OF BIRTH

HOME PHONE

DAY PHONE

 

 

 

(

)

(

)

STREET ADDRESS AND CROSS STREET

CITY

 

 

 

ZIP CODE

 

PART A — DESCRIPTION OF CURRENT TRANSPORTATION AND NEEDS

LIST APPLICANT’S ESSENTIAL DRIVING NEEDS

DISTANCE FROM APPLICANT’S RESIDENCE TO NEAREST PUBLIC TRANSPORTATION

DESCRIBE BEST TRANSPORTATION ROUTE, COMPANY NAME, PHONE NO., NO. OF INDIVIDUAL LINES

LIST NAMES AND DRIVER LICENSE NUMBERS OF ALL DRIVERS IN THE HOUSEHOLD

EXPLAIN SPECIFICALLY WHY EACH DRIVER IN THE HOUSEHOLD CANNOT DO THE REQUIRED DRIVING. INCLUDE DAILY WORK OR SCHOOL AND TRAVEL SCHEDULE OF EACH DRIVER, HOURS AND LOCATION OF EMPLOYMENT, DISTANCE FROM HOME AND APPLICANT’S SCHOOL. INCLUDE NUMBER OF EMPLOYEES IF SELF EMPLOYED. USE SEPARATE SHEET IF NECESSARY

IF HOUSEHOLD INCLUDES NON-DRIVING ADULT OR MINOR OLDER THAN APPLICANT, GIVE NAME AND RELATIONSHIP TO APPLICANT AND EXPLAIN WHY PERSON CANNOT/DOES NOT DRIVE. (IF MEDICAL REASON, SEPARATE STATEMENT OF FACTS BY PHYSICIAN NEEDED.)

EXPLAIN WHY CARPOOLS, TAXIS, BICYCLES, WALKING, VANPOOLS AND ANY OTHER PRIVATE TRANSPORTATION CANNOT BE USED.

PART B — ADDITIONAL INFORMATION REQUIRED IF REQUEST IS DUE TO FAMILY ILLNESS

RELATIONSHIP BETWEEN THE ILL PERSON AND THE APPLICANT

DOES THIS ILLNESS PREVENT THIS PERSON FROM DRIVING AND FOR HOW LONG?

Yes If yes, how long?

No

DESCRIBE CURRENT TRANSPORTATION ARRANGEMENTS

PART C — ADDITIONAL INFORMATION REQUIRED IF REQUEST IS BASED ON NEED FOR TRANSPORTATION TO AND FROM SCHOOL

CHECK APPROPRIATE BOX

 

 

High School

College/University

Other:

DESCRIBE CURRENT TRANSPORTATION ARRANGEMENTS

EXPLAIN THE CIRCUMSTANCES THAT NOW MAKE THE APPLICANT’S OPERATION OF A MOTOR VEHICLE ESSENTIAL

PART D — ADDITIONAL INFORMATION REQUIRED IF REQUEST IS BASED ON NEED FOR TRANSPORTATION TO AND FROM WORK

EXPLAIN CIRCUMSTANCES THAT NOW MAKE APPLICANT’S INCOME ESSENTIAL IN THE SUPPORT OF THE FAMILY

DESCRIBE CURRENT TRANSPORTATION ARRANGEMENTS

APPLICANT’S NET OR TAKE HOME INCOME

NUMBER OF PEOPLE IN HOUSEHOLD

DESCRIBE USE OF APPLICANT’S INCOME

TOTAL FAMILY NET OR TAKE HOME INCOME

$

Per

 

 

$

Per

 

 

 

 

 

 

PART E — ADDITIONAL INFORMATION REQUIRED IF REQUEST IS BASED ON FAMILY ENTERPRISE

NAME AND ADDRESS OF ENTERPRISE

NATURE AND TYPE OF ENTERPRISEYEARS IN BUSINESSNUMBER OF EMPLOYEES (INCLUDE FAMILY MEMBERS)

EXPLAIN SPECIFICALLY WHY EACH EMPLOYEE CANNOT DO THE REQUESTED DRIVING. INCLUDE DAILY WORK AND TRAVEL SCHEDULE OF EACH EMPLOYEE

California Relay Telephone Service for the deaf or hearing impaired from TDD Phones: 1-800-735-2929; from Voice Phones: 1-800-735-2922

DS 694 (REV. 2/2011) WWW

EXPLAIN WHY SOMEONE CANNOT BE EMPLOYED TO DO THE REQUESTED DRIVING

EXPLAIN WHY APPLICANT’S OPERATION OF A MOTOR VEHICLE IS NECESSARY TO THE ENTERPRISE

HOURS PER WEEK APPLICANT WOULD WORK

SALARY (IF ANY)

 

 

AUTHORIZATION AND CERTIFICATION: (If under 18 years of age, both parents must sign)

I/We hereby authorize the Department of Motor Vehicles to ask for and receive any additional information needed to determine eligibility for a critical need restriction from physician, school principal and/or employer certifying to a Statement of Facts. Medical information is conidential under Section 1808.5 VC.

I/We certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. (Perjury is punishable by imprisonment or ine or both.) Both parents must sign unless one has custody and writes: “I have sole custody.”

APPLICANT’S SIGNATURE

DATE

ADDRESS

CITY

ZIP CODE

X

 

 

 

 

FATHER’S SIGNATURE

DATE

ADDRESS

CITY

ZIP CODE

X

 

 

 

 

MOTHER’S SIGNATURE

DATE

ADDRESS

CITY

ZIP CODE

X

 

 

 

 

SECTION 2 — STATEMENT OF FACTS BY PHYSICIAN

Physician must complete a separate statement for each family member whose disability affects driving or transportation needs

NAME OF PATIENT

DIAGNOSIS

MEDICAL CONDITION(S) AND SYMPTOM(S)

PROGNOSIS (INCLUDE PROBABLE DATE WHEN SUFFICENT RECOVERY WILL HAVE BEEN MADE TO TERMINATE THE EMERGENCY. IF CONDITION IS CHRONIC, PHYSCIAN MUST STATE THAT FACT)

DOES PATIENT’S CONDITION RULE OUT DRIVING? YES NO

If yes,

Permanently

Temporary-low long?

DOES PATIENT’S CONDITION RULE OUT USE OF PUBLIC TRANSPORTATION? INCLUDING PARATRANSIT (CURB TO CURB SERVICE)

Yes

No

SECTION 3 — STATEMENT OF FACTS BY SCHOOL PRINCIPAL OR DEAN

School principal or dean must complete if hardship condition is to and from school. If hardship condition is to and from college, submit a printout of current schedule, including days and hours of all classes in which enrolled.

STUDENT’S NAME

 

LENGTH OF ATTENDANCE

STUDENT’S DAILY SCHOOL HOURS

 

 

 

 

EXPLAIN WHY SCHOOL AND OTHER TRANSPORTATION IS INADEQUATE FOR REGULAR ATTENDANCE AT SCHOOL AND ACTIVITIES AUTHORIZED BY THE SCHOOL

 

 

 

 

NAME AND ADDRESS OF SCHOOL

 

NAME OF SCHOOL DISTRICT

 

 

 

 

 

DISTANCE: RESIDENCE

TO SCHOOL BUS STOP (if any)

SCHOOL TO PUBLIC TRANSPORTATION

LAST DAY OF STUDENT’S SCHOOL YEAR

 

 

 

 

SECTION 4 — STATEMENT OF FACTS BY EMPLOYER (Employer must complete if hardship condition is to and from work.)

NAME OF EMPLOYEE AND NAME OF ESTABLISHMENT OR BUSINESS

DATE OF EMPLOYMENT

SALARY

$Per

ADDRESS AND CROSS STREET OF PLACE WHERE APPLICANT REPORTS TO WORK

TYPE OR NATURE OF EMPLOYMENT

WORK HOURS (STARTING &

MONDAY THRU FRIDAY

SATURDAY

SUNDAY

WEEKLY TOTAL

 

ENDING TIMES)

 

 

 

 

 

 

 

 

 

 

PERMIT TO EMPLOY MINOR ON FILE? IF YES, GIVE NAME, TITLE AND TELEPHONE NO. OF ISSUING PARTY

EXPIRATION DATE

 

Yes No

DISTANCE FROM APPLICANT’S RESIDENCE TO PLACE OF EMPLOYMENT

DISTANCE FROM PLACE OF EMPLOYMENT TO PUBLIC TRANSPORTATION

SECTION 5 — CERTIFICATION TO BE COMPLETED BY:

Physician

School Principal or Dean

Employer

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. This

section may be duplicated, if necessary, to accommodate certiication by more than one party.

NAME OF SIGNER (PRINT OR TYPE)

TITLE

ADDRESS

CITY

 

ZIP CODE

 

 

 

SIGNATURE

DATE

TELEPHONE NUMBER

X

 

(

)

 

 

 

 

For further information, contact the Driver Safety Actions Unit at (916) 657-6452, or from the DMV website at: http://www.dmv.ca.gov/

DS 694 (REV. 2/2011) WWW

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1. To start with, once filling out the dmv critical need, begin with the area with the subsequent blank fields:

Writing section 1 in restriction applicant

2. The third step is usually to fill in the following fields: Yes If yes how long, DESCRIBE CURRENT TRANSPORTATION, PART C ADDITIONAL INFORMATION, CHECK APPROPRIATE BOX, High School, CollegeUniversity, Other, DESCRIBE CURRENT TRANSPORTATION, EXPLAIN THE CIRCUMSTANCES THAT NOW, PART D ADDITIONAL INFORMATION, DESCRIBE CURRENT TRANSPORTATION, APPLICANTS NET OR TAKE HOME INCOME, Per, NUMBER OF PEOPLE IN HOUSEHOLD, and Per.

Completing part 2 in restriction applicant

3. Completing EXPLAIN WHY SOMEONE CANNOT BE, EXPLAIN WHY APPLICANTS OPERATION, HOURS PER WEEK APPLICANT WOULD WORK, SALARY IF ANY, AUTHORIZATION AND CERTIFICATION If, DIAGNOSIS, ADDRESS, ADDRESS, ADDRESS, ZIP CODE, ZIP CODE, ZIP CODE, DATE, CITY, and CITY is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

restriction applicant writing process shown (part 3)

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