RDMV130: New Hampshire Application for Walking Disability Privileges

Enter the Name (First, Middle Initial, Last) and the Date of Birth.

Enter the Mailing Address: Street, City, State and Zip Code.

Enter the Driver License or Non-Driver ID # (please write “none” if you do not have one).

Enter the Telephone Number and the E-Mail Address (Optional).

Upon approval of this application you will be issued one of the following. Please make your selection.

One (1) placard.

Two (2) placards. If you already have or are applying for Walking Disability plates you are not eligible for 2 placards.

Walking Disability plates (for first time) & one (1) placard Fee $8.00 (checked November 2, 2026). Permanent walking disability privileges required. Please send a copy of your current registration.

The undersigned applicant certifies under penalty of unsworn falsification pursuant to RSA 641:3, that the applicant is a resident of this State qualified for walking disability privileges pursuant to RSA 261:88.

Sign at SIGNATURE OF APPLICANT and enter the Date.

Section II, Medical Provider Information, must be completed by your medical provider.

Please CHECK ONE: Please issue a placard for a TEMPORARY disability for a period of months (cannot exceed 6 months).

Please issue a placard for a PERMANENT disability (These placards require periodic renewal/recertification per RSA 261:88.)

Please CHECK ONE: Licensed Physician, Podiatrist, Advanced Practice Registered Nurse (APRN) or Physician Assistant.

By signing, you certify, under penalty of unsworn falsification pursuant to RSA 641:3, that the person whose name appears on this form is under your treatment/care and, in your professional opinion, has a walking disability as defined/used under RSA 259:124 and RSA 261:88. RSA 261:88 includes the following criteria: I. Cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device; or II. Is restricted by lung disease to such an extent that the person's forced (respiratory) expiratory volume for one second, when measured by spirometry, is less than 1 liter, or the arterial oxygen tension is less than 60 mm/hg on room air at rest; or III. Uses portable oxygen; or IV. Has a cardiac condition to the extent that the person's functional limitations are classified in severity as class 3 or class 4 according to standards set by the American Heart Association; or V. Is severely limited in the ability to walk due to an arthritic, neurological, orthopedic, or other medically debilitating condition.

Please print legibly. Original Signature of Medical Provider is required. Signed under penalty of unsworn falsification. Enter the Name of Medical Provider, Telephone, Medical Provider Address and Date next to Medical Provider Signature.

If your placard is lost or stolen please write a letter requesting a replacement. The letter should include your name, date of birth and mailing address (maximum of 2 placards per individual applicant).

To renew your current Walking Disability license plates, please take your vehicle registration to your town clerk's office. You must have a valid placard in order to renew your plates. May I have 2 placards and a Walking Disability license plate at the same time? No. Pursuant to RSA 261:88, you may have either 2 placards OR 1 placard and 1 Walking Disability license plate. The only exception to this is Walking Disability motorcycle plates. You may have a Walking Disability motorcycle plate for each motorcycle you have registered. How do I request a Walking Disability license plate if I already have a placard? If you would like to request Walking Disability plates and you already have a valid placard you can write a letter requesting Walking Disability plates and send a copy of your current registration along with a check or money order for $8.00 (checked November 2, 2026).

Walking Disability placards for a permanent disability are valid for up to 5 years and have the same expiration date as your driver license or non-driver identification card.

The first time you apply for walking disability privileges, the placard will only be valid until the next renewal of your driver license or non-driver identification card, which may be less than 5 years. After that, it will expire every 5 years on the same date as your driver license or non-driver identification card.

Placards are assigned to the individual applicants that apply for them, not a specific vehicle. You may use your placard in any vehicle you are traveling in as long as you will be exiting the vehicle when parking in an accessible parking space. If you travel outside of NH you may still use your placard.

May I send a friend or relative to pick up my placard? Yes. Have your friend or relative bring your completed application (make sure you have signed it) along with their license or ID to the nearest DMV location.

If you would like to apply through the mail you may send your completed application to: NH Division of Motor Vehicles Walking Disability Section 23 Hazen Dr. Concord, NH 03305 You may bring your completed application to the nearest DMV locations.