Form Mvr 37A PDF Details

Navigating through the requirements for obtaining or renewing a Disability Parking Placard in North Carolina can be straightforward with a clear understanding of the MVR-37A form. This document serves as an essential tool in the application process, whether individuals are applying for the first time, renewing, or requesting additional placards. Designed by the North Carolina Division of Motor Vehicles, the form facilitates the certification and recertification processes for those in need of parking privileges due to various disabilities. With a nominal fee, applicants can request up to two placards, which are invaluable for ensuring closer and more accessible parking. The form is divided into sections that require personal information from the applicant and medical certification from a licensed provider. These sections confirm the type and severity of the disability, dictating the kind of placard an applicant is eligible for—be it temporary, permanent, or renewable after five years. Moreover, for those over the age of 80, medical recertification is waived during renewal, simplifying the process for elderly citizens. Documentation or certification from the U.S. Department of Veterans Affairs also plays a crucial role for veterans in proving eligibility. Understanding the intricacies of the MVR-37A form and its related processes, including fees, medical provider requirements, and the distinctions between different kinds of placards, is fundamental for applicants aiming to secure their right to accessible parking spaces.

QuestionAnswer
Form NameForm Mvr 37A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnorth carolina disability placard, nc mvr 37a form, mvr 37a form, mvr 37a

Form Preview Example

MVR-37A Front (Rev. 1/19)

Fee $5.00 Each (Limit 2)

MEDICAL CERTIFICATION FOR APPLICATION & RENEWAL OF DISABILITY PARKING PLACARD

North Carolina Division of Motor Vehicles

3148 Mail Service Center, Raleigh, NC 27697-3148

Application instructions:

1.Applicant must select the number of placards desired. (Limit of two per applicant.)

2.Applicant must complete and sign only the applicant section.

-Parent may sign for minors.

-If signing with a Power of Attorney, a certified copy must be attached or shown at the time of issuance.

3.Medical provider must complete and sign the medical provider's section if applicable or present documentation from the U.S. Department of Veterans Affairs.

4.Application and fee ($5.00 per placard) can be taken to your local License Plate Agency or mailed to the address above.

5.Medical recertification not required for persons 80 years of age or older at the time of renewal.

APPLICANT SECTION

I would like:

ONE placard $5.00

TWO placards $10.00

APPLICANT'S NC DRIVER LICENSE / ID NUMBER

APPLICANT'S/ORGANIZATION'S PRINTED NAME

STREET ADDRESS

CITY

STATE

ZIP CODE COUNTY

MAILING ADDRESS IF DIFFERENT FROM ABOVE

PHONE NUMBER

APPLICANT'S/ORGANIZATION REPRESENTATIVE'S SIGNATURE

MEDICAL PROVIDER'S SECTION

Disability parking placards and license plates are governed by the Motor Vehicle Laws of North Carolina General Statute Chapter 20, Article 2A. Afflicted, Disabled or Handicapped Persons. G. S. 20-37.5 Definitions (2) "Handicapped" shall mean a person with a mobility impairment who, as determined by a licensed medical provider: (check all that apply)

Cannot walk 200 feet without stopping to rest

Cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device

Is restricted by lung disease to such an extent that the person’s forced (respiratory) expiratory volume of one second, when measured by spirometry, is less than one liter, or the arterial oxygen tension is less than 60 mm/hg on room air at rest

Uses portable oxygen

Has a cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association

Is severely limited in their ability to walk due to an arthritic, neurological, or orthopedic condition

Is totally blind or whose vision with glasses is so defective as to prevent the performance of ordinary activity for which eyesight is essential, as certified by a licensed ophthalmologist, optometrist, or the Division of Services for the Blind

The medical provider certifies that the applicant qualifies for one of the parking placards listed below: (circle one)

1.Disability Parking Placard- Placard issued for 5 years and requires medical provider recertification upon renewal.

2.Temporary Disability Parking Placard - Placard issued for 1 to 6 months then expires. If needed beyond expiration a new application must be completed and requires recertification from a medical provider.

Temporary placard expiration in months (circle one):

1

2

3

4

5

6

3.Total and Permanent Disability Parking Placard – Placard issued for 5 years and does not require medical provider recertification upon renewal.

MEDICAL PROVIDER'S SIGNATURE

MEDICAL PROVIDER'S ADDRESS

 

 

 

 

MEDICAL PROVIDER'S PRINTED NAME

MEDICAL PROVIDER'S PHONE NUMBER

DATE

 

 

 

MEDICAL PROVIDER'S LICENSE NUMBER

PATIENT'S PRINTED NAME

 

 

 

 

MVR-37A Back (Rev. 07/17)

Authorized Medical Certifiers

Medical certification and recertification requirements for handicapped parking privileges must be satisfied by the certification of a licensed physician, a licensed physician assistant, a licensed nurse practitioner, a licensed ophthalmologist, a licensed optometrist or the Division of Services for the Blind or by a disability determination by the United States Department of Veterans Affairs that the applicant is handicapped.

For an initial application for temporary placard only, the certification that the applicant is handicapped may be made by a licensed certified nurse midwife.

Disability Parking Placards

A licensed medical provider certifies that the applicant is a person with an affliction, disability or handicap defined under G.S. 20-37.5. The Disability Parking Placard is issued for five years and requires a medical provider's re- certification upon re-issuance to continue parking in disability accessible areas. Applicants will be mailed a renewal application to be re-certified by their medical provider. Applicants may renew their Disability Parking Placard up to 90 days prior to the expiration date of the placard.

Temporary Disability Parking Placards

A licensed medical provider certifies that the applicant is a person with an affliction, disability or handicap defined under G.S. 20-37.5. The Temporary Disability Parking Placard is issued for a period of one to six months. If an extension is needed beyond the expiration date, a new application with medical provider's re-certification will be required. Upon expiration, Temporary Disability Parking Placards should be destroyed.

Total and Permanent Disability Parking Placards

A licensed medical provider certifies that the applicant is a person with an affliction, disability or handicap defined under G.S. 20-37.5 and is of a total and permanent nature. The Total and Permanent Disability Parking Placard is issued for five years and does not require a medical provider's re-certification upon re-issuance to continue parking in disability accessible areas. Applicants will be mailed a renewal application. Applicants may renew their Total and Permanent Disability Parking Placard up to 90 days prior to the expiration date of the placard.

Parking Privileges for Handicapped Drivers and Passengers

G. S. 20-37.6 (a) General Parking Any vehicle that is driven by or is transporting a person who is handicapped and that displays a distinguishing license plate, a removable windshield placard, or a temporary removable windshield placard may be parked for unlimited periods in parking zones restricted as to the length of time parking is permitted. This provision has no application to those zones or during times in which the stopping, parking, or standing of all vehicles is prohibited or which are reserved for special types of vehicles. Any qualifying vehicle may park in spaces designated as restricted to vehicles driven by or transporting the handicapped.

Rules that govern the Parking Placard for the Afflicted, Disabled or Handicapped Person

The placard is portable from one vehicle to another.

Hang the placard from the rearview mirror or place on the driver’s side dash if there is no rearview mirror.

The placard registration card must remain with each placard while in use.

The fee is $20.00 to replace the registration card for your placard if it becomes lost.

The fee to replace a lost/stolen placard itself is $5.00.

Damaged placards will be replaced at no fee.

Any organization certified by State Vocational Rehabilitation Agency that regularly transports handicapped persons may apply. G. S. 20-37.6 (c)

www.ncdot.gov/dmv

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Stage number 1 for submitting nc application renewal

2. The subsequent step is usually to submit the following blank fields: Temporary Disability Parking, Temporary placard expiration in, Total and Permanent Disability, MEDICAL PROVIDERS SIGNATURE, MEDICAL PROVIDERS ADDRESS, MEDICAL PROVIDERS PRINTED NAME, MEDICAL PROVIDERS PHONE NUMBER, DATE, MEDICAL PROVIDERS LICENSE NUMBER, and PATIENTS PRINTED NAME.

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