Individuals living with disabilities face numerous challenges in their daily lives, one of which is accessing convenient and affordable transportation. Recognizing this, the NJ Transit Reduced Fare Program aims to alleviate some of these challenges by offering discounted fares for those who qualify. Designed for persons with disabilities, the application process involves a rigorous certification by a licensed physician or nurse practitioner to ensure that only eligible candidates benefit from the program. Once approved, applicants are issued a Reduced Fare ID Card and can obtain a booklet of Reduced Fare Tickets through various authorized channels, enhancing their mobility and access to public transportation. The program sets specific eligibility criteria, excluding conditions such as pregnancy, obesity, acute or chronic alcoholism or drug addiction, and contagious diseases from qualification. It underscores the importance of proper documentation and certification, the confidentiality of applicant information, and the program's commitment to making transportation more accessible. For those navigating the application process, assistance is readily available, ensuring that eligible individuals can secure the discounts they need for more accessible public transportation.
| Question | Answer |
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| Form Name | Nj Transit Discounts For Disabled Form |
| Form Length | 5 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 15 sec |
| Other names | nj reduced, new jersey reduced application, cta reduced fare application, nj transit reduced fare card application |
REDUCED FARE PROGRAM
APPLICATION FOR
A PERSON WITH A DISABILITY
To be certified by a licensed physician
or nurse practitioner only.
NJ TRANSIT REDUCED FARE PROGRAM
One Penn Plaza East, 5th Floor, Newark, New Jersey 07105
Phone (973)
Fax
Email Reducedfare@NJTransit.com
INSTRUCTIONS
APPLICANT
Fill out the information in the “To be completed by Applicant” section and submit to a licensed physician or nurse practitioner for certification.
Eligible applicants will receive a Reduced Fare ID Card through the mail approximately four weeks after the physician has mailed in the application. A booklet of Reduced Fare Tickets may be obtained at participating banks, savings and loan associations, and authorized state and county agencies.
PHYSICIAN
Please complete all items (Items
NJ TRANSIT Reduced Fare Program
1Penn Plaza East, 5th Floor Newark, NJ 07105
Under “Ambulatory Disabled” (Item 6), check the subcategory that makes your client eligible and describe in detail the nature of the impairment or disability in the space provided.
Unless a category is specifically checked off and, in the case of “Ambulatory Disabled” more specifically categorized, we cannot accept this application. If there is no category that your patient fits into, he or she is not eligible for the program. These criteria have been set and are mandated by the law.
You are assured that you are not liable to NJ TRANSIT in any way as the result of furnishing your certification.
ELIGIBILITY CRITERIA
General Provisions:
1.The Eligibility Criteria listed on page 2 of the application are the sole basis for the determination of a disability for the NJ TRANSIT Reduced Fare Program.
A.An applicant 62 years of age or older who is not enrolled, may enroll in the Reduced Fare Program through the Senior Citizen Program. Senior Citizens applications are available at most banks, savings and loan associations and authorized state and county agencies.
2.Reduced Fare Identification Cards for persons with permanent disabilities are valid until expiration date shown on card.
3.NJ TRANSIT reserves the right to verify Certification Forms by contacting persons completing the forms.
4.Any fees charged for the completion of Certification Forms are not the responsibility of NJ TRANSIT.
5.Certification Forms will be confidential records and kept on file at NJ TRANSIT during the period of eligibility.
6.The criteria for eligibility on the application are in accordance with the following definition: “A person with a disability means any individual who, by reason of illness, injury, age, congenital malfunction, or other permanent or temporary incapacity or
disability, is unable without special facilities or special planning or design to utilize mass transportation facilities and services as effectively as persons who are not so affected.”
Exclusions
Persons whose sole incapacity is:
1.Pregnancy
2.Obesity
3.Acute or chronic alcoholism or drug addiction
4.Contagious diseases are specifically excluded from discount fare eligibility
For assistance in filling out this application, please call the NJ TRANSIT Reduced Fare Office
Monday - Friday, 8:00AM- 4:00PM at (973)
NO.
One Penn Plaza East, 5TH Floor, Newark, N.J. 07105
Phone (973)
Fax
Reducedfare@NJTransit.com
REDUCED FARE PROGRAM
APPLICATION FOR A PERSON WITH A DISABILITY
Disability Information Release Authorization:
As a part of my NJ Transit Reduced Fare Application Assessment, I realize that a licensed health professional, holding
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NO.
One Penn Plaza East, 5TH Floor, Newark, N.J. 07105
Phone (973)
Fax
Reducedfare@NJTransit.com
REDUCED FARE PROGRAM
APPLICATION FOR A PERSON WITH A DISABILITY
TO BE COMPLETED BY APPLICANT First Time Applicant Renewal Replacement
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PHYSICIAN CERTIFICATION (to be completed by licensed physician/ practitioner only)
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PHYSICIAN CERTIFICATION (continued)
ELIGIBILITY CRITERIA
The impairment or disability is considered: |
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Any person whose incapacity or disability will not allow that person to walk, even with the assistance of devices, but with or without the assistance of a personal care attendant (PCA), has the personal mobility and independence in a wheelchair that use of appropriate public transportation services is a reasonable expectation.
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Any person whose incapacity or disability will not allow that person to walk without the assistance of walkers, crutches, canes, braces, artificial legs, or other such adaptive device, and for whom use of appropriate public transportation services is a reasonable expectation.
( ) Ambulatory Disabled
Any person whose disability relates to a degree of visual, audio, physiological, mental or psychological disability or impairment as specified below, and for whom private personal transportation poses an unreasonable difficult or danger.
( ) Cerebrovascular accident (stroke)
() Pulmonary disability - (obstructions/ restrictions) that affect mobility. Those with PFT outcome < 50% of predicted values (FEV1; FVC; %FEV1;
() Cardiac disability
() Sight disability - those persons whose vision in the better eye after correction is 20/200 or less; and those persons whose visual field is contracted (commonly known as tunnel vision) to 10 degrees or less from a point of fixation, or the widest diameter subtends an angle no greater than 20 degrees.
() Hearing - loss is 90 dba or greater in the 500, 1000, 2000 Hz ranges.
() Faulty coordination from brain,spinal, peripheral nerve injury or arthritic condition.
() Epilepsy - petit and grand mal
() Autism
() Cerebral palsy
() Intellectual Disability - Those with I.Q.more than two standard deviations below the norm.
() Psychiatric Disabilities
∙includes a substantial disorder of thought, memory, perception, or orientation
∙grossly impairs judgment, behavior, capacity to recognize
∙greatly impacts ability to meet ordinary/independent life support needs of foods, shelter, clothing, management of finances, and health care.
() Other - please specify the disability that impairs mobility.
7.Does this person’s disability require that he or she use a personal care attendant (PCA) in order to use public transportation?
( ) yes ( ) no
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