Washington, DC

Application for Disability Parking Tags & Placard

Use this form to apply for disability parking tags(license plates), placard or both.

What are you requesting?

Check only one:

New Application Renewal

Check all that apply:

Disability Parking Tags Disability Parking Placard

Tell us about yourself.

First Name

Middle Name

Last Name

Date of Birth

SSN

Phone

I confirm that my application is true to the best of my knowledge. I understand that my disability parking tags and/or placard is/are for my use only and are non‐transferable. A designated driver may display the placard only if I am a passenger.

Signature

Date

Who will certify your disability? (check only one)

A false statement on this form is a violation of DC law and subject to a fine of up to $1,000, imprisonment up to 180 days or both.

I am self‐certifying in‐person at a DMV Service Center that I am missing a lower extremity and/or am unable to walk without the aid of a motorized wheelchair.

A medical practitioner has examined me and completed the following questions

Medical practitioner must complete if not self‐certifying

Does the person have a mobility impairment or limitation?

Yes No

Is the person limited in the ability to move without mobility aids (e.g. wheelchair, walker, crutches, cane, or long leg braces)?

Yes No

Does the person have a respiratory condition and/or other disease that limits mobility?

Yes No

Is the person’s mobility impairment temporary or long‐term?

Temporary Long‐term

Is the person’s mobility impairment temporary or long‐term?

Temporary Long‐term

Please describe in detail the nature & extent of the person’s mobility impairment.

Practitioner’s Signature:

Date

Phone

Practitioner’s Name

Practitioner’s Name: Practitioner’s ID #

Submit your application.

Placard: No fee. | Tags: Include $10 fee (check or money order payable to “DC Treasurer”).

If you are self‐certifying your mobility limitation: If a medical practitioner is certifying your mobility limitation:
• Bring this completed form and payment • For placards: Submit the application online at (if applicable) to a DMV Service Center. bit.ly/disabilityplacardtagform; or fax it to (202) 673‐9908.
• For tags: Mail the application and payment to:
• DC Department of Motor Vehicle | PO Box 90120 | Washington, DC 20090.

Washington, DC

Application for Disability Parking Tags & Placard

What are you requesting?

Submit your application.

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