Fill Your Bfs 108 Michigan Template

The BFS 108 Michigan form is an application for a disability parking placard issued by the Michigan Department of State. This form requires information from both the applicant and a medical professional to determine eligibility for the placard. To begin the process, fill out the form by clicking the button below.

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Documents used along the form

The BFS 108 Michigan form is an essential document for individuals seeking a disability parking placard in Michigan. Along with this form, several other documents and forms may be required or helpful during the application process. Each of these plays a specific role in ensuring that the application is complete and that the applicant meets all necessary criteria. Below is a list of commonly used forms and documents associated with the BFS 108 Michigan form.

Physician’s Statement: This document is crucial as it provides medical verification of the applicant's disability. It must be completed by a qualified healthcare professional who assesses the applicant's ability to walk and confirms their eligibility for a disability parking placard.
Nevada Promissory Note: A legally binding document that outlines the repayment terms and conditions, ensuring clarity between lenders and borrowers. For more information, visit https://promissoryform.com/blank-nevada-promissory-note/.
Proof of Residency: Applicants may need to submit documentation proving they are Michigan residents. This can include utility bills, lease agreements, or other official documents that display the applicant's name and address.
Driver’s License or ID Copy: A copy of the applicant’s Michigan driver’s license or state identification card is often required. This helps verify the identity of the applicant and ensures that they are a licensed driver if applying for free parking privileges.
Medical License Verification: If the healthcare provider completing the physician’s statement is licensed in another state, a copy of their medical license may need to be submitted. This ensures that the physician is authorized to practice and provide medical assessments.
Application for Free Parking: If the applicant qualifies for free parking, they must complete a specific section of the BFS 108 form. This additional application outlines the conditions under which they qualify for free parking privileges.
Organization Application Form: For organizations applying for disability parking placards to assist individuals with disabilities, this form is necessary. It details the services provided and the number of placards requested.
Release of Information Form: This document authorizes the release of the applicant’s medical information to the Michigan Department of State. It is a critical part of the application process, ensuring that the necessary medical data can be shared for verification purposes.

Gathering these documents can streamline the application process and help ensure that all necessary information is submitted correctly. By understanding the role of each form, applicants can navigate the process more effectively and increase their chances of receiving the disability parking placard they need.

Bfs 108 Michigan Preview

Placard Number:

MICHIGAN DEPARTMENT OF STATE
Disability Parking Placard Application	Office Use Only:
	Expiration
	Date:

Directions:

Applicants please complete and sign Part 1. Your physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant must complete Part 2 and the certification on the bottom of this page. If you also qualify for free parking, your physician, chiropractor, optometrist, nurse practitioner, or physician’s assistant

must also complete Part 3. Organizations applying for parking placards to provide transportation services for disabled persons complete Part 4. Completed applications may be presented at any Secretary of State branch office or mailed to the address on the reverse side of this form.

(Application cannot be processed without signed release of information and physician’s certification)

Part 1: Release of Information and Signature

I am applying for a disability parking placard as provided in Public Act 300 of 1949. I authorize the release of the medical information described below to the Michigan Department of State. I certify the information is true and realize by making a false statement on this application I am subject to the penalties described on the reverse side of this form.

(Please print)

Name (First, Middle, Last)

Date of Birth

Michigan Drivers License or ID Card #

Street Address

County

Disability Plate Number (if any)

City, State, Zip

Daytime Phone Number

Last Parking Permit Number

(

)

Do you have a CDL endorsement?

If yes, do you have a medical

waiver?

Are you a Michigan resident?

YES

NO 

If yes, attach copy of waiver

YES

Signature of Disabled Person

Date

Signature of Representative (If presented by representative)

Representative’s Driver License Number

Part 2: Medical Eligibility Standards and Physician’s Determination

The Michigan Vehicle Code [MCL 257.19a] states that a disabled person be determined by a licensed physician, physician’s assistant, chiropractor, nurse practitioner, or optometrist identifying one or more of the following characteristics which affect your patient’s ability to walk.

Circle all letters that apply	Right Eye:	Left Eye:	Both Eyes:	Visual field (in degrees):
a) Blindness. Corrected acuity level:	20/______	20/______	20/______	____________

b)An inability to walk more than 200 feet without having to stop and rest. Please provide the diagnosis for this ambulatory disability:_______________________________________________________________________________________

c)Patient must use a wheelchair, walker, crutch, brace, or other ambulatory aid to walk.

Describe:_______________________________________________________________________________________

d)Patient has a lung disease from which the forced expiratory volume for one second, when measured by spirometry, is less than one liter, or from which the arterial oxygen tension is less than 60mm/hg of room air at rest.

e)Patient has a cardiovascular condition which measures between 3 and 4 on the New York Heart Classification Scale, or which renders the patient incapable of meeting a minimum standard for cardiovascular health established by the American Heart Association and approved by the Michigan Department of Public Health.

f)Patient has an arthritic, neurological, or orthopedic condition that severely limits ability to walk.

Describe: _______________________________________________________________________________________

g)Patient has a persistent reliance upon an oxygen source other than ordinary air.

Physician’s Certification	A parking placard will be issued solely on the physician’s evaluation

Patient’s condition is: Permanent	Temporary	If temporary, estimated duration: ______months (maximum 6 months)
Patient’s condition is: Permanent	Temporary

Physician’s Name	Medical Specialty		Office Telephone

Street Address	City, State, Zip		Office Fax

I certify the person listed above is eligible for a disability placard as provided in Public Act 300 of 1949. I also understand that making a false statement to obtain a disability parking placard is a misdemeanor and may result in fines, imprisonment, or both.

Physician’s Signature

(Physician / Chiropractor / Physician’s Assistant / Optometrist / Nurse Practitioner)

Medical License Number *

Date

*If the medical license was issued in a state other than Michigan, the physician must submit a copy of their medical license.

BFS-108 (05/13) NOTE: If the individual listed above is also eligible for free parking, Part 3 on the reverse side of this application must also be completed.

Part 3: Free Parking Application And Physician’s Certification

The free parking application is completed only when the applicant qualifies for free parking. To qualify, your patient must be a Michigan licensed driver, have an ambulatory disability described in Part 2, and also have one of the following conditions. Economic need is not a consideration.

Circle all letters that apply:

a)The patient cannot insert coins or tokens in a parking meter or cannot accept a ticket from a parking lot machine due to a lack of fine motor control of both hands.

b)The patient cannot reach above their head to a height of 42 inches from the ground, due to a lack of finger, hand, or upper extremity strength or mobility.

c)The patient cannot approach a parking meter due to use of a wheelchair or other ambulatory device.

d)The patient cannot walk more than twenty feet due to an orthopedic, cardiovascular, or lung condition in which the degree of debilitation is so severe that it almost completely impedes the patient’s ability to walk. (A condition requiring applicant to rest after walking twenty feet when not using a wheelchair or other ambulatory device.)

I certify the person listed on the front of this application is also eligible for free parking as provided in state law [MCL 257.675]. I under- stand that making a false statement to obtain a free parking sticker is a misdemeanor and may result in fines, imprisonment, or both.

Physician’s signature: X			Date
		(Physician / Chiropractor / Physician’s Assistant / Optometrist / Nurse Practitioner)

_________________________________________________________________________________________________

Part 4: Organization Request For Disability Parking Placards

(Please print)

Name of Organization

County

Telephone Number

( )

Street Address

City, State, Zip

Describe the transportation services your organization provides to persons with disabilities:

Number of disability placards you are requesting: ________ (No more then 1 per vehicle used to transport clients.)

I am applying for a disability parking placard as provided in Public Act 300 of 1949 and certify the above information is true.

Signature of Organization Officer	Printed Name of Organization Officer	Date
X
Organization Officer’s Driver License Number	Position (Title) with Organization

Note: If the organization ceases to provide specialized services to disabled persons, the parking placard must be returned to the Secretary of State for cancellation.

__________________________________________________________________________________________________

Penalties

Michigan Vehicle Code Section 257.675 Prohibits:

●Using a disability parking placard to park in a designated parking space unless the disabled person is driving or being transported.

●Altering, modifying, or selling a disability parking placard or free parking sticker.

●Copying or forging, or using a copied or forged disability parking placard or free parking sticker.

●Making a false statement to obtain a disability parking placard or free parking sticker, or committing a deception or fraud on a medical statement attesting to a disability.

●Knowingly using or displaying a disability parking placard that has been canceled by the Secretary of State.

A violation is a misdemeanor and punishable by a fine up to $500 or imprisonment for up to 30 days, or both. A law enforcement officer may immediately confiscate a disability parking placard for improper use.

__________________________________________________________________________________________________

Return completed applications to any	Michigan Department of State
Secretary of State branch office or mail to:	Out-of-State Resident Services Unit
	PO Box 30764
	Lansing, MI 48918

If you have any questions regarding disability parking placards, please call 1-888-767-6424.

Authority granted under Pubic Act 300 of 1949, as amended.

Similar forms

The BFS 108 Michigan form is similar to several other documents related to disability services and parking permits. Here’s a list of nine documents that share similarities:

Disability Parking Permit Application (State-Specific): Like the BFS 108, this application requires medical certification and personal information to qualify for a disability parking permit.
Accessible Parking Permit Application (Local Government): This document, similar to the BFS 108, allows individuals to apply for accessible parking permits at the local level, often requiring proof of disability.
Medicaid Transportation Request Form: Both forms require medical verification and detail the need for special transportation services due to a disability.
Social Security Disability Benefits Application: This application, like the BFS 108, necessitates medical documentation and personal details to establish eligibility for benefits.
Veteran’s Disability Compensation Claim: Similar to the BFS 108, this claim form requires medical evidence of disability and personal information to qualify for benefits.
State Disability Insurance Claim Form: This form requires medical certification and personal details to determine eligibility for state disability insurance, much like the BFS 108.
Special Needs Trust Application: This application often requires documentation of disability and financial information, paralleling the need for medical verification in the BFS 108.
Small Estate Affidavit Form - For the transfer of small assets without probate, the streamlined Small Estate Affidavit process simplifies asset management for heirs.
Home and Community-Based Services Waiver Application: Both documents necessitate medical assessments and personal information to qualify for services aimed at individuals with disabilities.
Transportation Services for Disabled Persons Application: This application, like the BFS 108, is designed for organizations providing transportation services, requiring details about the services offered and the population served.

Misconceptions

Misconceptions about the Bfs 108 Michigan form can lead to confusion and frustration for applicants. Understanding these misconceptions is essential for ensuring a smooth application process. Here are six common misunderstandings:

Misconception 1: Anyone can apply for a disability parking placard.

In reality, only individuals with specific medical conditions that limit their mobility can qualify for a disability parking placard. A licensed medical professional must certify the applicant's condition.

Misconception 2: The application can be completed without a physician's involvement.

This is not true. The application requires a physician, chiropractor, optometrist, nurse practitioner, or physician's assistant to complete a section that verifies the applicant's medical eligibility.

Misconception 3: Disability parking placards are permanent.

Not all placards are permanent. Some are issued for a temporary period, typically up to six months, depending on the applicant's condition. Physicians must indicate whether the condition is permanent or temporary.

Misconception 4: Economic need is a requirement for free parking.

Applicants may believe that their financial situation affects their eligibility for free parking. However, the law does not consider economic need; it strictly assesses medical conditions that limit mobility.

Misconception 5: Organizations can apply for multiple disability placards without restrictions.

This is misleading. Organizations can only request one placard per vehicle used to transport clients. This ensures that placards are issued judiciously and for legitimate purposes.

Misconception 6: There are no penalties for misuse of a disability parking placard.

On the contrary, misuse of a disability parking placard can lead to serious penalties, including fines and possible imprisonment. The law strictly prohibits using a placard unless the disabled person is present in the vehicle.

Understanding these misconceptions can help applicants navigate the process more effectively and ensure compliance with the law. It is important to approach the application with accurate information and the necessary medical support.

Detailed Instructions for Using Bfs 108 Michigan

Filling out the Bfs 108 Michigan form is an essential step for individuals seeking a disability parking placard. The process involves providing personal information, medical certification, and possibly additional details if qualifying for free parking. Follow these steps to ensure the application is completed accurately.

Part 1: Release of Information and Signature
- Print your full name (First, Middle, Last).
- Provide your date of birth.
- Enter your Michigan Driver's License or ID Card number.
- Fill in your street address, city, state, and zip code.
- List your county and daytime phone number.
- If applicable, provide your disability plate number and last parking permit number.
- Indicate whether you have a CDL endorsement and if you have a medical waiver.
- Confirm your residency in Michigan by selecting yes or no.
- Sign and date the form, or have your representative do so, providing their driver’s license number.
Part 2: Medical Eligibility Standards and Physician’s Determination
- Have a licensed physician, physician’s assistant, chiropractor, nurse practitioner, or optometrist complete this section.
- Circle all applicable characteristics that affect your ability to walk.
- Provide a diagnosis for any ambulatory disabilities.
- Indicate if the patient uses any ambulatory aids and describe them.
- State whether the patient’s condition is permanent or temporary, and if temporary, estimate the duration.
- The physician must include their name, medical specialty, office telephone, address, and fax number.
- Obtain the physician’s signature and medical license number.
Part 3: Free Parking Application And Physician’s Certification (if applicable)
- Circle all conditions that apply to qualify for free parking.
- The physician must certify the patient’s eligibility for free parking and sign the section.
Part 4: Organization Request For Disability Parking Placards (if applicable)
- Print the name of the organization, county, and telephone number.
- Provide the street address, city, state, and zip code of the organization.
- Describe the transportation services offered to persons with disabilities.
- Indicate the number of disability placards being requested.
- Have an officer of the organization sign and date the form, including their driver’s license number and position.

Once the form is completed, it can be submitted in person at any Secretary of State branch office or mailed to the designated address. Ensure that all required sections are filled out correctly to avoid delays in processing the application.

Dos and Don'ts

When filling out the Bfs 108 Michigan form for a disability parking placard, it’s essential to follow specific guidelines to ensure a smooth application process. Here’s a list of things to do and avoid:

Do complete Part 1 accurately, providing all required personal information.
Do ensure your physician or qualified medical professional fills out Part 2 and signs it.
Do attach any necessary documentation, such as a medical waiver, if applicable.
Do double-check that all information is correct before submitting the form.
Do submit the application in person or mail it to the appropriate address provided on the form.
Don't leave any sections blank; incomplete forms can delay processing.
Don't provide false information, as this can lead to penalties, including fines or imprisonment.

By following these guidelines, applicants can help ensure that their requests for disability parking placards are processed efficiently and correctly.