Transportation Disadvantaged Application

Download a blank fillable Transportation Disadvantaged Application in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Transportation Disadvantaged Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Dear TOPS! Applicant:

Thank you for your interest in TOPS! The Florida Commission for Transportation Disadvantaged

(TD) program is one of the transportation programs provided by TOPS! The TD program is for

individuals who are prohibited from using the Broward County Transit (BCT) fixed-route bus service

due to financial limitations or require door-to-door service due to physical and/or mental disabilities.

The TD program provides two types of service:

1. Bus Pass Program – A monthly BCT fixed-route bus pass is provided at no charge to

qualifying individuals who are financially prohibited from using the fixed-route system.

2. Door-to-Door Paratransit Transportation – Shared-ride paratransit transportation is provided

to qualifying individuals who are prohibited from using the BCT fixed-route bus system due

financial, physical and/or mental restrictions. Door-to-door paratransit transportation will be

provided to health care, employment, education, shopping, social activities, other life-

sustaining activities or children who are handicapped, high-risk or at-risk.

ELIGIBILITY: Both services require the applicant to qualify under the current Federal Poverty Level

guideline, depending on the number in the household, at the 100 percent level.

Complete the TD program application for either service. The completed TD application must contain

all requested information, be legible and have all required identification and applicable financial

supporting documents included when submitted. Door-to-door Paratransit applications must also

have the medical information (Section 3) completed and signed by a Florida licensed physician.

Return to:

Paratransit Eligibility Services

Broward County Transit

1 N. University Dr., Suite 3100-A

Plantation, FL 33324.

________________________________________________________________________________

NOTICE OF COLLECTING SOCIAL SECURITY NUMBER (SSN) FOR GOVERNMENT PURPOSE

Broward County collects SSNs for different purposes. The Florida Public Records Law, Section 119.071(5), F.S. (2007) requires the County to give you

this written statement explaining the purpose and authority for collecting your SSN.

FORM

PURPOSE

AUTHORIZATION

TD Application

Conduct eligibility verification and monitor for system abuse

County policy (See Note)

NOTE: Broward County collects your SSN in the performance of a duty or responsibility the County must complete in accordance with law or business

necessity. In the event a law does not specifically provide the County with the authority to collect your SSN, it is imperative that the County collect your

SSN and this is expressly provided in section 119.081 (5) 2.b.

3/5/14