Disabled Tap Identification Card Application Form printable pdf download

Disabled TAP Identi>cation Card Applicatio

los angeles county transit operators association (lactoa)

section i – photo specifications

The

LACTOA

Disabled

TAP

Card Program makes it easy for passengers

with disabilities to qualify for reduced fares on all Los Angeles County

All applications with photos that do not adhere to the

transit operators (except Dial-a-Ride services). Call 213.680.0054 for

guidelines listed below will not be processed.

eligibility requirements or additional information.

tape photo

application instructions

inside box

All applicants are required to complete sections i, ii and iii

Full face photo only

of this application and provide a copy of a valid photo

Photo size 2" x 2"

If applicant has a qualifying medical disability (see section iii),

or 1" x 1¼"

then he or she is also required to complete section iv and must

No hats or sunglasses

request a doctor or other certifying professional to complete

Photo must ﬁt in space

and sign section v.

1 " x 1 ¼ "

provided (cut to size)

A non-refundable $2 application fee. If applying by mail, please

Photo must be on

send check or money order made payable to Metro.

photo paper, not

Photocopy of

driver’s license or

card, and documents

CA ID

photocopy paper

proving eligibility in section iii for all applicants except

2" x 2"

qualifying medical disability applicants.

Submit completed application in person or by mail (see last page).

section ii – applicant information (to be completed by applicant)

Last Name

First Name

Middle Name/Initial

Street Address

Apt #

City | State | Zip

Birth Date

Telephone Number

I declare under penalty of perjury under the State of California that the information I have given is true. I understand that I may lose

the use of my Reduced Fare

TAP

card if I misuse the card, or if I mark, tag or damage transit agency property.

Applicant Signature

Date

section iii – eligibility criteria and medical release

Applicants are eligible for the

Disabled

card if one of the following criteria listed below applies to the applicant.

LACTOA

TAP

Note: Applicants who qualify in one of the ﬁrst four categories must supply a photocopy of the document proving eligibility and a

current

driver’s license or

card.

CA ID

______

I have a Medicare Identiﬁcation Card (Medi-Cal Card not acceptable)

______

I have a valid California

Placard receipt (must have current “valid through” date to be accepted) or

DMV

Disabled Veterans

(service connected)

______

I receive Supplemental Security Income [

] or Social Security Disability Insurance [

] beneﬁts (copy of award letter,

SSI

SSDI

beneﬁt adjustment letter, beneﬁt check)

______

I am a Special Education Student in a Los Angeles County program (certiﬁcation letter on school letterhead signed by

the Special Education teacher)

if you meet the above requirements, you can stop here

______

I have a qualifying medical disability according to Social Security Disability (Requires completion of section iv and v)

continue to sections iv and v



See inside to complete application.

Disabled Tap Identification Card Application Form

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