Application for Maryland Parking Placards/License Plates
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
VR-210 (07-23)
For quickest processing of your disability placard, upload this form to our online services portal at:
https://mymva.maryland.gov/TAP/IND/?Link=Disability
Please read instructions on back carefully before completing form.
A. Customer Identifying Information - Individual with a Disability
Requested Service: New Replacement Lost Placard(s) Stolen Placard(s)
Placard Number(s): Police Report Number of Stolen Placard(s): Jurisdiction Reported:
Parking Placard:
One Two
Temp. Parking Placard:
One Two
License Plate:
One
Motorcycle Plates (In Glen Burnie Rm. 104 only)
One Two
First Name: Middle Name: Last Name:
Date of Birth: Driver’s License/Identication Number:
Residence Street Address: City: County: State: Zip Code:
Mailing Street Address (if different): City: County: State: Zip Code:
If Guardianship, Guardian’s First Name: Middle Name: Last Name:
Date of Birth: Driver’s License/Identication Number:
Attention: I/we certify the statements made herein are true and correct to the best of my/our knowledge, information and belief. I/we understand it
is illegal for anyone to park in any parking space designated for a person with a disability, other than an individual who has submitted and obtained a
certication from the MVA, that authorizes the use of a designated parking space. I/we also understand that the individual who has been certied to
have a disability must have a current disability certication card in his or her possession when using a disability placard or plate.
I further understand that applying for a disability placard or plate and by execution of this authorization, I give permission to my doctor to release
to the Motor Vehicle Administration all medical information relative to the qualication requirements that established my eligibility to obtain the
disability placard or plate. Additionally, I agree to release the MVA from any and all liability that may arise from the collection and storage of medical
information, in the procurement of this application. This authorization will not expire unless all disability placards and plates in my possession are
expired or I have returned all placards and plates for cancellation.
Signature of Individual with Disability or Guardian of Individual with Disability Date
B. Vehicle Owner Information (for plates only) - By signing above, I certify that I understand that my vehicle may be parked in a parking space
reserved for a disabled person only when the individual named above is present and in possession of a current Disability Certication Card.
Vehicle Title Number: Motorcycle #1 Title Number: Motorcycle #2 Title Number:
C. Disability Certication Information (doctor’s use only - see disability codes)
Please note if your patient has a temporary disability, you should only recommend a temporary placard for a period of 1-6 months. If an extension is
required, your patient can apply for an additional period of disability, for up to six months. This will require the approval of the appropriate clinician. A
permanent disability status should be reserved for conditions that will not improve.
Type of Disability: Permanent Temporary Disabled Veteran
Patient Name: Disability Code: Length of Temporary Disability:
months
Reason for Temporary Disability (Temp. Placard only):
Ofce Address: City: County: State: Zip Code: Phone Number:
Email Address: Medical License Number: State of Issue: Expiration Date
Type of Doctor: Licensed Physician Licensed Chiropractor Licensed Optometrist Licensed Podiatrist
Licensed Nurse Practitioner Licensed Physician’s Assistant Licensed Physical Therapist
Doctor/Nurse Practitioner’s Name (printed) Signature Date
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Instructions:
Purpose: An individual with a disability may use this form to request placards, license plates and/or motorcycle plates that will allow a vehicle in
which he/she is riding to park in a parking space reserved for the disabled. Two types of placards are available: Temporary Placards (red), which are
valid for a period of up to 6 months; and Permanent Parking Placards (blue), which are valid until the death of the disabled individual. An applicant
may request a parking placard, license plate and motorcycle plates at the same time. See the Form Completion Instructions below.
Fee Information:
Placard: There is not a fee for the placard(s).
Plates: A request for a disability plate and/or motorcycle plate requires the assessment of the substitute/replacement tag fee. Please submit your
completed application along with the appropriate $20.00 fee. If requesting a disability plate and/or motorcycle plate(s) and it’s time to renew your
vehicle registration, the registration fee is also required.
What can I apply for?
An individual with a permanent disability may apply for:
• One placard, or
• One regular disability plate, or
• One placard and one regular disability plate, or
• Two placards
In addition, up to two motorcycle disability plates can be requested with any combination listed above.
An individual with a Temporary disability may apply for:
• One or two temporary placards
What sections should I ll out?
Parking Placard - Complete Section A. An approved medical provider needs to complete Section C.
License Plates or Motorcycle Plates - Complete Sections A & B. An approved medical provider needs to complete Section C. You may only request
a disability plate or motorcycle plate(s) if the vehicle is titled in the name of the individual with a disability.
Note:
• A doctor’s certication may not be required if the individual has a disability that meets the denition of code 6 or V.
• For a replacement placard, only complete section A. For replacement plates, complete sections A & B.
• For temporary placards, Disability Code 10 is to be used.
Permanent Disability Codes
1. Has lung disease to such an extent that forced (respiratory)
expiratory volume for one second, when measured by spirometry,
is less than one liter, or arterial oxygen tension (p02) is less than 60
mm/hg on room air at rest.
6. Has lost an arm, hand, foot or leg (See Note D)
7. Has lost the use of an arm, hand, foot or leg.
2. Has cardiovascular disease limitations classied in severity as Class
III or Class IV according to standards set by the American Heart
Association.
8. Has a permanent disability, that adversely impacts the ambulatory
ability of the applicant and which is so severe that the person
would endure a hardship or be subject to a risk of injury if the
privileges accorded a person for whom a vehicle is specially
registered were denied.
3. Is unable to walk 200 feet without stopping to rest. 9. Has a permanent impairment of both eyes so that: 1) The central
vision acuity is 20/200 or less in the better eye with corrective
glasses, or 2) There is a eld defect in which the peripheral eld
has contracted to such an extent that the widest diameter of visual
eld subtends an angular distance no greater than 20 degrees in
the better eye (See Note C)
4. Is unable to walk 200 feet without the use of, or the assistance from,
a brace, cane, crutch, another person, prosthetic device, or other
assistance device.
10. Temporary Placard - Disability is not permanent but would
substantially impair the person’s mobility or limit or impair the
person’s ability to walk for at least three weeks, and is so severe
that the person would endure a hardship or be subject to risk of
injury if the Temporary Permit was denied.
5. Requires a wheelchair for mobility
V. Reserved for use by veterans with 100% disability. The Veterans Administration has certied by letter that the applicant has a 100% service
connected disability.
Notes:
A. A licensed physician, licensed nurse practitioner or licensed physician’s assistant may certify all qualifying conditions listed.
B. A licensed chiropractor, licensed podiatrist or licensed physical therapist may certify disability codes 3 through 8, and 10.
C. A licensed optometrist may certify only qualifying conditions regarding vision.
D. The person with a disability may self-certify the conditions listed under Disability Code 6 by appearing in person with proper identication.
In this situation, only the disabled person’s name and Disability Code must be recorded. If, however, a doctor certies the loss of a limb, the
doctor must complete all of Section C.
If someone other than the applicant submits the application for Disability Plates or Placards they must provide a state issued ID. Applications
may also be mailed with the appropriate fees to the Motor Vehicle Administration, 6601 Ritchie Highway N.E., Glen Burnie, Maryland 21062 Attn:
Disability Unit.
