Get Nj Transit Discounts For Disabled Form Open Editor Here

Get Nj Transit Discounts For Disabled Form

The NJ Transit Reduced Fare Program application is designed specifically for individuals with disabilities, offering them a way to receive reduced fares on NJ Transit services. This form requires certification from a licensed physician or nurse practitioner to confirm the eligibility of the applicant based on specific criteria related to their disability. Once approved, applicants are issued a Reduced Fare ID Card and have the option to obtain a booklet of Reduced Fare Tickets, facilitating more accessible and affordable travel.

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Content Overview

In New Jersey, individuals with disabilities might have increased challenges when accessing public transportation. Recognizing this, NJ Transit offers a compassionate solution through its Reduced Fare Program, specifically designed to serve this community. This program allows those with qualifying disabilities to receive fare reductions, thereby removing a barrier to mobility and independence. The program application process demands participation from both the applicant and a licensed physician or nurse practitioner, ensuring that only those who meet the specific eligibility criteria benefit. Once certified, eligible participants are issued a Reduced Fare ID Card, along with a booklet of reduced fare tickets, to be used within a set timeframe. However, not all conditions apply; exclusions such as pregnancy, obesity, acute or chronic alcoholism or drug addiction, and contagious diseases are clearly noted. This initiative underscores NJ Transit's commitment to inclusivity and the vital role of accessible transportation in fostering independence for individuals with disabilities. For those needing assistance with their application or seeking more information, NJ Transit provides resources and direct support, highlighting a structured yet personal approach to accessibility.

Document Sample

REDUCED FARE PROGRAM

APPLICATION FOR

A PERSON WITH A DISABILITY

To be certified by a licensed physician

or nurse practitioner only.

NJ TRANSIT REDUCED FARE PROGRAM

One Penn Plaza East, 5th Floor, Newark, New Jersey 07105

Phone (973) 491-7112

Fax (973)609-1753

Email Reducedfare@NJTransit.com

INSTRUCTIONS

APPLICANT

Fill out the information in the To be completed by Applicantsection and submit to a licensed physician or nurse practitioner for certification.

Eligible applicants will receive a Reduced Fare ID Card through the mail approximately four weeks after the physician has mailed in the application. A booklet of Reduced Fare Tickets may be obtained at participating banks, savings and loan associations, and authorized state and county agencies.

PHYSICIAN

Please complete all items (Items 1-7) in section marked Physician Certificationand mail directly to:

NJ TRANSIT Reduced Fare Program

1Penn Plaza East, 5th Floor Newark, NJ 07105

Under Ambulatory Disabled(Item 6), check the subcategory that makes your client eligible and describe in detail the nature of the impairment or disability in the space provided.

Unless a category is specifically checked off and, in the case of Ambulatory Disabledmore specifically categorized, we cannot accept this application. If there is no category that your patient fits into, he or she is not eligible for the program. These criteria have been set and are mandated by the law.

You are assured that you are not liable to NJ TRANSIT in any way as the result of furnishing your certification.

ELIGIBILITY CRITERIA

General Provisions:

1.The Eligibility Criteria listed on page 2 of the application are the sole basis for the determination of a disability for the NJ TRANSIT Reduced Fare Program.

A.An applicant 62 years of age or older who is not enrolled, may enroll in the Reduced Fare Program through the Senior Citizen Program. Senior Citizens applications are available at most banks, savings and loan associations and authorized state and county agencies.

2.Reduced Fare Identification Cards for persons with permanent disabilities are valid until expiration date shown on card.

3.NJ TRANSIT reserves the right to verify Certification Forms by contacting persons completing the forms.

4.Any fees charged for the completion of Certification Forms are not the responsibility of NJ TRANSIT.

5.Certification Forms will be confidential records and kept on file at NJ TRANSIT during the period of eligibility.

6.The criteria for eligibility on the application are in accordance with the following definition: A person with a disability means any individual who, by reason of illness, injury, age, congenital malfunction, or other permanent or temporary incapacity or

disability, is unable without special facilities or special planning or design to utilize mass transportation facilities and services as effectively as persons who are not so affected.

Exclusions

Persons whose sole incapacity is:

1.Pregnancy

2.Obesity

3.Acute or chronic alcoholism or drug addiction

4.Contagious diseases are specifically excluded from discount fare eligibility

For assistance in filling out this application, please call the NJ TRANSIT Reduced Fare Office

Monday - Friday, 8:00AM- 4:00PM at (973) 491-7112.

NO.

One Penn Plaza East, 5TH Floor, Newark, N.J. 07105

Phone (973) 491-7112

Fax (973)609-1753

Reducedfare@NJTransit.com

REDUCED FARE PROGRAM

APPLICATION FOR A PERSON WITH A DISABILITY

Disability Information Release Authorization:

As a part of my NJ Transit Reduced Fare Application Assessment, I realize that a licensed health professional, holding physician-level credentials in the area of my disability must verify my present medical condition. Therefore, by signing this form, I give my consent to release to NJ Transits Reduced Fare Program and its authorized designee of any records or information maintained by the licensed health care professional relevant to a determination that I am eligible to receive NJ Transit Reduced Fare. This authorization is effective for so long as NJ Transit Reduced Fare Program is reviewing my application; and/or to determine my continued eligibility for the NJ Transit Reduced Fare Program. This authorization to release medical information is subject to written revocation by me at any time. In the absence of my revocation, this authorization will only be valid for four (4) years. I understand that any fees associated with the completion of this request are my responsibility.

Applicant Name (PRINT)

Applicant Date of Birth

 

 

 

Applicant Signature

 

Today’s Date

 

 

 

Parent/ Legal Guardian Signature

Today’s Date

NO.

One Penn Plaza East, 5TH Floor, Newark, N.J. 07105

Phone (973) 491-7112

Fax (973)609-1753

Reducedfare@NJTransit.com

REDUCED FARE PROGRAM

APPLICATION FOR A PERSON WITH A DISABILITY

TO BE COMPLETED BY APPLICANT ฀ First Time Applicant ฀ Renewal ฀ Replacement

1. Name_

 

(Last)

(First)

(Middle)

 

 

2. Address

 

 

 

 

 

(Street)

 

(Apt.)

 

 

 

 

 

 

 

 

 

(City)

(County)

(State)

(Zip code)

 

3. Sex: (

) Male

4. Height_

(

) Female

 

 

 

 

5. Date of Birth_

 

6. Telephone Number

 

7. Signature of Applicant_

Check here if you are signing as a personal representative and complete below. This ONLY applies if someone other than the person with Disability signed above.

Print Name of Personal Representative

 

 

Phone Number

 

 

Signature of Personal Representative

 

 

Date

 

Relationship to Applicant

 

 

 

 

 

 

 

PHYSICIAN CERTIFICATION (to be completed by licensed physician/ practitioner only)

1. Name_

2. Office Address

 

 

 

 

(Street)

 

 

 

 

 

 

 

 

 

 

(Suite)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City)

 

(State)

 

 

 

(Zip Code)

 

 

 

3. Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Licensure Title

 

 

 

Specialty

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. License Number

 

 

 

 

State Issued

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

)

For Internal Use Only:

 

Staff initials

 

 

 

Date

 

 

Approved

Denied

Incomplete

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHYSICIAN CERTIFICATION (continued)

ELIGIBILITY CRITERIA

The impairment or disability is considered:

 

 

 

 

5. Permanent ( )

Temporary ( )

 

 

 

Estimated Period of Disability

 

From

to

 

 

(Date)

 

(Date)

6. ( ) Non-Ambulatory Disabled

Any person whose incapacity or disability will not allow that person to walk, even with the assistance of devices, but with or without the assistance of a personal care attendant (PCA), has the personal mobility and independence in a wheelchair that use of appropriate public transportation services is a reasonable expectation.

( ) Semi-Ambulatory Disabled

Any person whose incapacity or disability will not allow that person to walk without the assistance of walkers, crutches, canes, braces, artificial legs, or other such adaptive device, and for whom use of appropriate public transportation services is a reasonable expectation.

( ) Ambulatory Disabled

Any person whose disability relates to a degree of visual, audio, physiological, mental or psychological disability or impairment as specified below, and for whom private personal transportation poses an unreasonable difficult or danger.

( ) Cerebrovascular accident (stroke)

() Pulmonary disability - (obstructions/ restrictions) that affect mobility. Those with PFT outcome < 50% of predicted values (FEV1; FVC; %FEV1; FEF25%-75%). Dyspnea occurs during usual activities of daily living; climbing a flight of stairs or walking 100 yards; with the slightest exertion; or even at rest.

() Cardiac disability

() Sight disability - those persons whose vision in the better eye after correction is 20/200 or less; and those persons whose visual field is contracted (commonly known as tunnel vision) to 10 degrees or less from a point of fixation, or the widest diameter subtends an angle no greater than 20 degrees.

() Hearing - loss is 90 dba or greater in the 500, 1000, 2000 Hz ranges.

() Faulty coordination from brain,spinal, peripheral nerve injury or arthritic condition.

() Epilepsy - petit and grand mal

() Autism

() Cerebral palsy

() Intellectual Disability - Those with I.Q.more than two standard deviations below the norm.

() Psychiatric Disabilities -This section applies to those individuals who suffer from a serious, long term mental illness that

includes a substantial disorder of thought, memory, perception, or orientation

grossly impairs judgment, behavior, capacity to recognize

greatly impacts ability to meet ordinary/independent life support needs of foods, shelter, clothing, management of finances, and health care.

() Other - please specify the disability that impairs mobility.

7.Does this persons disability require that he or she use a personal care attendant (PCA) in order to use public transportation?

( ) yes ( ) no

8. Physician/ Practitioner Signature

 

Date

 

 

 

 

Form Attributes

Fact Name Detail
Program Name New Jersey Transit Reduced Fare Program for Persons with Disabilities
Contact Information One Penn Plaza East, 5th Floor, Newark, NJ 07105. Phone: (973) 491-7112, Fax: (973) 609-1753, Email: Reducedfare@NJTransit.com
Application Process Applicants must fill out a section and submit the form to a licensed physician or nurse practitioner for certification. The Reduced Fare ID Card arrives via mail approximately four weeks after physician submission.
Eligibility Criteria Individuals with a permanent or temporary incapacity or disability that hinders their ability to utilize mass transportation effectively. Excludes pregnancy, obesity, addiction issues, and contagious diseases.
Program Exclusions Not available to individuals whose incapacity is due only to pregnancy, obesity, acute or chronic alcoholism or drug addiction, or contagious diseases.
Governing Laws The criteria for eligibility are mandated by law under definitions that regard disabilities affecting an individual's capacity to utilize mass transportation facilities and services as effectively as those not so affected.

Nj Transit Discounts For Disabled: Usage Guide

Filling out the NJ Transit Discounts for Disabled form is a crucial step for individuals with disabilities in obtaining reduced fare on NJ Transit. This process involves both the applicant and a licensed physician or nurse practitioner. Following the steps accurately ensures that the application is processed smoothly, allowing eligible applicants to receive their Reduced Fare ID Card. It generally takes about four weeks after the physician has mailed in the application for the card to arrive through the mail. Here are the steps to complete this form:

  1. Under the section "TO BE COMPLETED BY APPLICANT", check the appropriate box to indicate if you are a First Time Applicant, applying for a Renewal, or requesting a Replacement.
  2. Fill in your personal information, including your Name (Last, First, Middle), Address (Street, Apt., City, County, State, Zip Code), and Sex (Male or Female).
  3. Enter additional details such as Height, Date of Birth, and Telephone Number.
  4. Sign the form in the provided space. If you are not the person with the disability but are signing on their behalf as a personal representative, check the relevant box and complete the section by providing your name, relationship to the applicant, phone number, and signature.
  5. The form requires that a "PHYSICIAN CERTIFICATION" section be completed by a licensed physician or nurse practitioner only. Thus, after completing your portion, submit the form to your licensed health care provider for certification.
  6. Your physician or nurse practitioner will need to fill out their section, including Name, Office Address, Telephone Number, their Licensure Title and Specialty, as well as their License Number. They will attest to your disability status, specifying whether it is permanent or temporary and detailing the nature of your disability. If necessary, they will also indicate if you require a personal care attendant to use public transportation.
  7. Upon completion, the physician or nurse practitioner will mail the form to the address provided: NJ TRANSIT Reduced Fare Program, One Penn Plaza East, 5th Floor, Newark, NJ 07105.

After the form has been submitted, NJ Transit will assess the application against the eligibility criteria for the reduced fare program. Successful applicants will receive their Reduced Fare ID Card through the mail. This ID card allows for the purchase of reduced fare tickets, facilitating more affordable transportation for individuals with disabilities.

Listed Questions and Answers

What is the NJ TRANSIT Reduced Fare Program for Persons with Disabilities?

The NJ TRANSIT Reduced Fare Program is designed to help individuals with disabilities travel at a reduced cost on NJ TRANSIT services. If verified by a licensed physician or nurse practitioner, eligible applicants receive a Reduced Fare ID Card, allowing them to purchase tickets at a discounted rate. This initiative supports easier access to mass transportation by offering financial assistance to those who qualify based on certain disability criteria.

How can someone apply for the NJ TRANSIT Reduced Fare Program?

To apply for the program, the applicant must fill out the "To be completed by Applicant" section of the application form and then have it certified by a licensed physician or nurse practitioner. The completed form should be mailed to the NJ TRANSIT Reduced Fare Program office. After processing, which can take approximately four weeks, an eligible applicant will receive a Reduced Fare ID Card through the mail.

Who is eligible for the NJ TRANSIT Reduced Fare Program?

Eligibility is based on several criteria outlined in the application's section regarding disability. These criteria include:

  • A permanent or temporary incapacity or disability that impairs mobility.
  • Excluding conditions such as pregnancy, obesity, acute or chronic alcoholism or drug addiction, and contagious diseases.
  • Individuals 62 years or older may also be eligible for the Senior Citizen Program for reduced fares.

It's important to note that eligibility is determined based on the details provided by a licensed healthcare professional on the applicant's behalf.

What happens after submitting the application for the NJ TRANSIT Reduced Fare Program?

Once the application is submitted and certified by a healthcare provider, it is reviewed by the NJ TRANSIT Reduced Fare Program team. If approved, the applicant receives a Reduced Fare ID Card by mail within approximately four weeks. This card can be used to purchase reduced fare tickets from participating banks, savings and loan associations, and authorized state and county agencies. NJ TRANSIT reserves the right to verify the information on the certification forms at any time.

Are there any costs associated with applying for the NJ TRANSIT Reduced Fare Program?

While there is no charge from NJ TRANSIT for processing the Reduced Fare Program application, any fees associated with the completion of the application by a healthcare professional are the responsibility of the applicant. It is advised to discuss any potential costs with the healthcare provider before completing the application process.

Common mistakes

Filling out the NJ Transit Discounts for Disabled form may seem straightforward, but there are common mistakes that can delay the process. Here's a list to help avoid these pitfalls:

  1. Not thoroughly reading the instructions – It's crucial to understand all the requirements before starting to fill out the form.
  2. Incomplete information in the applicant section – Every field must be filled out accurately, including contact details and disability information.
  3. Misunderstanding eligibility criteria – Ensure that the specific disability fits within the listed eligibility criteria.
  4. Choosing the wrong disability category – Accurately selecting the disability category is vital for proper processing.
  5. Forgetting to sign and date the form – Both the applicant and the licensed physician or nurse practitioner must sign and date the form where indicated.
  6. Physician certification errors – The section to be completed by a licensed physician or nurse practitioner must include a detailed description of the impairment or disability to ensure eligibility.
  7. Omitting the licensure information of the certifying physician – The licensure title, specialty, license number, and state issued are all required for verification purposes.
  8. Not specifying the disability's permanence – It must be clear whether the disability is permanent or temporary, including the estimated period of disability if applicable.
  9. Incorrectly indicating the need for a personal care attendant (PCA) – accurate communication about the necessity of a PCA for public transportation use is crucial.
  10. Not checking for accuracy before submission – Review the entire form for completeness and accuracy to avoid delays.

Remember, the key to successful submission is attention to detail. Double-check each section, ensure all information is present and correct, and familiarize yourself with the eligibility criteria. Doing so will facilitate a smoother application process for NJ Transit's Reduced Fare Program.

Documents used along the form

When applying for the NJ Transit Reduced Fare Program for Persons with Disabilities, individuals may need to provide additional forms and documents to support their application or to utilize associated benefits fully. Below is a list of other forms and documents often used alongside the Reduced Fare Program Application for a Person with Disability.

  • Proof of Identity Document: A government-issued photo ID, such as a driver's license or state ID, confirms the applicant's identity and age, ensuring that the person applying is indeed the one eligible for the discount.
  • Proof of Residence: Utility bills, lease agreements, or official mail addressed to the applicant serve as proof of residence, confirming that the applicant resides in New Jersey and is eligible for the NJ Transit Reduced Fare Program.
  • Medical Documentation: Additional medical records or a doctor’s detailed statement can supplement the required physician certification, providing a more comprehensive view of the applicant's disability and its impact on their mobility.
  • Income Verification Documents: Although not explicitly required for the NJ Transit program, some applicants might need to provide income-related documents if applying for other assistance programs that could intersect with transportation benefits.
  • Senior Citizen Program Application: Applicants who are 62 years of age or older might also consider applying for the Senior Citizen Program, which requires its own application form. This can be especially relevant for individuals who may qualify for both programs.

Together, these documents play a crucial role in ensuring the applicant meets all eligibility criteria and receives the appropriate benefits from the NJ Transit Reduced Fare Program. Being prepared with the right documents can streamline the application process and ensure those who qualify can access reduced fares as soon as possible.

Similar forms

The "Paratransit Service Application" for individuals with disabilities seeking access to specialized transit services parallels the NJ Transit Discounts For Disabled form in significant ways. Both applications necessitate validation of the applicant's disability through a healthcare professional's certification. The core intent is to ensure that individuals unable to use standard public transportation due to their disabilities have access to suitable alternatives, emphasizing the applicant's mobility needs and the role of a healthcare provider in certifying these needs.

Another related document is the "Parking Permit for People with Disabilities" application. This form also requires a healthcare provider's certification to confirm the applicant's disability and need for special parking accommodations. Similar to the NJ Transit form, it makes clear the criteria for eligibility—focusing primarily on the individual's mobility impairments—and underscores the importance of officially recognizing disabilities to provide necessary accommodations.

The "Application for Disability Benefits" from social security or insurance programs shares similarities with the NJ Transit form by requiring detailed information regarding the nature and extent of the applicant's disability, often including a section for physician certification. This connection highlights the documentation needed to establish the presence and impact of a disability, which can then be used to determine eligibility for various benefits, including reduced fare programs and financial assistance.

The "Disabled Veteran Identification Card Application" is another document exhibiting commonalities with the NJ Transit form. This type of application acknowledges the unique circumstances of disabled veterans by offering them certain privileges or discounts. Certification of the disability, often by a medical professional or the Veterans Administration, plays a crucial role in the process, reiterating the necessity for formal recognition of disabilities to access specific benefits designed for easing daily living.

Lastly, the "Disability Placard Application for Reduced Fare Programs" for public transportation mirrors the NJ Transit Discounts For Disabled application in its structure and purpose. It serves individuals seeking reduced fares on public transit due to their disabilities. Both forms necessitate medical certification to verify the disability, ensuring that those who genuinely need these accommodations can receive them. The focus on enabling mobility for people with disabilities through reduced fares or special placards underscores the overarching goal of inclusivity in public transportation.

Dos and Don'ts

When completing the NJ Transit Discounts for Disabled form, it’s important to follow specific dos and don’ts to ensure the application process is smooth and successful. Below are tips to help you navigate the form accurately.

  • Do ensure that all the information in the “To be completed by Applicant” section is accurate and fully filled out before submission.
  • Do have the form certified by a licensed physician or nurse practitioner, as only they are authorized to complete the certification section.
  • Do check the correct disability category under “Ambulatory Disabled” to clearly indicate the nature of the impairment or disability.
  • Do allow up to four weeks for processing and issuance of the Reduced Fare ID Card once the physician has mailed the application.
  • Do remember that any fees associated with the completion of this application are the responsibility of the applicant.
  • Do not apply if the sole incapacity is pregnancy, obesity, acute or chronic alcoholism or drug addiction, and contagious diseases, as these are not eligible for discounts.
  • Do not hesitate to contact the NJ TRANSIT Reduced Fare Office for assistance if any part of the application is unclear.

Following these guidelines will help in the successful submission and processing of the NJ Transit Discounts for Disabled form. It’s crucial to provide accurate and comprehensive information to avoid delays or denial of eligibility.

Misconceptions

When it comes to applying for NJ Transit discounts through the Reduced Fare Program for persons with disabilities, there are several misconceptions that can confuse applicants. Understanding the truth behind these can make the application process smoother and ensure eligible individuals receive the benefits they deserve.

  • Only doctors can certify the application: While a licensed physician's certification is required, it's important to note that a nurse practitioner can also complete the certification. This misconception may limit the options for some applicants who have regular care under nurse practitioners.

  • The program is only for permanent disabilities: The belief that the Reduced Fare Program is exclusively for individuals with permanent disabilities is incorrect. Applicants with temporary disabilities that meet the eligibility criteria can also apply. They need to indicate the estimated period of disability in the application, and their Reduced Fare ID Card will reflect the temporary nature of their condition.

  • Application approval is automatic: Some people think that once the application is submitted with a physician or nurse practitioner's certification, approval is guaranteed. However, NJ Transit reserves the right to verify the information provided on the Certification Forms. This means that approval is not automatic, and applications can be denied if they do not meet the criteria or if there is an issue with the verification process.

  • Seniors automatically qualify: There's a common misconception that senior citizens automatically qualify for the Reduced Fare Program for persons with disabilities. In reality, age alone does not qualify an individual for this specific program. Senior citizens can enroll through the Senior Citizen Program, which is separate. Eligibility for the Reduced Fare Program for persons with disabilities is based on the impact of a disability on the individual's ability to use mass transportation effectively.

Understanding these misconceptions can help applicants navigate the process more effectively and leverage the benefits designed to assist them. For any assistance or clarification, reaching out directly to the NJ Transit Reduced Fare Office is advisable.

Key takeaways

  • Applicants must fill out the section labeled "To be completed by Applicant" before a licensed physician or nurse practitioner can provide certification for the NJ Transit Reduced Fare Program.
  • Eligible applicants are informed that they will receive their Reduced Fare ID Card via mail approximately four weeks after the application has been submitted by the physician.
  • Participating banks, savings and loan associations, and authorized state and county agencies distribute a booklet of Reduced Fare Tickets.
  • In the "Physician Certification" section, the physician must complete all items and mail the form directly to the NJ TRANSIT Reduced Fare Program office.
  • The applications specify a need for detailed description under "Ambulatory Disabled" to ensure eligibility is accurately determined based on the nature of the impairment or disability.
  • Eligibility for the program is strictly based on criteria set by the law, encompassing a range of permanent or temporary disabilities that impair mobility or effective use of mass transportation.
  • Certain conditions, including pregnancy, obesity, acute or chronic alcoholism or drug addiction, and contagious diseases, do not qualify as disabilities for the discounted fare program.
  • NJ TRANSIT reserves the right to verify certification forms, which are kept confidential and on file for the duration of the eligibility period.
  • The application includes a Disability Information Release Authorization, which allows NJ Transit to obtain necessary medical information to assess eligibility for the program.
  • There is a provision for the renewal and replacement of the Reduced Fare ID Card, indicating the necessity for current eligibility status.
  • Fees associated with the completion of the certification forms are the applicant's responsibility, not NJ TRANSIT’s.
  • For assistance with the application process, NJ Transit Reduced Fare Office provides a contact number available Monday through Friday, 8:00 AM - 4:00 PM.
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