Transcription of APPLICATION REDUCED TRANSIT FARE IDENTIFICATION …
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APPLICATION REDUCED TRANSIT FARE IDENTIFICATION …
PART I - TO BE COMPLETED BY APPLICANT (Please print or type)PART II - TO BE COMPLETED BY PHYSICIAN OR AUTHORIZED AGENCY (Please print or type)MT-301 (5-18) APPLICATION REDUCED TRANSIT FARE IDENTIFICATIONCARD REDUCED TRANSIT FARE PROGRAM for persons WITH certify that the above named individual qualifies for a disability REDUCED Fare TRANSIT IDENTIFICATION Card because: (please check as manyreasons as are applicable. For further explanation please see reverse side)._____ (1) The person possesses a Medicare Card and is under 65 years of (2) The person cannot negotiate a flight of stairs or escalator with ease, reasonable speed, and/or without aid from another (3) The person cannot board or leave a TRANSIT vehicle with ease, reasonable speed, and/or without aid from another (4) The person cannot stand without major support in a moving vehicle operating under normal acceleration and (5) Due to uncorrectable visual impairment the person cannot read TRANSIT vehicle identifications or identify TRANSIT (6) Due to uncorrectable hearing impairment, the person cannot hear verbal announcements or TRANSIT information through
DEFINITION OF FUNCTIONAL IMPAIRMENTS FOR REDUCED TRANSIT FARE PROGRAM FOR PERSONS WITH DISABILITIES This Program is required by Section 5 of the Urban Mass Transportation Act of 1964, as Amended
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