LOS SANTOS CITY GOVERNMENT
DEPARTMENT OF HEALTH AND WELFARE
CARCER WAY 1, ROCKFORD HILLS, LOS SANTOS, SA
Handicap Identification Permit Application
Any person who requires the use of a handicapped parking space in the City of Los Santos, must apply for and hold a valid Handicap Identification Permit, as stipulated in the Handicap Identification of Vehicles Act of 2021 (YULIA ACT).
There are 2 types of Handicap Identification Permits issued by the Los Santos Department of Health and Welfare (DHW):
- individual – issued for 5 years if you have permanent disability
- temporary – issued for a minimum of one month and up to 6 months if you have a temporary disability.
To be eligible, you need to have mobility disability, which is defined by legislation as someone:- Persons requiring the use of portable oxygen;
- Persons with limited use, or no use, of one or both legs;
- Persons with the inability to walk 200 feet without stopping;
- Persons with neuro-muscular dysfunction that severely limits mobility;
- Persons with Class III or IV cardiac condition (by standards of the American Heart Association);
- Persons with severe limitation in the ability to walk due to an arthritic, neurological or orthopedic condition(s);
- Persons with restriction(s) because of lung disease to such an extent that forced (respiratory) expiratory volume for one second, when measured by spirometry, is less than one liter, or the arterial oxygen tension is less than sixty mm/hg of room air at rest;
- Persons with any other physical or mental impairment not previously listed which constitutes an equal degree of disability, and imposes unusual hardship in the use of public transportation and prevents the person from getting around without great difficulty.
Application Form
Please find enclosed the application form for a Handicap Identification Form. Please fill this in, in consultation with your medical practioner. Once the form has been filled in, you may submit the form here.
Please title your application "[HIP Application] Firstname Lastname".
After submission, please revisit our website and check to see if your application requires any amendments or has been approved and your HIP issued.
Please find enclosed the application form for a Handicap Identification Form. Please fill this in, in consultation with your medical practioner. Once the form has been filled in, you may submit the form here.
Please title your application "[HIP Application] Firstname Lastname".
After submission, please revisit our website and check to see if your application requires any amendments or has been approved and your HIP issued.
Form Code
Code: Select all
[divbox=white][color=#5597D0][right][u][size=80]DEPARTMENT OF HEALTH AND WELFARE
LOS SANTOS CITY GOVERNMENT
CARCER WAY 1, ROCKFORD HILLS, LOS SANTOS, SA[/size][/u][/right][/color][hr][/hr]
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[center][img]https://i.imgur.com/lgEdGOy.png[/img][/center]
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[center][color=#535a6c][size=200][b]LOS SANTOS CITY GOVERNMENT[/b][/size][/color]
[hr][/hr][size=140][b][color=#5597D0]HANDICAP INDENTIFICATION PERMIT REQUEST[/color][/b][/size][/center][hr][/hr]
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[justify][center]This form is used to request a Handicap Identification Permit. [/center]
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[b]Name:[/b] Answer
[b]Residential Address: [/b] Answer
[b]Phone Number: [/b] Answer
[b]Email Address: [/b] Answer
[b]Vehicle Make and Model: [/b] Answer
[b]License Plate Number: [/b] Answer
[b]Type of Disability: [/b] Temporary / Permanent (delete as necessary)
[b]Medical diagnosis: [/b] Answer
[b]Diagnosing Doctor & Affiliation: [/b] Answer (ex. Dr. Jane Smith, Pillbox Hill Medical Center)
[b]Additional Information (if any): [/b] Answer
[b]Signature: [/b] Answer
[b]Date:[/b] Answer[/divbox]