New York City riders with a qualifying disability use this MTA application to get reduced fares on subways and buses. A clinician sees it when a patient without Medicare or SSI-based eligibility needs Section 2, the disability certification, or when a patient with serious mental illness on SSI needs the separate mental health certification. The applicant mails it to the MTA or brings it in person.
A physician or other licensed health care provider (the Certifier) completes Section 2; for the serious mental illness pathway, a psychiatrist or other licensed mental health professional completes the certification in Section 1B. The applicant completes Section 1, signs the affirmation, and signs Section 3, the authorization to disclose health information, giving a copy to the Certifier.
The applicant enters name, mailing address, phone, date of birth and email, and attaches a passport-type photo (1.5 by 2 inches) with their name written on the back. The application must be completed in English, typed or printed in ink. A copy of valid photo ID, such as a driver's license, passport, IDNYC or state ID, goes with it.
The applicant, or a personal representative, signs under penalty of perjury that their statements and those made to any Certifier are true and complete. A personal representative also prints their name, address, phone and relationship to the applicant. The affirmation acknowledges that the MTA relies on the Certifier's statements and may investigate them.
The applicant checks the basis for the claim: Medicare for reasons other than age (attach the Medicare card), SSI with a serious mental illness, or one or more disabilities: deafness or hearing loss, blindness, ambulatory, cognitive or other physical disability. Applicants in the last group without Medicare or SSI need Section 2 and Section 3.
A psychiatrist or other licensed mental health professional gives name, office address, state professional license number and phone, then certifies that the applicant meets criteria for a DSM diagnosis other than alcohol or drug disorders, developmental disabilities, dementia or medical-cause mental disorders, or V-codes, with substantial dysfunction or dependence on treatment and impairment of extended duration. The DSM diagnosis must be written in.
The physician or licensed provider enters name, office address, telephone, best time of day to call and state professional license number. The MTA uses these details to verify the certification, which the applicant authorizes in Section 3. The same Certifier's name, affiliation, address and phone also appear in that Section 3 authorization.
The Certifier states they examined the applicant and signed the back of the attached photograph, then checks each category that applies. Blindness and deafness have measured thresholds; hearing loss means aided hearing not restored past a 90 dB average at 500, 1,000 and 2,000 Hz or speech discrimination of 40% or less in each ear. Ambulatory disability means needing a mobility aid, with the device circled. Cognitive and other physical disability mean the applicant cannot use the system without special or extra planning.
Part C asks for a diagnosis for each box checked in Part B. Part D records the expected duration: permanent, meaning more than 12 months, or temporary, meaning more than 3 but fewer than 12 months, with the number of months specified. The Certifier then signs and dates Section 2.
The applicant authorizes the named Certifier to complete Section 2, send it to the MTA and discuss it with the Reduced-Fare Program if contacted. The authorization lasts until the rider's benefits end and can be revoked in writing. The Certifier's name, affiliation, address and phone are entered, and a copy goes to the Certifier.
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Application for MTA Reduced-Fare Program for People with Disabilities
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Section 2 is completed by a physician or other licensed health care provider, who gives a state professional license number and the best time to call. The serious mental illness certification must come from a psychiatrist or other licensed mental health professional. Through Section 3, the applicant authorizes the Certifier to discuss the information with the MTA.
No. The application states that it must be completed in English, typed or printed in ink. The MTA publishes it as an English form, so the Certifier's diagnosis and other entries in Section 2 should also be in English.
An applicant receiving SSI with a serious mental illness checks that box in Section 1B and attaches an SSA Notice of Entitlement letter dated within two months of applying. A psychiatrist or licensed mental health professional certifies a qualifying DSM diagnosis, excluding alcohol or drug disorders, developmental disabilities, dementia and V-codes. Eligibility lasts only while the applicant receives SSI.
The MTA may ask riders to recertify four years after the benefit is issued. A temporary disability is certified for more than 3 but fewer than 12 months, with the months specified. Eligibility ends automatically if the rider is no longer disabled as described in the application.