People with a qualifying disability use this application to get a permanent, temporary or travel disabled person parking placard, or DP license plates, from the California DMV. A licensed medical provider certifies the qualifying condition on page 3 under penalty of perjury. DMV may compare the provider's signature with licensing records, may contact the provider, and returns illegible, incomplete or unsigned forms.
The applicant completes Sections 1 to 4. The medical provider completes Sections 5, 6 and 6A: physicians, surgeons, PAs, NPs and certified nurse-midwives may certify items 2 to 8, chiropractors items 6 to 8, podiatrists foot or ankle conditions, and eye-specialist physicians or optometrists item 1 only.
The applicant enters true full name, date of birth, physical and mailing address, county, phone and driver license or ID card number. A copy of proof of legal name and birthdate, such as a valid driver license or ID card, must be enclosed or DMV rejects the application. Organizations that transport disabled persons apply under the organization's name.
The applicant checks a permanent, temporary or travel placard, DP plates, or reassignment of existing plates, and says whether California has issued DP plates, disabled veteran plates or a permanent placard before. A prior holder does not need a new doctor's certification unless DMV cancelled the record, it is no longer on file, or four replacement permanent placards were issued in one 2-year renewal period.
The applicant certifies under penalty of perjury that they are a disabled person under CVC §295.5, or an authorized representative of an organization transporting disabled persons, and that they have read and accept the rules for using the placard or plates. DMV accepts only original signatures, not photocopies or faxes, and any alteration, cross-out or white-out voids the form.
Print your name (last, first, middle), medical license number, office address and daytime phone number. DMV may compare your signature with documentation filed with your licensing agency and may contact you about the application, so the license number and phone number need to be current and legible. Page 2 carries this section, and DMV cannot process the application without both pages 2 and 3.
Print the patient's name and check permanent placard or plates, temporary placard with an end date no more than six months away, or travel placard (up to 30 days for a California resident, 90 for a nonresident). Then check the qualifying item: 1 for vision criteria, 2 for cardiovascular disease at AHA class III or IV, 3 for lung disease by the FEV1 or pO2 thresholds, or 4 to 8 for mobility, assistive devices, lower extremities or both hands.
For any of items 4 to 8, write a full, legible diagnosis with enough detail to meet state certification requirements. The form's acceptable examples include Parkinson's Disease, arthritis of ankle and foot, congestive heart failure, and diabetes mellitus with peripheral vascular disease. Symptoms such as trouble walking, back pain or weakness, or a bare code like R60.9, need further explanation, and forms with incomplete or illegible information are returned.
Check your license type: physician, surgeon, physician assistant, nurse practitioner, certified nurse-midwife, chiropractor, podiatrist or optometrist. Then sign, print or stamp your name, and date. You certify under penalty of perjury that Sections 5, 6 and 6A are true, and you agree to keep information that substantiates the certification and make it available to your licensing agency at DMV's request.
Download the current version from the source each time; forms change without notice.
Application for Disabled Person Placard or Plates
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
A licensed physician, surgeon, physician assistant, nurse practitioner or certified nurse-midwife may certify items 2 to 8. A chiropractor may certify items 6 to 8 only, a podiatrist only a disability of the foot or ankle, and an ophthalmologist or optometrist only item 1, the vision criteria.
Not on its own. For items 4 to 8, Section 6A needs a full, legible description of the illness or disability, not symptoms. DMV gives "Parkinson's Disease" or "diabetes mellitus with peripheral vascular disease" as acceptable, and "trouble walking", "back pain", "weakness" or a bare code such as R60.9 as unacceptable.
Up to 180 days or the end date the medical provider writes in Section 6, whichever is less; the certification box itself says the date cannot exceed six months. A temporary placard cannot be renewed more than six times consecutively, and it carries a DMV fee that permanent placards do not.
Usually not. Permanent placards renew automatically twice over four years, and the third renewal is a reapplication without new certification. A prior permanent placard or plate holder also needs no new certification unless DMV cancelled it, it is no longer on record, or four replacement placards were issued in one 2-year renewal period.