The SPECIAL TRANSPORTATION SERVICE (STS) APPLICATION FORM is a critical document for individuals seeking eligibility for complementary paratransit services under the Americans with Disabilities Act (ADA) of 1990. This extensive form gathers comprehensive personal, medical, and emergency contact information to assess the applicant's need for specialized transportation services within Miami-Dade Transit. If you or someone you know requires these specialized transit services, ensure to fill out this form accurately by clicking the button below.
The Special Transportation Service (STS) Application Form is a comprehensive document designed to assess the eligibility of individuals for the Special Transportation Service in accordance with the Americans with Disabilities Act (ADA) of 1990. This form is meticulously structured to gather detailed information about the applicant including personal information, emergency contacts, and the specific nature of the applicant's disability. A significant portion of the application is dedicated to medical verification, which requires completion by a licensed Florida physician, to ensure that the applicants meet the ADA eligibility criteria for paratransit services. This evaluation considers the applicant's functional ability to use conventional public transport systems like buses, rails, or movers and includes checks for mobility, neurological, visual, and cognitive impairments, among others. Importantly, the form also enquires about the type of assistance or transportation aids the applicant may require, stressing the need for medical documentation to support the application. The applicant's consent for release of medical information for the purpose of eligibility determination underlines the confidentiality with which the information is handled, reflecting a process that is both thorough and sensitive to the needs and rights of individuals with disabilities.
DEPARTMENT OF TRANSPORTATION AND PUBLIC WORKS (DTPW)
Para información en Español llame al (786) 469-5000
Pou enfòmasyon an Creole rele (786) 469-5000
Dear Applicant:
This package was prepared and sent to you in response to your request to apply for the Miami-Dade Department of Transportation and Public Works (DTPW), Paratransit Administration Division, Special Transportation Service (STS). A copy of the application form is enclosed for your convenience. Please read the enclosed material carefully before attempting to complete the application. Information about your disability provided in this application will be kept strictly confidential.
Copies of this form are available in accessible formats upon request. If you have questions or need assistance completing this form, please contact our Paratransit Customer Service Office at: (786) 469-5000 or e-mail us at: paratransit@miamidade.gov
***Florida Relay Service (TTY) - 1(800) 955-8771 or 711***
Pursuant to the Americans with Disabilities Act (ADA) of 1990, Paratransit Service Provisions, STS provides shared-ride transportation service for people with disabilities who are unable to use Metrobus, Metrorail, or Metromover independently. This might include not being able to get to or from bus stops, not being able to board or disembark the bus, or not being able to understand (due to a cognitive or development disability) how to ride and use fixed route services.
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STS Application - revised 08/2022
To evaluate your eligibility for this service, please complete the application form and be as thorough as possible. It is important that all sections of the application are completed. If any sections are left blank, the form will not be accepted.
The DTPW goal is to continue to provide reliable and accessible transportation. All Miami-Dade County buses have lifts, ramps, and the ability to lower their front end, easing access to the inside of the bus. Bus operators announce transfer points, designated points of interest, and route numbers. Priority seating for people with disabilities and the elderly is provided at the front of every bus. All Metrorail and Metromover stations are equipped with escalators and elevators, both of these services also provide priority seating. DTPW provides additional free and reduced fare services to the public including reduced fare permits, monthly and discount passes, golden and patriot passports.
Choose one of the following to send the completed STS
application
•Fax: 786-469-5033
•Email: paratransit@miamidade.gov
•US Mail: 701 NW 1st Court, Suite 131
•Miami, Florida 33136.
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STS Application - revised 8/2022
INSTRUCTIONS:
The applicant or an assistant must complete Parts I and II of the application. A Florida licensed-physician must complete and sign the
MEDICAL VERIFICATION - PART III.
You may Choose one of the following to send the completed STS application
It is recommended that you obtain from your medical representative objective medical documentation, which can substantiate your medical condition(s) and provide insight regarding your functional abilities or limitations when using the fixed route transportation system. If medical documentation is not attached to the application, we may request further documentation from your medical representative before a determination is made.
The STS Certification Unit will provide a determination within 21 days by mail. If you have not heard from us within 21 days, please call our Customer Service Office at 786-469-5000. Additional medical documentation may be required to determine eligibility.
All questions must be answered. Incomplete and/or unsigned application will not be accepted and may cause a delay in your eligibility determination.
MEDICAL VERIFICATION: (to be completed by a Florida licensed physician)
The ADA requires all public entities operating fixed-route transportation service for the general public to also provide complementary Paratransit service to persons unable to use the fixed-route system independently. The DTPW provides complementary Paratransit shared-ride service to individuals certified as per ADA Paratransit eligible. The applicant who has asked you to review and sign this form is applying to the DTPW to be considered eligible for Paratransit service. This application form will assist the DTPW to evaluate when and under what circumstances the applicant can use Metrobus, Metrorail, or Metromover service independently and when the applicant requires Paratransit service. STS
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shared ride is intended only for those trips that the person cannot make on the Metrobus/Metrorail/Metromover system.
ADA GUIDELINES:
Applicants shall be individually evaluated, and eligibility shall be based on a functional ability to use conventional public transportation: Metrobus, Metrorail, and Metromover. Functional inability to use public transportation includes the ADA guidelines described below:
1.The individual is unable, as a result of a physical or mental impairment (including a vision impairment), and without the assistance of another individual, (except the operator of a wheelchair lift or other boarding device), to board, ride, or disembark from an accessible bus or rail vehicle.
2.The individual needs the assistance of a wheelchair lift or other boarding assistance device and is able, with such assistance, to board, ride, and disembark from accessible transit vehicles.
3.The individual has a specific impairment-related condition which prevents the individual from traveling to or from: Metrobus; Metrorail; and/or Metromover stops/stations.
MEDICAL REPRESENTATIVE:
In order to process this applicant’s request to become a qualified STS rider, we require that the medical verification section of this form be completed and signed to expedite applicant STS determination. Please attach objective medical findings, which substantiate the disability(ies). Examples include:
Electroencephalogram (EEG) or Neuropsychological Evaluation with FSIQ, Snellen (visual acuity) and/or Perimeter Chart (field of vision) Report(s), Elisa Western Blot result reading CD4 + counts,
X-ray, MRI, or CAT scan Findings,
Respiratory FVC/FEV1
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SPECIAL TRANSPORTATION SERVICE (STS)
APPLICATION FORM
l. APPLICANT SECTION:
S.S.# (9 digits) ____-____-____ Date of Birth: ____/____/____ Sex: [ ] Male [ ] Female Receiving Medicaid: ( ) Yes ( ) No As of date: __________ Medicaid. #: ____-____-____
Last Name: _____________________ First Name: _____________________ M.I.: ____
Street Address: _________________ Apt. #: __ City: ____ State: ___ Zip Code: ______
Home Phone: ( ) _____________________ Email address: ____________________
EMERGENCY CONTACT:
Name: ____________________ Relationship: _____________ Phone: ( ) _________
If someone assisted the client to complete this form:
Name: ___________________ Relationship: _________ Phone: (
) _____________
ETHNICITY: (for statistics only, optional)
[ ] White Non-Hispanic [ ] Black Non-Hispanic [ ] Hispanic [ ] other (specify): __________
_________
Print Name: ___________________________ Relationship to applicant: ____________
III.MEDICAL VERIFICATION: (to be completed by a Florida Licensed-Physician)
***Please provide detailed medical evidence of disability(ies)***
A. Please describe the type and nature of the applicant’s disability(ies) or impairment- related condition(s) (Please be as specific as possible). __________________________
______________________________________________________________________
B. Is this disability or impairment-related condition moderate to severe? [ ] Yes [ ] No
C. Is this disability: [ ] Permanent
[ ] Temporary
If temporary, please provide dates: From: _____________ To: _____________
D. Is this applicant receiving: [ ] Radiation/Chemo
[
] Dialysis
treatment schedule or duration: ___________
From: ________ To: _________
E. Is this disability(ies) controlled by medication? [
] Yes [ ] No
Explain: _______________________________________________________________
F. According to your diagnosis and medical opinion can the applicant do any of the following?
Use the Bus system independently
] Yes [
] No
Walk to the bus stop
] Yes
Wait for the bus
Board the bus with assistance of a ramp or kneeling bus
See bus signs, stops and traffic signs
Understand how to use bus (fare, orientation in the system)
Transferring from one bus route to another or to Metrorail/Metromover
What other limitation can you identify that would prevent the applicant from using public transportation? __________________________________________________________
G.
Mobility Aid:
] Wheelchair [ ] Walker
] Crutches
] Braces
] Service Animal
] Cane
] None
[ ] Other: __________________
If Wheelchair user type: [ ] Manual
[ ] Motorized
[ ] Scooter (Three wheeled)
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H. Indicate the type of transportation required by the applicant, based on his/her functional ability:
[ ] Ambulatory (sedan/van with steps) [ ] Wheelchair (van with a lift)
J. Based on the applicant’s disability, do you recommend him/her to bring a Personal
Care Attendance (PCA) on each trip?
[ ] Yes
[ ] No
It is The DTPW policy to ensure compliance with the Health Insurance Portability and Accountability Act - 45CFR Parts 160 and 164 (HIPAA) Privacy Rule by obtaining authorization, as appropriate, from clients whose Protected Health Information (PHI) is used or disclosed for any purpose not otherwise permitted by Federal Medicaid Rules or/and the Privacy Rule.
NOTE: Failure to attach documentation will delay the eligibility determination process and will require DTPW to contact your office to obtain pertinent documentation before rendering a decision.
Please attach pertinent medical documentation (e.g., evaluations, test results, notes, reports, etc.) that would help to explain the diagnosis or limitations on the applicant’s ability to use Metrobus, Metrorail, or Metromover independently.
In signing, I acknowledge that, to the best of my knowledge, the information in this evaluation form is true and correct. Furthermore, I certify that, I have attached objective medical tests/documentation which substantiates the above statement. I understand that providing false or misleading information could result in the re-examination of the eligibility status of the applicant as well as prosecution to the maximum extent allowed by the laws of the State of Florida.
[ ] Yes, I have attached the required medical documentation.
_________________________________
___________
_______________________
Print name / Signature of Physician
Date
State of Florida License #
________________________________________ (___)__________ (___)_________
Office Address City State Zip Code
Telephone #:
Fax #:
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Before diving into the steps needed to fill out the Special Transportation Service (STS) Application Form, it’s essential to understand what happens after the form is completed. Once you've filled out this form accurately and included all necessary documentation, your application will undergo a review process to determine eligibility for Miami-Dade Transit Agency’s STS. Remember, the details provided, especially in the medical verification section, play a critical role in this determination. The aim is to ensure that this program serves those who truly need special transportation due to disabilities. It's crucial to double-check all the information for accuracy and completeness to avoid delays in processing. The guidelines below are designed to help you navigate the form smoothly.
For the Medical Verification Section, which must be completed by a licensed Florida physician:
It's essential to remind that you should NOT mail in your completed application. Follow the specific submission instructions provided by the Miami-Dade Transit Agency, which may require you to submit the form in person or through another specified method.
What is the Special Transportation Service (STS) Application for?
The Special Transportation Service (STS) Application is designed for individuals seeking eligibility to use Miami-Dade Transit Agency's STS, a complementary paratransit shared-ride service. This service is offered in compliance with the American with Disabilities Act (ADA) of 1990, catering to those unable to utilize standard bus, rail, or mover services due to physical or mental disabilities. The application process aims to assess the applicant's functional abilities and determine the necessity for specialized transportation based on their specific conditions.
Who needs to complete the Medical Verification section, and what information is required?
A Florida licensed physician must complete the Medical Verification section. This segment requires the physician to elucidate the applicant's disability or disabilities that impede their ability to use conventional public transportation. It includes checking relevant ADA eligibility categories, detailing the nature and type of the disability, and specifying any mobility aids the applicant uses. Physicians are also asked to recommend whether the individual should be accompanied by a personal care attendant during their travels. Importantly, attaching objective medical documentation such as test results or evaluations that substantiate the disability is crucial for processing the application efficiently.
Can applicants specify a preferred format for receiving information?
Yes, applicants have the option to request information in a format accessible to them. The form includes a section where one can select from various formats such as Braille, Large Print, Audio, or Computer Disk (ASCII). This ensures that all individuals, regardless of their disability, can access and understand the information pertinent to the STS program and their application.
What happens if the information provided in the application is not accurate?
The application contains a stern warning that supplying false or misleading information can lead to serious consequences. If inaccuracies are discovered, the applicant's eligibility status may be re-examined, and they could face prosecution to the full extent permitted by Florida law. This clause underscores the importance of honesty and accuracy in disclosing one's medical condition and functional abilities.
Why is it advised not to mail the completed application?
The instructions explicitly advise against mailing the completed application. This likely aims to ensure that the application is processed efficiently and correctly by preventing it from getting lost or delayed in the mail. Applicants might be instructed to submit their forms through other, more direct methods, such as in-person submission or through a secure electronic submission process, to facilitate a timely review and determination of eligibility.
Filling out the Special Transportation Service (STS) Application Form requires careful attention to detail to avoid common mistakes that can delay or affect the approval process. One prevalent error is incompletely filling out the applicant section. Every field, from the Social Security Number to the detailed wheelchair specifications if applicable, must be thoroughly completed. Neglecting to fill in sections such as the applicant's weight or omitting details about the wheelchair dimensions can lead to delays in processing the application.
Another frequent oversight is failing to provide accurate and detailed emergency contact information. It's not enough to simply list a name and phone number; the relationship to the applicant is also crucial. This information is vital in case of an emergency and can be pivotal in ensuring the applicant's safety and well-being.
Mistake number three involves the ethnicity section, which is optional but important for statistical purposes. Some applicants skip this section, not realizing that such data helps in planning and improving the STS service for diverse communities. Providing this information contributes to a better understanding of the service's demographics.
Incorrectly answering questions related to the applicant's ability to transfer from a wheelchair to a sedan is another common error. This is not a trivial detail but a critical factor in determining the type of special transportation service needed. Misrepresenting or incorrectly filling this part out can result in being assigned an unsuitable transportation service, leading to inconvenient or unsafe situations.
Assistance in filling out the form is often required, yet many fail to properly document this in the specified section. Acknowledging who helped fill out the form, their relationship to the applicant, and providing their contact information is not just a bureaucratic requirement. It ensures there's a clear line of communication in case any part of the application needs clarification. Leaving this section blank or incomplete can hinder the application's processing.
Lastly, one of the most critical mistakes is not properly attaching or detailing medical verification. The application form demands an attachment of a medical representative's letterhead or a prescription form, alongside detailed medical documentation that substantiates the disability. Skimming over this section or providing insufficient documentation can significantly delay the eligibility determination process. This documentation is the foundation for justifying the need for STS services, and any ambiguity or lack of clarity can be detrimental to the applicant's case.
When submitting a Special Transportation Service (STS) Application Form, applicants often need to include additional documentation to support their request for services. These documents are crucial for providing a comprehensive view of the applicant's needs and ensure a smooth evaluation process. Understanding each document's purpose can help applicants gather the necessary information before submission.
Incorporating these documents with the STS Application Form creates a robust application package, providing the review committee with a thorough understanding of the applicant's situation. Proper and complete documentation facilitates a smoother evaluation process, enabling quicker determinations of eligibility for the crucial transportation services offered.
The Special Transportation Service (STS) Application Form shares similarities with the Disability Parking Permit Application commonly used by state motor vehicle departments. Both require detailed personal information, medical documentation, and a section for medical practitioner verification to establish the applicant's need for special accommodation. Whereas the STS form focuses on eligibility for transportation services, the Disability Parking Permit Application emphasizes the need for close parking access due to mobility or health issues. Both applications serve to ensure that individuals with disabilities receive necessary accommodations under the law, showcasing a tailored approach to meet their specific needs.
Another document analogous to the STS Application Form is the Medicaid Transportation Assistance Application. This form also collects detailed personal and medical information but is geared towards qualifying individuals for medical transportation benefits under Medicaid. Like the STS form, it may require a healthcare professional's certification to establish the necessity of specialized transportation due to health conditions. Both forms facilitate access to essential services, underscoring a systemic effort to support those with mobility challenges or health conditions that impact their use of standard transportation options.
The Vocational Rehabilitation Transportation Service Application bears resemblance to the STS Application Form. It is designed for individuals with disabilities seeking employment or training opportunities, requiring personal, medical, and emergency contact information alongside a professional's verification of the need for specialized transportation. While the STS application addresses general transportation needs under ADA requirements, the Vocational Rehabilitation application is more focused on enabling participation in employment-related activities, highlighting the broader spectrum of services aimed at fostering independence and inclusion for individuals with disabilities.
Similarly, the Paratransit Eligibility Application, often used by public transportation systems, mirrors the STS Application Form in its purpose and content. Both solicit detailed applicant information, including medical conditions that restrict the use of standard public transit options, and require a certification by a healthcare provider. These applications are integral to determining individuals’ eligibility for adapted transportation services, ensuring that those who cannot use conventional public transportation due to a disability have access to necessary mobility services.
The Application for Reduced Fare Program for People with Disabilities is another document similar to the STS Application Form. Aimed at providing discounted travel rates for public transportation, this application gathers detailed personal and disability-related information, necessitating medical verification, much like the STS form. Both forms are key to facilitating affordable access to transportation services for individuals with disabilities, affirming their right to mobility and participation in communal life.
Lastly, the Section 504 Accommodation Request Form, used within educational institutions and workplaces, parallels the STS Application Form in its fundamental aim to accommodate individuals with disabilities. Though the 504 Form is broader, encompassing a wide range of accommodations (not solely transportation), it similarly requires detailed documentation of the disability and how it affects the individual’s ability to participate in educational or work activities. Both forms are vital components of ensuring compliance with disability rights laws, promoting equal opportunities and access for all individuals regardless of their physical capabilities.
When filling out the Special Transportation Service (STS) Application Form, it is important to understand the do’s and don’ts to ensure your application is accurate and properly processed. Here’s a list to guide you through:
When considering the Special Transportation Service (STS) application form, a number of misunderstandings frequently arise among applicants. These misconceptions can lead to confusion about the application process, requirements, and the service itself. Below are six common misconceptions and explanations to clarify each point:
Understanding these misconceptions is crucial for a smooth application process to the Special Transportation Service (STS), ensuring that all applicants submit their forms correctly, with the necessary documentation, and through the proper channels.
Filling out the Special Transportation Service (STS) Application Form requires careful attention to detail and accuracy. Here are six key takeaways for individuals looking to apply for this vital service:
Understanding and adhering to these key points ensures a smoother application process for those seeking STS services, which play a vital role in providing accessible transportation options for individuals with disabilities.
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