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Application Instructions
Headandshouldercolorphoto
ofapplicant.Photomustfitinthe
1 inch
boxtotheright.A colorcopyof
x
applicantsstateIDordriver
licenseisacceptable
1.25inch
Diagnosisfromprofessionalon
.
theircompany letterheadora
copyofyourMedicareCardor
SocialSecurityDisabilityDetermination.
1. Completetheapplicantinformationsection.
2. IfyoualreadyhaveaMedicareCardorSocial
SecurityDisabilityDetermination,includeacopy
withtheapplication.
3. ForthosewithoutaMedicareCardorSocial
SecurityDisabilityDetermination,alicensedmedical
professionalmust completetheProfessional
Verificationsectionontheothersideofthisform.
SeeRequirementsSection.
4. Include the following in your mailing:
CompletedReducedFare IDApplication
Copyofapplicantsdriverlicense,stateIDor
otherpicture identificationverifyingdateofbirth
(Donotsendoriginal,itwillnotbereturned)
Self-AddressedStamped#10BusinessSizeEnvelope
5. Mail to:
DowntownTransitCenter
ReducedFareIDProgram
BuhlBuilding,535GriswoldStreet,Suite600
Detroit,MI48226
Applicant Information
Pleaseprintclearlythefollowinginformationusingapen.
Name
Address
CityorTownship
State
Zip
DateofBirth:(Required)
PhoneNumber
SignatureofApplicant
Pleaseallow5-10daysforapplicationprocessing.
Questionsaboutthisapplicationoreligibility?Call(313)223-2185.
OfficeUseOnly
NopictureID
Nomoney
( 866 ) 962-5515
Noreturnenvelope
Nocolorphoto
Professionallettermissing
___________________________________
smartbus.org
facebook.com/rideSMARTbus
Rev.1/8/16
2016
Professional Verification
Definition
Any disability that physically or cognitively limits mobility independence.
Eligibility
Professional verification is not required if applicant already possess a Medicare Card or Social
Security Disability Determination. (See Application Instructions on the other side.) If applicant
does not possess either of the above two documents, please check the appropriate disability
categories that applies:
Neurological disorder that interferes with
coordination, strength or endurance such as
polio, cerebral palsy, multiple sclerosis, paralysis
or frequent uncontrolled seizures and special
sensory disorders such as legal blindness or
50% bilateral loss of hearing.
Any disability of more than six months (180 days)
which requires the use of walkers, crutches,
wheelchairs or other mobility devices.
Requirements
In order to process the Reduced Fare ID application, the following MUST be included on the
professional office letterhead:
Notes:
1. An incomplete and/or fraudulant application will not be processed.
2. Submission of all required documents does not guarantee approval for the Reduced Fare Program.
3. ReplacementCards:
ReducedFare IDcardsmaybereplacedforafee,money orders ONLY. A$5.00administrativefeewillbeapplied
forthefirstreplacementcard.Foreachreplacementthereafter,anadditional$5.00feewillbeapplied
(i.e.$10.00,$15.00,$20.00,etc.)
2016 Suburban Mobility Authority for Regional Transportation