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The PS 15 Maine form serves a crucial role for individuals seeking an exemption from the seatbelt requirement due to medical conditions. This application, issued by the Maine Bureau of Motor Vehicles, is designed for both new applicants and those needing to reapply or replace their existing placard. It requires personal information, including the applicant’s name, address, and daytime phone number, alongside a physician's statement confirming the medical condition that necessitates the exemption. The form outlines the proper use of the removable windshield placard, which must be displayed in a manner that does not obstruct the driver's view. It's important to note that this placard has a limited validity, expiring when the physician's certificate expires, which cannot exceed one year. The physician must detail the specific medical condition and explain why wearing a seatbelt poses a risk for the patient. Clear instructions for submitting the form are provided, ensuring that applicants understand the process. This structured approach helps streamline the application process while ensuring that those in need receive the necessary accommodations.

Dos and Don'ts

When completing the Ps 15 Maine form, attention to detail is crucial. Here are some important dos and don’ts to consider:

  • Do ensure that all sections of the form are filled out completely. Missing information can delay processing.
  • Do provide accurate contact information. This includes your daytime phone number and address to facilitate communication.
  • Do have your physician fill out their section thoroughly. Their signature and details are essential for validation.
  • Don't forget to sign and date the applicant's statement. An unsigned form will not be accepted.
  • Don't use abbreviations or shorthand when filling out the form. Clarity is key to avoid misunderstandings.
  • Don't submit the form without reviewing it. Double-checking for errors can save time and prevent complications.

Key takeaways

Here are some key takeaways for filling out and using the PS 15 Maine form:

  • The PS 15 form is used to apply for a seat belt exemption in Maine.
  • Complete the application by selecting whether it is a new application, re-application, or replacement.
  • Provide accurate personal information, including your name, address, and daytime phone number.
  • The placard must be displayed correctly: hang it from the rearview mirror or place it on the dashboard if there is no rearview mirror.
  • The exemption placard is valid for one year, expiring when the physician's certificate expires.
  • A physician must confirm the medical condition justifying the seat belt exemption.
  • Ensure the physician includes their printed name, signature, and address on the form.
  • Submit the completed form to the Bureau of Motor Vehicles, Disability Section, at the specified address.
  • Keep a copy of the application for your records and to track the status of your request.

Instructions on Filling in Ps 15 Maine

Filling out the Ps 15 Maine form requires careful attention to detail. This form is essential for individuals seeking a seat belt exemption due to medical reasons. After completing the form, you will submit it to the Bureau of Motor Vehicles for processing. Below are the steps to guide you through filling out the form accurately.

  1. Choose the application type: Indicate whether this is a new application, re-application, or replacement by checking the appropriate box at the top of the form.
  2. Provide your personal information: Fill in your name, address, daytime phone number, and date of birth in the designated fields.
  3. Read the applicant’s statement: Understand the statement regarding the removable windshield placard and its proper display.
  4. Sign and date: Sign your name and enter the date in the applicant's signature section.
  5. Physician’s statement: Have your physician complete the section that describes your medical condition and the reason for the exemption. Ensure they specify the expiration date, which cannot exceed one year.
  6. Physician’s information: Your physician should print their name, sign, and date the form. They must also provide their address and license number.
  7. Review the form: Double-check all entries for accuracy and completeness before submission.
  8. Submit the form: Send the completed form to the Bureau of Motor Vehicles, Attn: Disability Section, at the provided address.

Learn More on This Form

  1. What is the purpose of the Ps 15 Maine form?

    The Ps 15 Maine form is an application for a seat belt exemption. It allows individuals with specific medical conditions to obtain a removable placard that exempts them from the requirement of wearing a seatbelt while operating or riding in a motor vehicle. This exemption is intended for those whose medical conditions make wearing a seatbelt a risk.

  2. Who is eligible to apply for a seat belt exemption using the Ps 15 form?

    Eligibility for the seat belt exemption requires a medical condition that justifies the need for an exemption. An applicant must have a physician complete the necessary section of the form, detailing the medical condition and the reasons why wearing a seatbelt poses a risk. The exemption is typically valid for one year, based on the physician's certification.

  3. How should the placard be displayed in the vehicle?

    The placard issued under the Ps 15 form must be displayed in a way that does not obstruct the driver's view. When the vehicle is in motion, the placard should hang from the rearview mirror. If the vehicle does not have a rearview mirror, the placard must be placed on the dashboard.

  4. What happens if the physician's certificate expires?

    The placard issued for the seat belt exemption will expire when the physician's certificate expires. This certificate cannot exceed one year. It is important for the applicant to renew the certificate and reapply for the placard if they continue to require the exemption after the expiration date.

  5. Where should the completed Ps 15 form be sent?

    Once the form is completed, it should be mailed to the Bureau of Motor Vehicles, specifically to the Disability Section. The address is 29 SHS, Augusta, ME 04333-0029. Additionally, applicants can contact the Bureau at 207-624-9000 ext 52149 for any inquiries or assistance regarding the application process.

File Attributes

Fact Name Description
Purpose The PS 15 Maine form is used to apply for a seat belt exemption for individuals with specific medical conditions.
Application Types Applicants can submit a new application, a re-application, or a request for a replacement placard.
Placard Display The issued placard must be hung from the rearview mirror or displayed on the dashboard if the vehicle lacks a rearview mirror.
Expiration The placard expires when the physician's certificate expires, which cannot exceed one year.
Physician's Role A physician must provide a statement confirming the medical condition that necessitates the exemption from wearing a seatbelt.
Governing Laws This form is governed by the laws of the State of Maine, specifically pertaining to motor vehicle regulations.
Contact Information For inquiries, applicants can contact the Bureau of Motor Vehicles at 207-624-9000 ext 52149.
Submission Details Completed forms should be mailed to the Bureau of Motor Vehicles, Attn: Disability Section, 29 SHS, Augusta, ME 04333-0029.
Signature Requirement Both the applicant and the physician must provide their signatures and dates on the form to validate the application.

Documents used along the form

The Ps 15 form in Maine is specifically designed for individuals seeking a seat belt exemption due to medical reasons. Alongside this application, several other forms and documents are often required to ensure a complete and accurate submission. Below is a list of additional documents that may be needed.

  • Physician's Certificate: This document must be completed by a licensed physician, confirming the medical condition that justifies the seat belt exemption. It typically outlines the patient's specific condition and the risks associated with wearing a seatbelt.
  • Proof of Residency: Applicants may need to provide documentation that verifies their residency in Maine. This can include utility bills, lease agreements, or any government-issued documents that display the applicant's name and address.
  • Identification: A valid form of identification, such as a driver's license or state ID, is often required to verify the identity of the applicant. This helps to prevent fraud and ensures that the exemption is granted to the correct individual.
  • Medical Records: In some cases, additional medical records may be requested to provide further evidence of the applicant's medical condition. These records should be relevant and support the claims made in the physician's certificate.
  • Application Fee: Depending on the local regulations, there may be a fee associated with processing the Ps 15 form. Applicants should check with the Bureau of Motor Vehicles for the current fee schedule and acceptable payment methods.
  • Employee Handbook Form: Understanding workplace policies is crucial; utilize the detailed New Jersey Employee Handbook resources to navigate your rights and responsibilities effectively.
  • Renewal Application: For individuals who have previously received a seat belt exemption, a renewal application may be necessary. This ensures that the exemption remains valid and that the applicant's medical condition is still applicable.
  • Authorization for Release of Information: This form allows the Bureau of Motor Vehicles to obtain necessary medical information from the applicant's healthcare provider. It ensures compliance with privacy regulations while facilitating the review process.
  • Vehicle Registration: Providing proof of vehicle registration may be required to confirm that the applicant is the owner of the vehicle for which the exemption is being requested.
  • Affidavit of Understanding: This document may be needed to affirm that the applicant understands the implications of the exemption and agrees to comply with the regulations surrounding its use.

Completing the Ps 15 form along with the necessary supporting documents is crucial for a successful application. Each document plays a significant role in establishing eligibility and ensuring compliance with Maine's regulations regarding seat belt exemptions.

Misconceptions

Understanding the Ps 15 Maine form can be crucial for those seeking a seat belt exemption. However, there are several misconceptions surrounding this application. Here are five common misunderstandings:

  • Misconception 1: The placard is permanent.
  • Many believe that once they receive the placard, it is theirs indefinitely. In reality, the placard must be renewed annually, as it expires when the physician's certificate expires.

  • Misconception 2: Any doctor can provide the necessary certification.
  • While a physician must complete the form, not all healthcare providers are authorized to issue the required medical certificate. It’s essential to consult with a qualified medical professional who understands the specifics of the exemption.

  • Misconception 3: The placard can be used in any vehicle.
  • Some people think the placard is universally applicable. However, it must be displayed in the vehicle of the individual to whom it is issued. Using it in another person’s vehicle may lead to complications.

  • Misconception 4: The application process is quick and straightforward.
  • While the form may seem simple, the process can take time. Applicants should allow for potential delays, especially if additional documentation or clarification is needed from the physician.

  • Misconception 5: The exemption applies to all situations.
  • Some individuals assume that the exemption allows them to forgo wearing a seatbelt in any scenario. However, the exemption is specific to their medical condition and must be justified by a physician's statement.

Document Preview

MAINE BUREAU OF MOTOR VEHICLES

APPLICATION FOR SEAT BELT EXEMPTION

___ New Application ___ Re-Application ___ Replacement

Applicant’s Name:________________________________________

Address: _______________________________________________

_______________________________________________

BMV Use Only

Placard #: ________________

Issue Date: _______________

Exp Date: ________________

Returned #: _______________

Replaced #: _______________

Issued By: ________________

Entered: __________________

Daytime Phone #: ______________________________ DOB: _____________

Applicant’s Statement of Understanding:

This removable windshield placard is designed to hang from the rearview mirror when the vehicle is in motion without obstructing the view of the operator. If the vehicle is not equipped with a rearview mirror, the placard must be displayed on the dashboard. A placard issued to a person expires when the physician's certificate expires which may not exceed one year.

Applicant’s Signature:_____________________________________________ Date: _________________

/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

Physician’s Statement:

This seatbelt exemption should expire on ___________________ (may not exceed one year).

This patient has a medical condition that warrants an exemption from the requirements of having to wear a seatbelt while riding in or operating a motor vehicle.

The patient’s specific condition is:

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Wearing a seatbelt is a risk for this patient because:

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Physician’s Printed Name: ____________________________________________________________________

Signature: ________________________________________________________________Date _____________

Physician’s Address: ________________________________________ License #: ______________________

__________________________________________________________ Phone #: ______________________________

PS-15 (09/09)

Phone: 207-624-9000 ext 52149

Fax: 207-624-9204

Mail to: Bureau of Motor Vehicles

Attn: Disability Section

29 SHS Augusta ME 04333-0029