Cheyenne Transit ADA Paratransit Eligibility Application
This file includes the application and instructions for Cheyenne Transit's ADA Paratransit service. It details the eligibility criteria and provides guidelines on how to complete the form. The document must be filled out in full and submitted to determine eligibility for Paratransit service.
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How do I fill this out?
To fill out this form, carefully read the enclosed materials before beginning. Ensure all fields are completed in full and provide the necessary personal and medical information. Don't forget to have your licensed health care professional complete the Professional Verification section.
How to fill out the Cheyenne Transit ADA Paratransit Eligibility Application?
1
Read the enclosed materials carefully before starting.
2
Complete all personal information fields in full.
3
Have a licensed health care professional complete the Professional Verification section.
4
Sign and date the application to certify the information provided.
5
Submit the completed application by mail or in the required format.
Who needs the Cheyenne Transit ADA Paratransit Eligibility Application?
1
Individuals with disabilities who are unable to use the fixed-route bus service need this application to qualify for Paratransit service.
2
Caregivers assisting disabled individuals may need to fill out this form on behalf of the applicant.
3
Healthcare professionals who need to complete the Professional Verification section for their patients.
4
Individuals who reside within 3/4 mile of a fixed route but are unable to travel due to a disability.
5
Applicants who wish to appeal their eligibility determination will need this form.
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1
Open the PDF in PrintFriendly's editor.
2
Fill out all required personal information fields accurately.
3
Have the Professional Verification section completed by a licensed health care professional.
4
Add your signature using the signature tool.
5
Save and download the completed document for submission.
What are the instructions for submitting this form?
Submit the completed form by mailing it to Cheyenne Transit Program, 322 W Lincolnway, Cheyenne, WY 82001. You can also fax it to 307-637-6251 or submit it online via the official website. Ensure all sections are complete and verified by a licensed health care professional before submission. For assistance, contact the office at 307-637-6253.
What are the important dates for this form in 2024 and 2025?
Eligibility determination within 21 calendar days. Recertification required every 3 years. Appeal within sixty days of the notification letter.
What is the purpose of this form?
The purpose of this form is to determine eligibility for Cheyenne Transit's ADA Paratransit service. It provides a comprehensive application that must be filled out by individuals with disabilities who cannot use the fixed-route bus service. This ensures that those who need assistance receive the necessary Paratransit services to aid their transportation needs.
Tell me about this form and its components and fields line-by-line.
- 1. Personal Information: Includes fields for the applicant's name, address, date of birth, and emergency contact details.
- 2. Format Preference: Allows the applicant to select their preferred format for information receipt, such as large print or audio tape.
- 3. Certification Section: This section is for the signature and certification by the person completing the form.
- 4. Professional Verification: Must be completed by a licensed health care professional to verify the applicant's disability.
What happens if I fail to submit this form?
If you fail to submit this form, you will not be able to access Cheyenne Transit's ADA Paratransit services.
- Loss of Service: The inability to use Paratransit services for your transportation needs.
- Delayed Assistance: Any required transportation assistance will be delayed until the form is properly submitted.
How do I know when to use this form?
- 1. New Application: When applying for Paratransit services for the first time.
- 2. Recertification: When your current eligibility period is nearing its end and requires renewal.
- 3. Appeal: If you need to appeal an eligibility determination.
- 4. Change in Condition: If there has been a significant change in your disability or condition affecting your use of fixed-route services.
- 5. Change of Address: If you have moved and need to update your address to ensure continued services.
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What information do I need to provide on the form?
You need to provide personal information, emergency contact details, and have the Professional Verification section completed.
What if my application is incomplete?
Incomplete applications will be returned once. If still incomplete the second time, it will be held for 60 days before being discarded.
How long does it take to determine eligibility?
A determination will be made within 21 calendar days of receiving a completed application.
Are there any fees for completing the certification forms?
Any fees charged for the completion of certification forms are not the responsibility of the Cheyenne Transit Program.
How long is eligibility valid?
Eligibility is valid for at least 90 calendar days and recertification is required every 3 years.
Can I appeal my eligibility determination?
Yes, you may appeal within sixty days of the notification letter.
What are the requirements for eligibility?
You must reside within 3/4 mile of the fixed route corridor and your trip must fall within the hours of the closest CTP bus route.
