Get Recertification Application - Palm Beach County Home

Filling out the RECERTIFICATION APPLICATION for Palm Beach County Home online is a straightforward process designed to help you maintain eligibility for essential paratransit services. This guide will walk you through each step, ensuring that you can complete the application accurately and efficiently.

Follow the steps to complete your application with ease.

1. Use the ‘Get Form’ button to obtain the RECERTIFICATION APPLICATION and open the form in your preferred editor.
2. Begin with Part 1: General Information. Fill in your last name, first name, street address, middle initial, apartment number, building number, city, state, telephone number, zip code, date of birth, and email address. Also, provide emergency contact details, including their name, relationship, address, and phone number.
3. Proceed to Part 2: Applicant Certification. Read the certification statement thoroughly and then sign and date the application. If someone assisted you in completing the form, provide their name and phone number.
4. In Part 3: Disability Verification, check all applicable types of disabilities that prevent you from using Palm Tran buses. Provide additional details regarding your disability and any mobility aids or equipment you use.
5. Indicate whether you require assistance from a Personal Care Attendant, and specify if your disability is temporary or permanent. If it is temporary, include the estimated duration.
6. Complete the Medical Verification section, which requires your physician to validate your disability. Ensure that all necessary medical documentation is attached.
7. Once you have filled out all sections thoroughly, review your application for accuracy. You can then save the changes, download, print, or share the completed form as needed.

Complete your RECERTIFICATION APPLICATION online today to ensure continued access to vital transportation services.