Municipality of Anchorage

People Mover Half Fare Application

 Information & Eligibility

The Federal Transit Administration requires transit agencies receiving federal funding to offer a fixed route Half Fare program to seniors, people with disabilities and individuals with Medicare cards. People with disabilities for this purpose are defined by FTA as;

 “those individuals who, by reason of illness, injury, age, congenital malfunction, or other permanent or temporary incapacity or disability, including those who are non-ambulatory wheelchair-bound and those with semi-ambulatory capabilities, are unable without special facilities or special planning or design to utilize mass transportation facilities and services as effectively as persons who are not so affected.”

 Having a disability does not necessarily qualify an individual for the Half Fare Program.  Income is not a determining factor.  People Mover defines senior citizens as age 60 and over and Youth as ages 5-18. Excluded conditions to Half Fare eligibility include: pregnancy, obesity, acute or chronic alcoholism drug addiction, contagious diseases and temporary disabilities with a duration of less than 90 days.

 Seniors and youth may show government issued photo ID to verify age when boarding the bus. Individuals with Medicare cards may show card to driver as proof of eligibility.  All others need to complete the Half Fare application process to obtain a People Mover Half Fare ID card.  ID cards are valid from 6 months and up to 3 years.  Any fees charged for the completion of Certification Forms are not the responsibility of the Municipality of Anchorage or the Public Transportation Department. The Public Transportation Department reserves the right to verify certification forms.

 Applicant Instructions

 1.   Complete the Half Fare Application.   (Answer all questions. Disability alone does not qualify a person for a half fare.  Ability to pay a fare is not a determining factor.)

 2.   Submit to the Customer Service office at the Downtown Transit Center, 700 West 6th Avenue, #109, Anchorage, Alaska  99501

 3.   Bring photo identification and any required proof (see application) to Customer Service at the Downtown Transit Center (700 W. 6th Avenue, #109).

 If applying as a person with a disability, complete all questions on the application.  Your physician will need to complete the Physician Certification form.  Fill out and sign the Applicant Release section and submit to a licensed physician for certification. The physician will return the certification to the Public Transportation Department.

 4.   You may also check the status of your application by e-mailing mailto:PeopleMover@muni.org or calling 343-6544. Applications will be kept on file for 60 days.

 Physician Instructions

1.  Complete all questions in section marked “Physician Certification.”   Please do not leave items blank.  Disability alone does not qualify a person for a reduced fare.  Ability to pay a fare is not a determining factor.

 2.   Submit Physician Certification form directly to People Mover or send with client in a sealed envelope from physician’s office.

 

 

People Mover

 

Fax:

 

(907) 343-4042

Half Fare Program

Phone:

(907) 343-6543

700 W. 6th Avenue, #109

TTY:

(907) 343-4775

Anchorage, Alaska  99501

E-mail:

PeopleMover@muni.org

This form is available in alternate formats upon request.

HALF FARE PROGRAM - APPLICATION

MUNICIPALITY OF ANCHORAGE PUBLIC TRANSPORTATION DEPARTMENT

 APPLICANT INFORMATION

____________________________________
Last Name

___________________________________
First Name

 

_______________________________
Middle Initial

____________________________________
Phone

___________________________________
E-mail Address

 

_______________________________
Birthdate (MM/DD/YYYY)

____________________________________
Mailing Address

___________________________________ 

 

_______________________________
Apartment/Unit #

____________________________________
City
____________________________________

___________________________________
State
___________________________________

 

_______________________________
Zip Code
_______________________________

Emergency Contact/Agency Support                                                            Phone

 QUALIFYING INFORMATION

To be eligible for People Mover Half Fare you must meet one or more of the eligibility conditions below and bring photo ID and proof of eligibility.  Circle all that apply.

  • Senior (Bring photo ID, Age 60 and over)
  • Youth (Bring photo ID, Age 5-18)
  • Medicare Card Holder (Bring photo ID and Medicare Card)
  • Veteran (Bring form DD214 and photo ID)
  • AnchorRIDES Eligible:  Expiration Date:                                   
  • Eligible with another transit agency:  (Bring proof. Temporary/90 days only) Agency Name:                                                             Expiration Date:                        
    City and State of issue:                                                                                                 
  • Person with a Disability: Eligible disabilities are defined as being unable, without special facilities or special planning or design, to utilize public transportation facilities and services as effectively as persons who are not so affected. Exclusions include: pregnancy, obesity, acute or chronic alcoholism or drug addiction, contagious diseases and temporary disabilities with a duration of less than 90 days.

                1.  Specify disability(s): _________________________________________________

                2.  How does your condition affect your ability to effectively use public transportation? ______________________________________________________________

                    ________________________________________________________________________________________________________________________________

                3.  Have your doctor complete the Physician Certification and return to People Mover.

 

 I understand that information provided is for the purpose of determining eligibility and all information will be kept confidential. I have read and understand all reduced fare program information and affirm that the information provided is true and complete. I understand that fraud or abuse will result in confiscation of the card and termination of my eligibility.

 

Signature of Applicant_______________________________________________________________                  Date__________________________________________________________

HALF FARE PROGRAM - PHYSICIAN CERTIFICATION MUNICIPALITY OF ANCHORAGE PUBLIC TRANSPORTATION DEPARTMENT

Customer Service Division:  Phone: (907) 343-6544   Fax: (907) 343-4042

PATIENT/APPLICANT RELEASE

I authorize Dr.                                                        to complete this application and verify my disability, to the Municipality of Anchorage, Public Transportation Department.

Name: ________________________

Birthdate: ________________________        Date: _______________________

Signature: _______________________________________________________

Physician Certification

Physician Name: _________________________________________________

Physician License #: ______________________________________________

Telephone Number: ______________________________________________

Address: _______________________________________________________

Diagnosis or Disability(s): _______________________________________________________________________________________________________________________________

Does condition effect the individuals ability to perform activities of daily living (ADL's)? (circle one)    Yes    No

Does condition effect the ability to ride the bus? (circle one)    Yes    No

Explain: Do not list low income or ability to pay. Address need for accessible features, special facilities or planning.

_____________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________

Does condition involve a contagious disease? (circle one)    Yes    No

Does individual pose a danger to others? (circle one)    Yes    No

Year (estimate) condistion was diagnosed: _________________

Is condition permanent? (circle one)    Yes    No
    If "No," estimate duration/months: ______________________

Does individual (somtimes or always) need a Personal Care Attendant (PCA)? (circle one)    Yes    No

I certify that I have examined the patient listed above; that I am legally licensed under the laws of the State of Alaska to practice medicine; and that I have completed this form to the best of my ability.

Signature: ____________________________________________________________

Date: ________________________________________________________________

ELIGIBILITY CRITERIA

Check those that apply.

Non-Ambulatory Disabilities

___ Impairments which require the individual to use a wheelchair.

Semi-Ambulatory and Physical Disabilities

___ Restricted mobility. Permanent use of a walker,  crutches, long leg brace or other orthopedic appliance.
       State type of mobility aid:                                                  

___ Cardio-pulmonary disease.  Serious loss of heart or lung reserves as shown by X-ray, EKG or other tests and in spite of medical treatment, there is breathlessness, pain or fatigue.

___ Dialysis.  Individual who must use a kidney dialysis machine in order to live.

___ Acquired Immune Deficiency Syndrome (AIDS)

___ Loss of Extremities(both hands/one hand and one foot/both feet) Please specify:       ______________________________________________________________

___ Other.  Please specify:                                                          __________________________________________________________________________________

Hearing or Visual Disabilities

___ Legally deaf. Hearing impairment that is bilateral and not correctable with hearing aid.

___ Legally blind/Severe contraction of visual field. Visual impairment that is bilateral and not correctable with lenses.

Cognitive Disabilities

___ Developmental Disabilities. Persons with a disability due to mental retardation, autism, or other related condition that originated before age 22.

___ Adult Cognitive Impairment. Persons whom by reason of traumatic brain injury or illness occuring after age of 18.

___ Epilepsy. Grand mal or Phychomotor.  Persons who are seizure- free for a continuous period of six months are disqualified.
                Date of last seizure:                                      

___ Neurological Disabilities. Neurological and physical impairments not controlled by medication (i.e., cerebral palsy or multiple sclerosis).

Chronic/Serious Mental Illness: Complete sections 1 & 2. Alcoholism, drug addiction and substance abuse are not eligibile.

1.  From Diagnostic and Statistical Manual of Mental Disorders

    (DSM): List code #:                                                            

    Specify disorder:_      ___________________________

2.  Applicant must meet one of the following conditions:

___ Living in an assisted living home; under supervision with agency support services; has public guardianship or other appointed guardian. If over 18, bring proof of guardianship.

      Name facility/guardian: ________________________________________________________________________

      Phone: ____________________________________________________________________________________

___ Receiving Social Security Disability (SSDI). Bring proof.

___ Actively participate in a training program or therapy established under federal, state or local government agency. (temp/6 months only)

       Name of Agency/Program: ____________________________________________________________________

       Case Manager & Phone: _____________________________________________________________________

Return form to:
People Mover Half Fare Program
700 W. 6th Ave., #109
Anchorage, Alaska 99501
Fax: 907.343.4042
Email: PeopleMover@muni.org

Must be in a sealed envelope if given to patient to hand-carry.