People Mover Half Fare Program
For People with a Qualifying Disability
PROGRAM & ELIGIBILITY INFORMATION
WHAT IS IT?
The Federal Transit Administration requires transit agencies receiving federal funding for fixed route service to offer a Half Fare Program to Seniors, Medicare Card Holders and people with a qualifying disability. People with qualifying disabilities for this purpose are defined by FTA as persons;
“who, by reason of illness, injury, age, congenital malfunction, or other incapacity or temporary or permanent disability (including any individual who is a wheelchair user or has semi-ambulatory capabilities), cannot use effectively, without special facilities, planning, or design, mass transportation service or a mass transportation facility.”
WHO IS ELIGIBLE?
Having a disability does not necessarily qualify an individual for the Half Fare Program. Income level or employment status are not determining factors. People Mover defines senior citizens as age 60 and over. Excluded conditions to the Half Fare eligibility include: pregnancy, obesity, alcoholism or drug addiction, contagious diseases and disabilities lasting less than 90 days.
HOW TO SHOW PROOF OF ELIGIBILITY?
Seniors and Youth may show a government issued photo ID to verify age when boarding the bus. Individuals with Medicare cards may show Medicare Card with photo ID to driver as proof of eligibility. All others need to complete the Half Fare Program application process to obtain a People Mover Half Fare ID card. The Half Fare ID Cards are valid for 3 months and up to 10 years, length of eligibility depends on information provided by the certifying physician of these forms.
WHAT IS THE HALF FARE ID CARD?
The Half Fare ID card is used as proof of eligibility to pay a reduced fare. The card has no cash value and must be shown to the bus operator each time the bus is boarded and the reduced fare is paid.
IS THERE A COST?
There is a fee for printing/reprinting a Half Fare ID card, please go to our website or call the Rideline to speak with a customer service agent for the current fares and fees.
All half fare cards must be renewed periodically. Individuals certified by completing this application process with approved healthcare providers will be required to obtain a new application packet and have their approved healthcare provider complete the certification forms with their updated eligibility criteria. Renewals should be completed prior to the expiration date on your current Half Fare ID Card, keep in mind processing times when planning for renewals.
THE APPLICATION PROCESS
HOW DO I APPLY?
To qualify for the Half Fare, it will be necessary for you to complete a half fare application and obtain documentation that proves your eligibility.
The completed application and supporting documentation must be submitted to People Mover directly from the doctor's office.
Fill in your information on page 2, sign for acceptance of policies and authorization for release of information by your treating physician.
Have your physician who is treating you for a qualifying disability complete and sign pages 3 and 5 of this application. The treating physician must be licensed to practice medicine in the State of Alaska.
Leave these forms with your doctor. You should not take these forms with you as your doctor will need to fax or mail this application to our office for review.
Incomplete, illegible or applications that appear to have been altered will be denied and must restart the application process. You will receive an application status notice mailed to the address on the application.
Please allow a minimum of 14 business days for processing.
Complete all questions in all sections on pages 3 and 5 of this application. If a line is provided asking for explanation, it must be completed as well. Please do not leave questions unanswered.
Disability alone does not qualify a person for the Half Fare Program, the disability MUST INHIBIT the applicant's ability to EFFECTIVELY use mass transportation services WITHOUT special facilities, planning, or design.
Income or ability to pay are not factors in determining eligibility.
Use the definitions on page 4 to identify qualifying disabilities and minimum standards to meet that criteria.
RETURN APPLICATION BY FAX, MAIL, OR EMAIL ONLY.
People Mover Half Fare Program
700 W 6th Ave. #109
Anchorage, AK 99501
This form is available in alternate formats upon request.
HALF FARE PROGRAM - APPLICATION
MUNICIPALITY OF ANCHORAGE PUBLIC TRANSPORTATION DEPARTMENT
Emergency Contact/Agency Support Phone
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
I authorize Dr. to complete this application and verify my disability, to the Municipality of Anchorage, Public Transportation Department.
Birthdate: ________________________ Date: _______________________
Physician Name: _________________________________________________
Physician License #: ______________________________________________
Telephone Number: ______________________________________________
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.
Check those that apply.
___ 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.
___ 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: ________________________________________________________________________
___ 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
Must be in a sealed envelope if given to patient to hand-carry.