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The regional application process adopted by the 21 transit operators in the San Francisco Bay Area is outlined in the diagram on page 2:2. Throughout the nine-county region, the eligibility process used is that of self-assessment with professional verification as needed. The application process for ADA paratransit begins when an individual requests a form from a local transit agency. The work of the ADA certifying staff begins when the application is received and initially reviewed for completeness of information. This process continues with a review and analysis of all responses to questions on the application.

An in-depth look at the regional form is followed by an overview of some of the common obstacles and roadblocks that ADA analysts can confront in their work. Other materials in Section 2 cover questions and concerns related to professional verification and accessible formats. A chart on second level functional assessment describes a process that can be used when eligibility cannot be determined at the first level of review. Under the ADA, second level assessment is an option for transportation operators.

Throughout the nine-county region, the eligibility process used is that of: self-assessment with professional verification as needed.

"If you believe you have a disability (including mobility or cognitive impairments), which prevents you from independently using public fixed-route transportation facilities and/or vehicles, please complete this regional application form and return it to the transit agency serving your community. The questions on this application are designed to provide assistance in determining your functional abilities."

2 . 2

Steps in the Regional Eligibility Application Process

Applicants request an application form for ADA paratransit services.

Applications are submitted to local transit operator or paratransit service provider.

(Receipt of application is acknowledged in writing by some operators.)

Applications are initially reviewed for completeness of information.

Incomplete Applications.

Applicants notified (by mail and/or phone) and additional information is requested.

Complete Applications.

Complete applications are further analyzed to determine ADA eligibility. Professional verification is requested as needed.

Applicants are to be notified of eligibility determination within 21 days of receipt of a COMPLETE application.

Applicants denied ADA paratransit service receive a letter with information about the appeal process.

ADA eligible applicants are notified of category and conditions.

Applicants receiving limited (conditional) service can appeal.

Appeal Request.

Applicants denied ADA paratransit service can make an appeal request within 60 days of date of denial.

Presumptive Eligibility.

Applicants are granted this eligibility when ADA determinations take over 21 days from receipt of completed application.H

Presumptive eligibility is valid until such time as an actual ADAeligibility determination is rendered by the transit agency.

Appeal Hearing

A decision on the appeal must be completed within 30 days of the hearing or presumptive eligibility is granted.

2 : 3

The Three ADA Eligibility Categories

Under the ADA, there are three categories of persons with disabilities who are eligible for ADA paratransit.

All applicants for ADA paratransit eligibility are evaluated based upon a criterion defined in the ADA regulations.

Every applicant found eligible for ADA paratransit is classified under one of three ADA categories. The categories define why the individual cannot use the fixed-route system.

Category 1

The individual cannot independently use ACCESSIBLE fixed route due to disability.

An individual who because of a physical or cognitive disability is prevented from:

boarding an accessible fixed route vehicle;
riding on the accessible fixed route vehicle;
disembarking from the accessible vehicle.

Category 2

The fixed-route services needed by the individual are NOT ACCESSIBLE.

An individual who because of a physical or cognitive disability is prevented from:

boarding, riding and disembarking because vehicles on the route or key stations are not accessible.

Category 3

The individual has a specific impairment - related condition which in interaction with a barrier prevents getting to or from a bus (or rail) stop or station.

To be a basis for eligibility, the condition must prevent the individual from:

traveling to a boarding location.
traveling to and from a disembarking location.

2.4

Certification Process

Every person wishing to be certified ADA Paratransit Eligible must follow the following process.

All information, including the application form and other eligibility materials, will be made available on cassette tape, large print, diskette, or other accessible formats as requested.

The goal of this certification process is to determine eligibility for most applicants at the first level of review.

First Level
1. Application Submitted

Applicant submits application form (the same form is used throughout the region) which emphasizes self-assessment of disability and whether disability prevents use of fixed-route transit.
Applicant submits application to the transit operator they expect will most regularly provide them with service.
If necessary, the application will be forwarded to the transit "home" operator serving the area in which the applicant lives.
Screener reviews application for completeness; if the application is incomplete or requires further clarification, the person is contacted and requested to provide the necessary information.

2. Application Reviewed

Screener will review completed application to determine whether the applicant is unable to use fixed-route transit, as defined by the region-wide functional criteria.
Screener may decide, if necessary, to interview the applicant, either by telephone or in person.
Screener may decide, if necessary, to obtain documentation for a licensed third-party professional familiar with applicant's situation.
21-day time limit for operator to make a determination of eligibility starts upon receipt of completed application form and any supplemental information needed to complete the screening.

3. Decision on Eligibility Made

Screener will determine:

the applicant is eligible; or
the applicant is ineligible; or
further assessment is needed.

2.5

ADA Regional Application for Complementary Paratransit Service

In the nine-county region individuals with disabilities who want to apply for ADA paratransit submit applications to the transit operator or designated paratransit service provider in the city (or county) of residence.

The ADA requires that the eligibility determination process take no more than 21 days once a completed application is received. If the process takes longer than 21 days, a person is given presumptive eligibility until a determination is made.

Q How are the 21 days counted?

The 21 days are counted consecutively from the day that a complete ADA regional application is received by an operator. If an application has to be returned for more information the 21 days begins the day when all of the information is received.

Q What are the elements that make an application for ADA paratransit complete?

A completed application should include thorough identification information about the applicant, complete responses to all questions, a signature certifying information is truthful. Some operators also require a signed statement authorizing professional verification for the application to be complete.

The following pages take an in-depth look at the questions on the application form and further identify the components of a complete application. The discussion on the application questions describes the links between them and indicates how these connections are used in the eligibility analysis process.

Q What is the responsibility of the applicant?

The primary responsibility of an applicant for ADA paratransit is to submit a complete and factual application that defines his or her disability and accompanying functional limitations that are relevant to the determination process.

Q What is the responsibility of staff who make ADA certification determinations?

Certifying staff have a responsibility to thoroughly understand the ADA regulations as they relate to the eligibility of individuals and to trips. They have a responsibility to review each application thoroughly -- seeking clarification and additional information as needed. They have a further responsibility to use their most thoughtful judgment to determine if an applicant meets the strictly limited ADA criteria for paratransit.

Regional Application

Page 1 of application
* See Appendix B for a copy of the San Francisco Nine-County Bay Area Application for ADA Complementary Paratransit Service.

The ADA regulations state that individuals are paratransit eligible if they are prevented from making the trip on the fixed-route system. Inevitably, some judgement is required to distinguish between situations in which travel is prevented and situations in which it is merely more difficult.

Federal Register, Vol 56-No. 173 p. 45746

Identification Information

Applicant's full name
Full home address and a mailing address if different from home address
Phone information (day, evening and/or TDD/TTY)
Date of birth (including year)
Female or male
Primary language
Information regarding need for an accessible format (for the regional application and future information).
Name, relationship, and phone number of person, if any, who assisted in completing an application
A YES or NO is marked to indicate if this same person can be contacted for additional information
Emergency contact person, if any, including phone numbers and relationship to applicant

Disability Information -- Questions 1(a), 1(b), 1(c)

To be considered for ADA paratransit eligibility, applicants must have a disability that prevents them from utilizing or accessing the regular fixed route system.
* Certification staff must first look at the applicant's description of his or her disability to determine that a qualifying condition exists which prevents the use of fixed-route service.

Qualifying Condition/s Establishing the Disability

1a: Identifying the disability

Q 1a: What is your disability or health related condition that prevents you from using public transit?

The response must include a simple statement naming the disability. Symptoms can also be provided. This question is an opportunity for applicants to explain in their own words why they qualify. However, an applicant might misunderstand the question and list conditions not related to those preventing public transit use. Analysts need to determine which conditions affect mobility and ability to access public transit.

1b: Identifying the limitations

Q 1b: Explain HOW your disability or health related condition prevents you from independently using the public transit services (BART, bus, light rail [streetcar]).

One important element of the regional certification process is the self-assessment which acknowledges the individual's ability to provide clarifying information about his or her transportation disability. The applicant must explain HOW the identified disability or health condition (Question 1a) prevents independent use of public fixed-route transportation services.

Responses to 1b should make a definite connection between the stated disability and how this disability limits the ability to use fixed route.

If an applicant who is a wheelchair user states that she is limited by being unable to navigate unpaved areas or hills to reach the stop, a connection has been made between the stated disability and limitations.
If an applicant who is a wheelchair user states his limitation as being unable to board a bus or use the BART because the stations are under-ground, a clear connection has not been made. It could be that the applicant is unfamiliar with the accessible features of the fixed route buses or that the BART stations have elevators and other accommodations.
An applicant with arthritis who wears a leg brace states that she is unable to wait for transit on busy streets because she becomes nervous and agitated. On the application, a clear connection has not been made between the stated disability and the individual becoming nervous and agitated while waiting for a bus. The applicant has stated a limitation that does not connect with the identified disability.

Information about an applicant's limitations can be further identified from responses to questions 4 through 12 related to the ability to access the fixed route.

Questions 15 and 16: (mobility aids and personal care attendants) can also provide additional information about the limitations of an applicant. Questions 4-12 and 15-16 can be cross-referenced with responses to the questions on qualifying conditions (1a, 1b and 1c) to develop a better understanding of an applicant's eligibility for ADA paratransit.

1c: Permanent or temporary condition

Q 1c: Are the conditions you described permanent or temporary? If temporary, how long do you expect the condition to continue?

The applicant must respond whether the condition is permanent or temporary. If temporary, the applicant is required to specify a time period related to the duration of anticipated need for ADA paratransit services. Responses to this question are used to determine if an ADA eligible person (under any category) is permanent or temporary.

An applicant might state that his or her condition is permanent. Yet professional verification from a medical doctor might describe the same condition as temporary. For example, a post-stroke individual might consider the condition as permanent, while the professional reports that the condition could improve either partially or completely with physical therapy. If this is the case, permanent eligibility for paratransit services may not be an appropriate eligibility outcome.

Q 2: How do you currently travel to your most frequent destinations?

The mode of transportation applicants use to get to "most frequent destinations" is addressed in this question. The list of possible responses includes public transportation vehicles, paratransit as well as private cars. Responses provide some idea how the applicant now gets from one place to another and if public fixed-route transit is among the methods. If fixed-route transit is used, unconditional eligibility for paratransit services may not be an appropriate eligibility outcome.

3: Day-to-day health condition

Q 3: Does your health condition or transportation disability change from day to day in a way that affects your ability to use public buses, BART, or light rail [streetcars]?

This question probes whether the disability or health condition varies from day to day and how this affects ability to use fixed-route transit. Individuals with varying health conditions may have circulation problems, chronic pain, multiple sclerosis, or be undergoing treatments or therapies. Other individuals could be adversely affected by extremes in temperature or a level of pollen or other environmental conditions. Responses to this question could indicate that an applicant might need paratransit only for certain trips, but could use fixed-route transit for all other trips. If this is the case, conditional eligibility for paratransit service may be an appropriate eligibility outcome.

If YES or DON'T KNOW is the response, the applicant must provide an explanation for the answer to be complete.

Questions 4 through 12

Ability to Access Fixed-Route System

Questions 4-12 address the applicant's ability to independently perform specific functions associated with the fixed-route system. Responses provide a way to identify the barriers that the applicant faces (or believes he or she faces) in using the fixed route system.

Questions 4-12 follow a logical sequence of steps that are taken when making a trip by fixed-route service.

Responses to questions 4-12 assist certification analysts with answers to a key ADA eligibility question:

How does the disability or health condition of this applicant affect his or her ability to access the fixed-route system?

Applicants responding NO or SOMETIMES to any or all of questions 4-12 must provide an explanation. If an explanation is not provided, responses are not considered complete.

4: Ability to understand directions needed to complete a trip by fixed route

Q 4: Are you able to understand directions needed to complete a trip?

This question pertains to a person's ability to read a printed bus schedule or access schedule/route information by phone, TDD or in person.

A person's inability to read or speak English is not considered a disability under the ADA. (Note: applicants are informed on the regional application that Question 4 does not relate to facility in the English language.) A person's inability to read bus schedules or information at bus stops because of illiteracy is also not considered a disability under the ADA. If an applicant states that getting transit directions is confusing, there could be a need for an interview to determine why it is confusing. A screener should determine if this confusion is related to the stated disability.

A person responding NO or SOMETIMES to question 4 must provide an explanation that is consistent with the stated disability and limitations (e.g., a cognitive impairment could limit an understanding of bus schedules).

5: Ability to identify the correct public transit stop

Q 5: Are you able to identify the correct public transit stop?

Responses will identify if a person can recognize and/or distinguish the correct bus stop or station. The answer should relate to the identified disability given by the applicant (e.g., mental retardation, impaired vision).

6: Ability to identify the correct public transit vehicle

Q 6: Are you able to identify the correct public transit vehicle?

Again, a negative or SOMETIMES response to being able to identify the correct vehicle should directly relate to the disability and limitations stated by the applicant. For example, a person with night blindness might not always be able to recognize the correct bus and a person with a cognitive disability might not be able to distinguish one vehicle from another. But it would be inconsistent for an applicant who lists a hearing impairment to respond that he or she is unable to identify the correct bus.

7: Ability to get to and from the nearest public transit stop

Q 7: Are you able to get to and from the nearest public transit stop?

Applicants responding NO or SOMETIMES to this question must identify the number of city blocks they can independently travel. This information on ability to get to and from the bus stop is important to the determination process. If applicants claim an inability to get to the nearest stop, they must also state the distance they are able to travel to reach a stop. If not, the response to this question is not complete.

8: Ability to wait at least 15 minutes at a public transit stop

Q 8: Are you able to wait for at least 15 minutes at a public transit stop?

Responses to this question that are NO or SOMETIMES could indicate that the person has a disability that prevents him or her from standing or being in an exposed situation. This question also addresses whether the addition of a seat or bus shelter would change the situation enough for the applicant to make a 15 minute wait possible.

When an applicant explains that he or she is unable to wait when it gets too cold, and there is no stated impairment with regard to weather conditions, this response could possibly relate to discomfort rather than a disability. More information is necessary.

9: Ability, without assistance, to board and disembark from public transit

Q 9: Are you able to get on and off the following public transit vehicle without assistance? (Public bus, BART, light rail)?

Applicants might respond they can independently board and disembark one type of public transit vehicle and not another. The explanation provided should help clarify why this is so and help make connections to the functional limitations that result from the disability.

An applicant who has no problems getting on and off public transit might, however, have problems in getting to and from a stop or station. This could affect the type of eligibility status received.

10: Ability to get on and off public transit that has a lift or has a kneeling feature

Q 10: Are you able to get on or off a public transit bus if it has a lift or if the front of the bus is lowered?

Applicants might respond they are unable to use a lift or board a bus with a kneeling feature without ever having tried it. The same applicant might respond to question 2 (present means of travel) in a way that indicates lack of public transit use. It could mean that lack of knowledge or experience about fixed route is a factor in their answer rather than how the disability limits functional ability. This might possibly trigger a referral for travel training and provide an opportunity to point out accessible features of the fixed route.

Individuals responding they are able to access buses with lifts or a kneeling feature might be eligible for paratransit trips when these features are not present.

11: Ability to grasp handles, railings, coins or tickets

Q 11: Are you able to grasp handles or railings, coins or tickets while boarding or exiting the transit vehicle?

This question might be answered in a manner that indicates the person is not aware of accommodations that assist persons unable to handle coins or tickets . Individuals (with a cane or walker) might also not be aware that the lift feature of a vehicle could accommodate them thus making it easier to board and exit a bus.

The explanation, however, might also indicate that the stated disability limits the functioning ability to grasp handles or railings as they board and disembark -- preventing the use of fixed route.

12: Ability to maintain balance and tolerate public transit movement

Q 12: Are you able to maintain balance and tolerate public transit vehicle movement when seated?

This question assumes that the passenger will be seated once inside the vehicle either in a seat reserved for persons with disabilities or another seat. The question probes whether, once seated, a person can maintain balance and not be adversely affected by the movement of the vehicle. Responses should relate to "being seated" and not inability to stand and ride.

Applicants responding they are unable to maintain balance and tolerate vehicle movement while seated should have an identified disability that would limit this functional ability.

Knowledge and/or Training about Public Transit

Questions 13 and 14 provide a way to determine what, if any, knowledge or experience an applicant has related to fixed route transit. Responses are intended to assist the analyst in designating an eligibility category, conditions of service and a duration of service for the applicant.

13: Applicant's public transit training

Q 13: Have you ever had any training or instruction to learn how to use the public transit (BART, bus, light rail streetcars)? If yes, where and when did you receive this training?

This question is used to determine if the applicant had training/instruction on the fixed route and where and when it was provided. Information obtained could relate to the need to provide additional training.

14: Knowledge about the accessibility of public transit

Q 14: Is the public transit you need accessible?

Responses to this question might indicate that the applicant is unaware of the accessibility of the local fixed route system or lacks information about the transit system itself. For some individuals the word accessible means close by or easy to access and does not relate to equipment.

Mobility Aids and Personal Care Attendants

Questions 15 and 16 focus on the aids or assistive devices used and if the applicant has a personal care attendant. The extent to which this attendant is used when traveling outside the home is also explored. Responses are intended to supplement the information regarding limitations of the applicant.

15: Mobility aids used

Q 15: Do you use any of the following mobility aids or specialized equipment?

The mobility aid or aids listed as used should be consistent with responses related to the applicant's identified disability and responses to questions 4-12 on ability to access fixed route. If ADA paratransit eligibility is awarded, this information is also helpful for scheduling service in that an operator can determine the type of vehicle necessary to properly accommodate the rider.

An applicant who does not check any of the listed mobility aids or does not fill in an aid or piece of equipment should be considered a person not using one.

16: Personal care attendant

Q 16: Does a personal care attendant accompany you when you travel outside your home?

This question provides information related to the person's ability to function WITH, WITHOUT or SOMETIMES with a personal care attendant. Under the ADA, a personal care attendant "always may ride with the eligible individual." For detailed information on personal care attendants, see pages 3:13-15.

Present User of Paratransit?

17: Present Use of Paratransit Service

Q 17: Do you currently use paratransit service?

The applicants responding YES or SOMETIMES must also state when they use paratransit service and also list the name of the provider of this service.

This question identifies if the person has already been considered ADA eligible locally or in another transit system or if they are presently using non-ADA paratransit services. Individuals who are present or past users of non-ADA services might not understand the difference between the two types of service, especially the strict eligibility criteria for ADA service.

Certification Statement (page 6)

The application is not complete without the signature of the applicant certifying that all information is truthful. The date the statement is signed is also required. In situations where the applicant is unable to sign, an X can be used or the person identified as completing the application can sign for the applicant.

The Certification Statement not only certifies that information is true and correct, but that the applicant understands that:

false information may result in a denial of paratransit service.
all information in the application will be kept confidential.
only information required to provide the paratransit services will be disclosed to those performing the services.
a professional familiar with the applicant's functional abilities to use public transit may be contacted in order to assist in the determination of eligibility.

Professional Authorization -- Release of Information

The application has a section for the applicant to sign a statement authorizing a designated licensed professional to provide information (as needed) about the disability or health related condition. (See pages 2:18-2:22 for more information on professional verification.) When the certification analyst believes that professional verification is necessary to substantiate eligibility, he or she should not pursue professional authorization until the applicant has signed a release statement. In this case, the application should be considered incomplete until such time as a professional authorization is signed.

The licensed professional should be someone familiar with the applicant's disability as it relates to his or her functional abilities to use public transit. Although the professionals are asked, as necessary, to provide verification of the existence of a disability, this verification is only one piece of information to be considered by staff responsible for making eligibility determinations.

The Professional Authorization statement as written on the regional application provides the applicant assurance that:

the information obtained from the professional will be used solely to determine eligibility.
he or she has a right to a copy of this Professional Authorization form once returned by the designated professional.
the authorization may be revoked at any time at his or her request.

2.6

Obstacles and Roadblocks to Making Determinations

ADA eligibility certifications can most often be determined on the basis of the initial information submitted on a complete application form. Inadequate or contradictory information can create obstacles that must be overcome before an ADA eligibility determination can be made.

The 21- day certification period does not begin until a completed regional ADA application has been received by the operators.

Q What about an application with INCOMPLETE information?

ADA eligibility screeners report that applications are often submitted with incomplete information because applicants do not always understand what is being asked of them. In some cases individuals who apply for ADA paratransit have limited ability to complete application forms. Other individuals don't completely answer questions related to their ability to use fixed route because they have not had experience using t his mode of transportation. Questions requiring an explanation for a no or sometimes or yes or don't know response are often not completed. Thus, the ADA screener is left with incomplete information about a person's ability or perceived ability to access fixed-route transit.

Incomplete applications require that ADA certifying staff make an effort to get more information. This effort can include:

Sending a written request for additional information to the applicant .
Returning application forms with incomplete or blank sections highlighted.
Conducting a phone interview with the applicant (or a designated person) to obtain the missing information.
Conducting an in-person interview with the applicant at the transit or broker site to obtain the additional information. Eligibilit y analysts report that face-to-face interviews can of en facilitate the rephrasing of questions to assist applicants in better understanding what is being asked of them.
Requesting professional verification.
A combination of any or all of the above steps might be taken to gain the complete information needed to make an eligibility determination.

Q What about INCONSISTENCIES in responses on the application form?

An application can often be complete in that all questions are answered and, where necessary, explanations are provided. However, screeners often discover contradictory responses in reviewing the application. In order to reconcile inconsistencies, phone or in-person interviews are conducted with the applicant and/ or the person completing the application. In some situations professional verification will need to be sought and follow-up phone interviews might also have to be conducted with the prof essional.

Contradictory evidence can also surface when the applicant is being interviewed for additional information. Examples of inconsistencies or contradictions include:

An applicant with a mobility impairment replies that she uses public transportation vehicles to get to and from her most frequent destinations. Yet, when asked to respond to a series of questions on the application related to ability to perform specific functions to access fixed route, she responds NO to each one.
An applicant who uses a leg brace and a cane responds that he is unable to identify the correct transit stop and correct bus. There is nothing in the application about a cognitive disability that could prevent his recognition of transit stops and vehicles. This information appears to be contradictory.
An applicat ion is completed by a social worker on behalf of a client recovering from a heart attack. The social worker responds that the applicant is unable to get to and from the bus stop, board or disembark and balance when vehicle is in motion. The applicant is contacted for additional information and clarification on his functional abilities to access fixed route. During the interview what the applicant says he is functionally able to do contradicts the explanations of the social worker. Further questioning reveals that the social worker had only one brief meeting with the applicant before his leaving the hospital and wasn't fully aware of his functional abilities.
An ADA application for a middle aged male who is developmentally disabled is submitted by a parent . The application states that the man is unable to recognize the correct bus stop or transit vehicle. Yet , on the form it is stated that the applicant reaches his most frequent destinations by both fixed route and private car. There is no personal care attendant mentioned. There is no travel training or instruction noted on the application. There appears to be a contradiction in that he independently uses fixed route while being unable to recognize the correct bus stop or vehicle.

In all these situations the inconsistencies are roadblocks that prevent making a determination without seeking additional information from the applicant and/ or the person completing the application, or a licensed professional.

Q What about the review of applications listing disabilities or medical conditions that are UNFAMILIAR to an eligibility screener?

ADA eligibility analysts generally do not bring a medical background to the job. Nor is it a requirement. Experience with a range of applications can create a familiarity with the mental and physical impairments commonly listed by applicants. This knowledge however does not mean that generalizations about the functional abilities of one person with a specific disability can apply to another individual with the same disability or condition.

To assist in making eligibilit y determinations, ADA eligibility analysts can access knowledge about various disabilities by:

Peer-to-peer contacts with certifying staff on-site and throughout the region (see page 5:11) .
Resource books that transit operators and brokerage staff have on file, including medical dictionaries, handbooks of disabilities, and materials on specific disabilities. (See Appendix G for a listing of disability organizations that supply information with little or no fee. Note that these organizations have web sites where information can be obtained.)

2.7

Professional Verification

In the nine-county region, the application process is characterized by self-assessment with professional verification as needed. Self-assessment means that applicants initially provide all information about the disability and their ability to access fixed route. Professional verification as needed means a licensed professional authorized by the applicant may be contacted if more information is needed to make an eligibility determination. Throughout the region operators rely on professional verification as needed to establish ADA paratransit determinations. A signed release allows a transit operator, if needed, to contact a professional to verify information about a person's disability and how the impairment affects his or her ability to use the fixed-route system. However, a signed release is not always required in the region for an application to be considered complete.

Verification by a professional is considered as one more piece of information to be taken into consideration in making an ADA eligibility determination. The professionals are not asked to make any determination or recommendation.

Some questions on professional verification are as follows:

Q What are situations when professional verification might be needed?

This verification might be requested when there are questions about the extent or the nature of the disability. Professional information might also be needed to clarify information because of possible inconsistencies in answers to questions related to ability to use fixed route. For example, applicants might state that they cannot use the bus and further in the application respond that when they ride they have difficulty when the bus is in motion. Professional verification might also be used at a juncture when additional input is needed prior to determining conditions of travel, prior to a denial or during a time when an application is being reconsidered.

Q What are the questions generally asked of the professional?

Does the applicant have a functional or cognitive disability?
Does the applicant's disability PREVENT (not make difficult) the use of public fixed route?
How does the applicant's disability or health condition affect her/his physical or cognitive functioning?
What is the applicant's ability to:
- understand directions needed to complete a trip?
- identify the correct bus, train, or transit stop?
- travel INDEPENDENTLY to and from the nearest transit stop? - wait standing 15 minutes at a stop or station?
- wait seated 15 minutes at a stop or station?
- get on and off a transit vehicle without a person's help?
- get on and off if a kneeler or lift is deployed?

The questions are meant to clarify the functional abilities of the applicant as they relate to his or her disability. The purpose is not to obtain a diagnosis from the professional.

Q Who are the licensed professionals that an applicant can list?

The regional process allows for a broad range of professionals to be contacted for verification. In addition to licensed physicians an applicant can list, for example, psychologists, social workers, occupational and physical therapists, independent living specialists, rehabilitation specialists, registered nurses, developmental disability counselors. (See page 2:22 for additional information on the types of licensed professionals who can assist with eligibility determinations.)

Q How can one evaluate the appropriateness of the professional identified by the applicant?

The professional that is listed by the applicant should be someone who specializes in, or has knowledge about, the type of disability that is identified on the application. For example, a primary care physician might not know about the functional capabilities of an applicant to board an accessible bus while the physical therapist he or she visits would have such knowledge.

"Professional verification will be particularly important in cases when applicants have claimed a 'hidden disability' or a medical condition such as a cardiac or pulmonary condition, mental illness or a joint disease. Verification will also assist in determining the extent of a sensory impairment (e.g., level of vision or visual acuity) or the degree of cognitive capability."

Q What about professional verification for an applicant with more than one disability?

There are cases where an applicant has two very different types of disabilities, (e.g., orthopedic and cognitive) and it might be necessary to request information from more than one licensed professional. The applicant would need to be contacted to supply the name of another professional if not already listed on the application. An additional professional authorization would need to be signed.

Q What are some issues and concerns related to professional verification that need to be considered by ADA eligibility analysts?

There can be misunderstandings about what is being asked in terms of verification. The professional needs to identify not only the disability, but how this disability affects a person's functional capabilities to use fixed route services.
The professional is often not familiar with the accessible features of the fixed route system and/or does not understand the specialized nature of ADA paratransit services.
Professional verification forms are often routed to medical secretaries for completion and not to the physician. The returned form might not provide adequate information about an applicant's physical or cognitive functioning. (At HMOs and other large medical facilities, medical secretaries work extensively from medical records and may not consult with physicians.)
Social workers and other professionals often act in an advocacy role for their clients. Therefore, without an understanding of the criteria for ADA paratransit they will often advocate for persons to be certified who are capable of using the accessible fixed route system.

Q What are some common misunderstandings that professionals have about the criteria for ADA paratransit?

Some professionals often focus on issues of safety, vulnerability and/or the independence of the applicant. None of these factors are a criterion for paratransit service under the ADA. Some professionals also confuse ADA paratransit with other van services (pre-ADA) that were provided based solely on the existence of a disability or a person's age.

"The substantive eligibility process is not aimed at making a medical or diagnostic determination. While evaluation by a physician (or professional in rehabilitation or other relevant fields) may be used as part of the process, a diagnosis of a disability is not dispositive. What is needed is a determination of whether ... the individual can use fixed route transit in his or her own circumstances. That is a transportation decision primarily, not a medical decision."

Appendix D, 49 CFR Part 37, Federal Register, 9/6/91, p. 45746.

Substantive:

Of or relating to the essence or substance; essential.

Q What are the next steps to take when a professional verification report seems to contradict the information provided by the applicant?

Phone interviews could be conducted with the professional and the applicant to clarify possible inconsistencies between the verification report and information in the application form.

Q How else is professional verification used?

Information from professional verification reports can also be used as part of an appeal process initiated by an applicant denied services.

Q Are there issues of confidentiality related to the use of professional verification?

Medical doctors and other licensed professionals are legally bound to maintain confidentiality of patients or clients.

The release form that is part of the ADA regional application process addresses the confidentiality issues by having an applicant authorize a designated professional to release information about his or her disability to the transit agency. Some operators in the region notify applicants if a professional (i.e., medical doctor, social worker, therapist) is being contacted; others do not.

Q How valuable is the role of professional verification in the certification process?

Information obtained from professionals who are familiar with the individual applicant, the disability and how it affects that person can provide valuable input into the determination process. However, a medical doctor, for example, is not an expert in the ADA or fixed-route transportation, nor does he or she always understand the functional abilities needed to access a bus or light rail vehicle. A doctor can facilitate the determination process by stating the physical or cognitive limitations of the applicant.

ADA eligibility certifiers do gain familiarity with various disabilities. However, since most disabilities can affect an individual in a range of ways and to varying degrees, it is not always possible, without professional verification, to identify how a specific applicant might be affected by his or her physical or mental disability.

Whatever the value of input gained as part of the professional verification, it is only one more piece of information to consider in the ADA eligibility determination process. It is the certifying staff that has ultimate responsibility for making the eligibility determination.

Q Is there a standard professional verification form used in the region?

No. Transit operators in the region do not have a standard form for this purpose.

Q Can an applicant review the professional verification report written on his or her behalf?

Yes, the applicant has a right to review and receive a copy of the professional report form. Some operators require requests to be in writing. Certifying staff should be prepared to send a copy of the professional verification to the applicant since the professional is required to return the form directly to the transit operator. Forms that are returned from the applicant instead of the professional are not considered legitimate documents.

Examples of Licensed Professionals Who Can Assist with Eligibility Determinations

Professionals who can assess the functional capabilities of individuals to use fixed route transit services:

Clinical Social Workers: These are individuals who provide psychiatric social work assistance to mentally or emotionally disturbed patients of hospitals, clinics, or other medical centers, and to their families. They investigate case situations and present information to psychiatrists and/or help patients to respond constructively to treatment and assist in adjustment leading to and following treatment. Clinical social workers serve as a link between patients, psychiatric agencies, and the community. They are usually required to have knowledge and skill in casework methods acquired through a degree program at a school of social work.

Independent Living Specialists: Individuals who work with independent living programs or centers to provide special training to persons with disabilities in the performance of all or most activities of daily living.

Occupational Therapists: Persons who use purposeful activities to treat individuals who are limited by physical injury or illness, psychosocial dysfunction, develop-mental or learning disabilities, poverty and cultural differences, or the aging process to maximize independence, prevent disability, and maintain health.

Physiatrists: Physicians who test the physical functioning of a person and supervise the person's rehabilitation program.

Physical Therapists: Persons who are licensed to assist in the examination, testing, and treatment of people with disabilities through the use of special exercise or other techniques.

Rehabilitation Specialists: Persons who assist individuals in regaining normal or near normal functional capabilities after a disabling disease, injury, addiction, or incarceration.

Professionals who can assist in verifying the nature and extent of disabilities:

Audiologists: Persons who specialize in the physiology, anatomy, and pathology of the ear and the diagnosis and treatment of disorders of the ear.

Opthomologists: Persons who specialize in the physiology, anatomy, and pathology of the eye and the diagnosis and treatment of disorders of the eye.

Physicians: Health professionals who have earned a degree of Doctor of Medicine (M.D.) after completing an approved course of study at an approved medical school. Physicians can be trained in general medical practice, or in specialized areas of medicine.

Psychologists: Persons who specialize in the study of the structure and function of the brain and related mental processes. A clinical psychologist is qualified by a graduate degree in psychology and training in clinical psychology and provides testing and counseling services to patients with mental and emotional disorders.

Registered Nurses: Professional nurses who have completed a course of study at a state-approved school of nursing and passed the required national examinations.

This list provides some examples, but is not a comprehensive listing of licensed professionals.

List developed from Americans with Disabilities Act (ADA) Paratransit Eligibility Manual Final Report, U.S. Department of Transportation, 1993.

Sources: Mosby's Medical, Nursing, and Allied Health Dictionary, the C.V. Mosby Company, 1990; and Dictionary of Occupational Titles, Volume 1, 4th edition, U.S. Department of Labor, 1991.

2.8

Second Level Functional Assessment

"It is possible that upon review of your application, you may be asked to provide additional information. This may include contacting a licensed professional familiar with your functional abilities, a phone or personal interview, or a physical or cognitive functional evaluation" (i.e., a second level assessment).

from San Francisco Nine-County Bay Area Application for ADA Complementary Paratransit Service

Second level functional assessments are conducted when clarification is needed to understand the extent to which an applicant's physical or mental impairment impacts the ability to use the fixed route system. Under the ADA, it is an option available to transportation operators.HPresumptive eligibility is valid until such time as an actual ADA eligibility determination is rendered by the transit agency.

Second Level Functional Assessment

First level review of ADA application conducted and completed by transit operator.

Eligibility of applicant unable to be determined by initial (first level) review.

The applicant is referred to a professional for second level functional assessment.

A physical and/or cognitive assessment is conducted by an outside professional as part of the assessment.

Purpose: to assess if the applicant's disability prevents use of fixed route transit or travel to and from bus stops or stations.

The outside professional submits results of evaluation to transit operator responsible for making the eligibility determination.

Transit operator makes ADA paratransit eligibility determination and notifies the applicant.

Applicants denied ADA paratransit service receive a letter with information about the appeal process.

ADA eligible applicants a e notified of category and conditions.

Applicants receiving limited (conditional) service can appeal .

Appeal Request .

Applicants denied ADA paratransit service can make an appeal request within 60 days of date of denial .

Presumptive Eligibility.

Applicants are granted this eligibility when ADA determinations take over 21 days from receipt of completed application.H

Appeal Hearing

A decision on the appeal must be completed within 30 days of the hearing or presumptive eligibility is granted.

2.9

Accessible Formats

The operators throughout the region follow a policy on accessible format s as stated on the first page of the regional application form. Some frequently asked questions regarding accessible formats follow:

Q What are accessible formats?

Accessible formats include materials presented in large print versions, recorded on audio tapes, in Braille or on a comput er disk. The definition of an accessible format under the ADA does not include presenting eligibility materials in languages other than English.

Q Under ADA rules, does a transit operator have to provide the requested accessible format when another format is also appropriate?

The ADA states that information does not need to be available in the format preferred by the applicant, but it does have to be presented in a format that is accessible to the applicant. For example a person request ing materials in a Braille format could be given an audio tape if he or she is able to utilize it.

Q What are t he ADA eligibility materials that a regional operator must present in accessible formats, if requested?

All printed eligibility materials must be provided in accessible format . These include:

The application form
Information sheets about the regional application process
Notices and letters related to the eligibility process ( i.e., receipt of application, request for additional information, determinations, the appeal process, travel training information, recertification forms) .

"All information regarding the certification process and paratransit services will be made available in accessible formats (i .e, Large Print, Braille, Audio Tape, other) upon request."

San Francisco Nine-County Bay Area Application for ADA Complementary Parat ransit Service

Q Does an applicant requesting an accessible format have to submit a completed regional application in writing or typing?

Yes. Transit operators in the region, based on ADA guidelines, require that applications be returned in the standard format . Applicants may designate another person to complete the form for them, if unable to complete their own application. There is a place on the application for the name of the person who completes the form. Operators are not required to complete applications for ADA paratransit applicants.

Q How does an applicant learn about the availability of accessible formats?

An applicant may learn about alternative accessible formats from telephone inquiries to a transit operator, information on application forms and other materials describing the ADA regional eligibility process. The first page of the regional application form also asks the applicant : " Do you need this application and future written information provided to you in accessible format?". If respondents check YES they are asked to indicate the format they prefer. ( Diskette, Audio Tape, Braille, Large Print or Other.)

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