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Orange County Transportation Services ADA Paratransit Pla03 <br /> C. Application &Verification <br /> ADA PARTRANSIT APPLICATION <br /> The Orange County paratransit system operates in accordance with the Americans with Disabilities Act <br /> (ADA) of 1990, and each program is designed to serve individuals whose disabling conditions or functional <br /> limitations prevent them from using regular, fixed-route services. <br /> Return Completed Form to: <br /> Orange County Public Transit <br /> Attn: ADA Certification Review <br /> 600 NC Hwy 86 N <br /> Hillsborough, NC 27258 <br /> 919-245-2008 <br /> How Do I Apply? <br /> If you believe you qualify, complete Part A of this application and then give both Parts A and B to a Health <br /> Care Provider who is familiar with your condition to have them complete Part B. Your signature on the <br /> application authorizes this professional to provide information to the participating paratransit system <br /> regarding your eligibility for ADA paratransit services and any needed clarification of functional limitations <br /> due to your disabling condition. The application must be properly and fully completed in order to be <br /> considered. <br /> What Happens After I Turn in my Application? <br /> You are contacted within 21 business days by a staff to schedule your functional assessment. For your <br /> assessment, you are provided a free trip to and from a functional assessment center, to determine your <br /> eligibility based on the following factors: <br /> a. Information you provided on your application <br /> b. Information provided by your healthcare professional <br /> c. A brief assessment of your actual functional abilities <br /> d. A review of available transportation options in the area in which you desire to travel <br /> If you have questions or have not been contacted within 21 business days of submitting your application, <br /> call the phone number(s) listed above. If, at that time, a determination of your eligibility has not been <br /> made, you are temporarily eligible for the paratransit services until such time as your application can be <br /> reviewed. <br /> You will receive notice of your eligibility determination by mail. If you do not agree with the eligibility <br /> determination, you have the right to appeal. Information on how to file an appeal are included with your <br /> eligibility notice. If an eligibility determination takes longer than 21 days, you may be given eligibility to <br /> use the paratransit system until a final decision about your eligibility is made. This does not apply if,through <br /> inactions on your part, we are unable to complete the processing of this application. <br /> Orange County Planning Department Page 27 <br />