Individual cannot independently use accessible fixed route transit due to a disability either some or all of the time.
The first category of eligibility includes those persons who are unable to fully use accessible fixed route bus services. Included in this category is:
"Any individual with a disability who is unable, as a result of a physical or mental impairment (including a vision impairment), without the assistance of another individual (except the operator of a wheelchair lift or vehicle on the system which is readily accessible to and usable by individuals with disabilities." [Section 37.123(e)(1) of the ADA regulations]
This applies to an individual who cannot independently negotiate the fixed route bus system (board, ride or disembark from a bus or train).
The fixed route vehicles the passenger needs to use are not accessible and/or the lift cannot be deployed at needed stops.
The second category of eligibility includes:
"Any individual with a disability who needs the assistance of a wheelchair lift or other boarding assistance device and is able, with such assistance, to board, ride and disembark from any vehicle which is readily accessible and usable by individuals with disabilities if the individual wants to travel on a route of the system during hours of operation of the system at a time, or within a reasonable period of such time, when such a vehicle is not being used to provide designated public transportation on the route." [Section 37.123(e)(2) of the ADA regulations] This also applies to any individual who would be able to use the fixed route bus system if an accessible vehicle were available, or for an individual who wants to use a designated station/stop, but the lift cannot be deployed or would be damaged if deployed or temporary conditions render a designated stop unsafe for use by passengers.
Individual's specific impairment related condition prevents him/her from getting to or from the fixed route transit system.
The third category of ADA paratransit eligibility includes:
"Any individual with a disability who has a specific impairment-related condition which prevents such individual from traveling to a boarding location or from a disembarking location on such system." [Section 37.123(e)(3) of the ADA regulations]
This applies to an individual who, because of his/her disability, cannot access a bus stop or a rail station to board the fixed route bus system and cannot access his/her final destination after disembarking from a fixed route bus. Eligibility under this category is determined for a specific ride each time the eligible customer calls.
An important qualifier for this category is also included in the regulations:
Environmental conditions and architectural barriers not under the control of the public entity do not, when considered alone, confer eligibility for ADA paratransit service to passenger. (Please note, an inconvenience in using the fixed route bus system is also not a basis for eligibility)
The Humboldt Transit Authority reserves the right to conduct a re-certification process as necessary to keep our records up-to-date. Service will be provided only to persons who have been certified. Qualified Medical Professionals will be asked to assist in making the determination of certification by completing a form describing the applicant’s disability. The final decision as to whether or not the applicant qualifies for Dial-a-Ride will be made by Humboldt Transit Authority.
To help us accurately determine your eligibility for Dial-a-Ride, please fill out the application form as completely and thoroughly as possible. Once you have completed the form the Humboldt Transit Authority will determine if it will be necessary for an in-person interview.
If we determine that more information is needed to process your application, or that your application is incomplete, we will schedule an in-person interview. If you know that you will need transportation to the interview, please let us know when we schedule your interview. At the time of your interview, we will ask you additional questions about your eligibility so we can further evaluate your travel abilities and limitations.
If you are determined eligible for dial-a-ride for some trips or for all trips, we will provide you with that information in your letter of eligibility. If it is determined that you are able to use fixed route buses for some or all of your trips, we will notify you in writing of the exact reasons for this decision and provide information about how to appeal our decision. This decision will be made within 21 days of the date you complete your in-person interview or assessment. If a decision is not made within 21 days, we will provide you with dial-a-ride until a final decision is made.
Complaints or comments about the system should be reported to Humboldt Transit Authority, Consuelo Espinosa, at 443-0826 for investigation and appropriate action. All information will be confidential. All passengers are expected to comply with vehicle rules, and understand the "HTA No Show Policy". The HTA No Show Policy is provided in this packet on Page 17.
If you believe you may be eligible for paratransit services please contact our paratransit eligibility department at:
This packet includes information and forms you need to apply for paratransit eligibility in the Humboldt County Area. As part of the requirements of the Americans with Disabilities Act (ADA), paratransit service is provided by all public transportation systems. This special type of public transportation service is limited to persons who are unable to independently use regular public transit, some or all of the time, due to a disability or health related condition.
In order to use ADA paratransit service, you must be certified as eligible. Eligibility is determined on a case-by-case basis. According to ADA regulations, eligibility is strictly limited to those who have specific limitations that prevent them from using accessible public transportation.
Your application may be approved for full eligibility (unconditional) or on a limited basis for some trips only (conditional eligibility). If you are found to be capable of using regular bus transit for all trips, without the help of another person, you will not be eligible for paratransit.
To apply for eligibility you must fully complete the attached application form and have the professional verification (pages 12-16) completed and signed by a licensed professional. We will review your ability to use accessible public transportation. After reviewing your application, we may need more information. We may need to:
Applicants persons assisting them are encouraged to read the brochures called "Dial-a-Ride Riders Guide"and before completing the attached form. If you need a brochure call the transit agency. It provides more details about ADA paratransit and the criteria eligibility.
Your application must be properly completed and it will be processed within 21 days after it has been received. You may be required to be available for a second level assessment. A second level assessment could include a telephone interview with you, medical verification, or an in-person interview.
You will receive notice of your eligibility determination by mail. If you are certified as eligible, you will be eligible to travel throughout the Dial-a-Ride service areas. If you do not agree with the eligibility determination, you have the right to appeal. Information on how to file an appeal will be included with your eligibility notice. If an eligibility determination takes longer than 21 days, you may be given eligibility that allows you to use the paratransit system until a final decision about your eligibility is made. This does not apply if, we are unable to complete the processing of your application, due inactions on your part.
133 V Street
Eureka, CA 95501
To qualify for Dial-A-Ride Service, one must meet the following criteria
Check One: ____ Unable to use public transportation ____ Resident of a convalescent home
Date: _________________________ Emergency Contact No.:___________________________
Birthday: _______________________ Phone:_________________________________
Address: __________________________ City: ______________ State: _____ Zip: ___________
Male_____ Female_____ Email Address (optional):____________________________________
Do you Speak English? Yes or No, I speak____________________________________________
Agency Certifying: _________________________________________________________________
What is your disability/medical diagnosis that prevents you from using Public Transit? *No longer driving is NOT a limitation* ____________________________________________________________________________________ ____________________________________________________________________________________
When do the effects of your condition effect you to get you to your destination? ____________________________________________________________________________________ ____________________________________________________________________________________
How does your condition affect you when you ride public transit in a functional way?
Is this condition temporary? YES NO
If yes, please list the date you expect the temporary condition will no longer exist: ________________
Does your disability change from time to time due to medical treatments, medications, or other reasons?
If yes, how?
Can you climb three (3) 12-inch steps without assistant? YES NO
How many steps can you go up or down? __________
Can you wait outside without support for more than 10 minutes? YES NO
If accepted to use Dial-A-Ride, will you require the assistance of an attendant? YES NO
If yes, please name the attendant: __________________________________
Can travel 200 feet without assistance: YES NO
Can travel 3-6 blocks without assistance: YES NO
Can travel 6-9 blocks without assistance: YES NO
Can climb 12-inch steps without assistance: YES NO
Can access bus using lift or ramp: YES NO
Can wait outside without support for 10 minutes: YES NO
If you require the use of mobility aids, please circle all that apply:
Manual Wheelchair YES NO
Electric Wheelchair YES NO
Electric Scooter YES NO
Cane YES NO
Walker YES NO
Service Animal YES NO
Care Worker/Attendant YES NO
Oxygen Tank YES NO
If you use a manual wheelchair, what type of obstacles could prevent you from using the public transit system that are equipped with a lift or ramps?____________________________________________________________________________________ ____________________________________________________________________________________
Do you have a communication disability which necessitates the use of some type of communication aid? YES NO
If yes, what kind of communication aid do you require?
Please check the box that best describes your current living situation:
____24 hour care or Skilled Nursing Facility
____Assisted Living Facility
____I receive assistance from someone that comes to my home to help with daily living activities
____I live with family members who help me
____I live independently (without the assistance of another person)
If you Checked manual wheelchair, power wheelchair or power scooter, circle the picture that most looks like your device.
1. Manual Wheelchair that looks most like this: (Circle One)
1 2 3
2. Power Wheelchair that looks most like this: (Circle One)
1 2 3
3. Power Scooter that looks most like this: (Circle One)
1 2 3
In order for the Humboldt Transit Authority to evaluate your request for eligibility, it may be necessary to contact a health care or rehabilitation professional for additional information about how your disability prevents you from using regular bus service. It is important that you identify one or more qualified professionals who are familiar with your particular disability and how it prevents you from using the bus system. You must include complete telephone and address information including zips codes for all professionals listed.
Qualified professionals include:
Family Physician Independent Living Specialist Rehabilitation Specialist
Ophthalmologist Independent Independent Physical Therapist Registered Nurse
Occupational Therapist Dialysis Social Worker Social Worker
|Family Physician (or other qualified professional):___________________________________________________||Family Physician (or other qualified professional):___________________________________________________|
|Professional's agency (if any) Phone#:___________________________________________________||Professional's agency (if any) Phone#:___________________________________________________|
CERTIFICATION AND AUTHORIZATION:
I certify that the information provided in this application is true and correct. I understand that falsification of information may result in denial of service. I authorize the professional listed above to release to Humboldt Transit Authority information about my disability and its effect on my ability to travel on the regular bus system. I understand that I may revoke this authorization at any time. Unless earlier revoked, this form will permit the professional listed to release the information described up to 60 days from the date below.
Signature of Applicant:_________________________________Date:____________________
Signature of person assisting applicant:_____________________________________________