Texas Vi 4 Form in PDF Modify Texas Vi 4 Here

Texas Vi 4 Form in PDF

The Texas Vi 4 form is an application for a window tint medical exemption, managed by the Texas Department of Public Safety Regulatory Services Division. It is designed for individuals who require a medical exemption from the state's standard window tinting regulations, allowing them to have darker tints than are normally permitted. If you believe you qualify for this exemption, click the button below to get started on filling out your form.

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In Texas, sunlight streaming through a car's windows is a common sight, but for some, this seemingly benign occurrence can present serious health risks. Addressing this issue is the purpose of the Texas Vi 4 form, designed by the Texas Department of Public Safety Regulatory Services Division. Essential for individuals needing an exemption from the state's window tint laws due to medical conditions, this form serves as an application for a Window Tint Medical Exemption. Applicants are required to fill out the form in detail, providing personal information such as their name, driver's license number, and contact details, alongside specific details about their vehicle(s). The form also necessitates a certification from a physician, optometrist, or ophthalmologist, validating the medical necessity for the exemption. This certification can be in the form of a signed letter on the physician's letterhead or an original prescription that outlines the medical reasoning behind the exemption. Once submitted through the designated channels — either online, via fax, or through mail — applicants must allow up to 15 working days for the processing and approval of their exemption. This process underscores the state’s commitment to ensuring the health and safety of its residents, while also maintaining the integrity of its vehicle regulations.

Texas Vi 4 Sample

Texas Department of Public Safety Regulatory Services Division www.dps.texas.gov

MUST USE MOST CURRENT FORM

FORM MUST BE TYPED

VEHICLE INSPECTION WINDOW TINT

 

 

FOR DPS USE ONLY

APPLICATION FOR WINDOW TINT MEDICAL EXEMPTION

 

 

APPLICANT (PLEASE USE NAME AS IT APPEARS ON DRIVER LICENSE)

 

 

 

Name

DL #

State

Expiration

Patient Name

Relationship to Applicant

(IF DIFFERENT FROM APPLICANT)

 

Residence

City

State

 

 

County

ZIP

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing

City

State

 

 

County

ZIP

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth

Email

Home Phone

Cell Phone

Business Phone

Other Phone

VEHICLE INFORMATION

Vehicle #1

VIN

Year

Make

Model

VEHICLE #2

VIN

Year

Make

Model

VEHICLE #3

VIN

Year

Make

Model

PHYSICIAN, OPTOMETRIST OR OPHTHALMOLOGIST

Name

Address

Email

 

 

License #

 

 

 

 

 

 

 

 

City

State

 

 

Zip

 

 

 

 

 

 

Phone

Fax

 

 

 

 

 

 

 

Vehicle Owner Certiication

I certify and afirm that all information presented in this form is true and correct, that any documents I have presented to DPS are genuine, and that the information included in all supporting documentation is true and accurate. I make this certiication and afirmation under penalty of perjury and I understand that knowingly making a false statement or representation on this form is a criminal violation.

Applicant / Legal Guardian’s Signature

 

Date

Completed application must be accompanied by one of the following:

Letter, on physician letterhead, signed by the physician, indicating the medical reason for the exemption.

An original prescription including the applicant’s name, physician’s signature and indicating the medical reason for the exemption.

Letters and prescriptions must be dated within one year of exemption request. If the exemption is approved, an exemption letter will be sent to the applicant listed above.

SUBMIT completed form with required documentation:

Online Secured Email

Contact Us, select “Vehicle Inspection” and complete the online form.

http://www.txdps.state.tx.us/rsd/contact/default.aspx

Fax to (512) 424-2774

Mailing Address: Texas Department of Public Safety

Regulatory Services Division, Compliance & Enforcement Service

Window Tint Medical Exemption

P. O. Box 4087

Austin, Texas 78773-0543

Please allow up to 15 working days for your application to be processed, approved and to receive your exemption certiicate.

VI-4 (Rev. 3/16)

File Characteristics

Fact Detail
Document Title Application for Window Tint Medical Exemption
Issuing Authority Texas Department of Public Safety Regulatory Services Division
Website www.dps.texas.gov
Form Number VI-4
Revision Date March 2016
Requirement Must be typed and use the most current form
Submission Options Online Secured Email, Fax, Mailing Address
Supporting Documents Letter on physician letterhead or original prescription indicating medical reason for exemption
Processing Time Up to 15 working days
Governing Law Texas Transportation Code; Texas Administrative Code Title 37, Part 1

Detailed Guide for Writing Texas Vi 4

Filling out the Texas Vehicle Inspection Window Tint Medical Exemption Form, commonly known as the Texas VI-4 form, requires careful attention to detail. This process ensures that individuals with a valid medical reason can legally have tinted windows beyond the standard legal limit. After you complete the VI-4 form, you must submit it alongside the required medical documentation. The Department of Public Safety (DPS) will review your submission. If approved, you will receive an exemption certificate. This step is crucial for anyone needing window tinting due to medical conditions, as it aligns with Texas regulations while ensuring the individual's well-being.

  1. Gather required information and documents: Ensure you have your driver's license, vehicle registration details, and medical documentation ready.
  2. Type all information: The form must be filled out electronically; handwritten forms are not accepted.
  3. Applicant Details: Enter your full name as it appears on your driver's license, driver's license number, the state of issue, and expiration date.
  4. If applicable, Patient Details: If the patient is different from the applicant, provide the patient's name, and specify the relationship to the applicant.
  5. Contact Information: Fill in your complete residence and mailing addresses, including city, state, county, and ZIP code. Also, provide your date of birth, email, and phone numbers (home, cell, business, and any other).
  6. Vehicle Information: Enter the details for up to three vehicles that the exemption will cover. Include the Vehicle Identification Number (VIN), year, make, and model for each.
  7. Physician, Optometrist or Ophthalmologist Information: Provide the name, address, and license number of the certifying medical professional. Include their city, state, ZIP, email, phone number, and fax.
  8. Certification: Read the certification statement carefully. By signing, you certify that all information provided is true and accurate to the best of your knowledge. Remember, making a false statement on this form is a criminal offense.
  9. Supporting Documentation: Attach either a letter from your physician on their letterhead or an original prescription that states the medical reason for the exemption. Ensure the document includes the physician's signature and is dated within one year of the exemption request.
  10. Submit the Form: Choose your submission method: online via secured email, fax, or mailed to the Texas Department of Public Safety. Make sure to use the correct contact details as provided on the form.

After submitting the form and necessary documentation, allow up to 15 working days for processing. The Texas Department of Public Safety will review your application. If everything is in order, you will receive your window tint medical exemption certificate. This certificate is the document that will allow you to legally have your vehicle's windows tinted beyond the state's standard limit, ensuring your medical needs are accommodated while keeping you compliant with Texas law.

Common Questions

What is the Texas VI-4 Form?

The Texas VI-4 Form is an application used by the Texas Department of Public Safety for individuals seeking a medical exemption for window tint regulations. This form allows individuals with certain medical conditions that are exacerbated by sunlight to apply for permission to use darker window tints than the law typically allows.

Who needs to fill out the Texas VI-4 Form?

Any resident of Texas who has a medical condition that requires them to have protection from sunlight beyond the standard window tint limits must fill out this form. The applicant can be the person with the medical condition or a legal guardian acting on their behalf.

What Information is required on the VI-4 Form?

The form requires detailed information, including:

  • The applicant's full name as it appears on their driver's license, including driver's license number, state of issuance, and expiration date.
  • Contact information for the applicant, including residence and mailing addresses, phone numbers, and email.
  • Detailed vehicle information for up to three vehicles, including VIN, year, make, and model.
  • Information about the physician, optometrist, or ophthalmologist supporting the exemption request, including their name, address, license number, and contact information.

What documentation must accompany the Texas VI-4 Form?

The completed application must be submitted along with a letter on physician letterhead or an original prescription that includes the medical reason for the exemption sought. This documentation must be signed by the physician and include the applicant's name.

How can the Texas VI-4 Form be submitted?

The form and accompanying documentation can be submitted through:

  1. Online secured email by contacting the Texas Department of Public Safety through their website and selecting "Vehicle Inspection".
  2. Fax to (512) 424-2774.
  3. Mailing Address: Texas Department of Public Safety Regulatory Services Division, Compliance & Enforcement Service Window Tint Medical Exemption, P. O. Box 4087, Austin, Texas 78773-0543.

How long does the process take?

Applicants should allow up to 15 working days for their application to be processed, approved, and to receive the exemption certificate. This timeline starts from the moment the Texas Department of Public Safety receives the completed form and necessary documentation.

What happens if the exemption is approved?

If the exemption is approved, an exemption letter will be sent to the applicant. This letter is the formal documentation of the medical exemption for window tint, indicating that the vehicles specified in the application are legally allowed to have window tints darker than the state standard due to medical necessity.

Is it possible to apply for more than one vehicle?

Yes, the Texas VI-4 Form allows applicants to list up to three vehicles under the same application. Each vehicle's VIN, year, make, and model must be provided.

What if my contact information changes after I submit my application?

If your contact information changes after you've submitted your application, it's important to notify the Texas Department of Public Safety as soon as possible. This ensures that any correspondence, including the exemption certificate, reaches you without delay.

Common mistakes

When completing the Texas Vi 4 form for a window tint medical exemption, people often make several mistakes that can delay the approval process or result in rejection. Understanding these common errors can help ensure the process is smooth and successful.

  1. Not using the most current form. The Texas Department of Public Safety updates their forms occasionally. Using an outdated form, even if the information provided is correct, can result in an application being rejected.

  2. Failure to type the application. The form explicitly requires that it must be typed. Handwritten forms are not accepted and will lead to an automatic rejection of the application.

  3. Filling out the application with incorrect information as it appears on the driver's license. Every detail, including the name and driver's license number, must match the information on the applicant's driver's license exactly.

  4. Including incorrect vehicle information. The VIN, year, make, and model for each vehicle must be accurately recorded. Mistakes here could lead to issues with the exemption being properly applied to the vehicle.

  5. Omitting contact information or providing outdated contact details. Current contact information, including email and phone numbers, is critical for any follow-up communication.

  6. Failing to submit the required documentation, such as a letter or original prescription from a physician, optometrist, or ophthalmologist. This documentation must clearly state the medical reason for the exemption and be dated within one year of the exemption request.

Here are some additional points to remember:

  • Ensure the physician's letter or prescription includes all necessary details and is signed by the healthcare provider.
  • Verify all personal and vehicle information twice before submitting the application.
  • Remember to sign and date the application form, as an unsigned application will not be processed.

By avoiding these common mistakes, the process of applying for a window tint medical exemption in Texas can be much smoother, helping applicants receive their exemption certificates more swiftly.

Documents used along the form

When applying for a window tint medical exemption in Texas, using the Texas VI-4 form, additional documentation is often required to support the exemption request. Apart from this primary document, other forms and documents play a crucial role in ensuring an individual's application is both complete and compliant with Texas regulations. Understanding these supplementary documents can streamline the application process, guaranteeing a smoother interaction with regulatory bodies.

  • Doctor's Letter: This is a detailed letter from a licensed physician, optometrist, or ophthalmologist, written on official letterhead. It attests to the medical necessity of the applicant requiring a window tint exemption. The letter must include a specific medical justification for the exemption, the physician's signature, and be dated within one year of the exemption request.
  • Original Prescription: An alternative to the doctor's letter, this document must contain the applicant’s name, be signed by the prescriber, and clearly indicate the medical reason for the window tint exemption. Like the doctor's letter, an original prescription must be current, dated no more than one year from when the exemption request is submitted.
  • Proof of Identification: A copy of a valid Texas driver's license or identification card of the applicant is necessary to confirm their identity and residency. The name on the identification must match the name provided on the Texas VI-4 form.
  • Vehicle Registration Documents: Documentation that proves the applicant owns or is authorized to make modifications to the vehicle(s) listed on the VI-4 form. This could include the vehicle registration document itself or a notarized letter from the owner giving permission for the modifications.
  • Exemption Renewal Forms: For individuals who already have a window tint medical exemption, renewal forms or documentation might be required to extend the exemption period. These documents confirm that the medical condition necessitating the exemption is still present and that the exemption is still needed.

Each document serves its unique purpose, complementing the Texas VI-4 form to paint a complete picture of an applicant's situation. These documents ensure that the application for a window tint medical exemption is grounded in verifiable medical needs and that the vehicle in question is legally eligible for such modifications. This comprehensive approach helps the Texas Department of Public Safety evaluate and process requests more efficiently, maintaining the balance between regulatory standards and individual needs.

Similar forms

The Texas VI-4 form, designed for Window Tint Medical Exemption, closely aligns with the Disability Placard Application used in many states for individuals requiring special parking privileges due to a disability. Both documents necessitate detailed personal information, vehicle identification, and a specifically outlined need for exemption, either for window tinting based on medical reasons or for parking conveniences due to physical limitations. They serve to provide exceptions to general rules for individuals whose medical conditions warrant such needs, ensuring that the accommodations are justified and documented appropriately.

Similarly, the Texas VI-4 form shares common aspects with Handicap License Plate Applications, which are utilized by drivers or vehicle owners seeking to obtain license plates indicating disability status. Like the VI-4 form, applicants must provide personal, vehicle, and medical practitioner information to verify the requirement for special designation. Both applications serve a regulatory exemption purpose based on health conditions, necessitating authoritative verification by a healthcare professional to ensure compliance with specific eligibility criteria.

Another document echoing the VI-4 form is the Application for Disabled Veteran License Plates and Parking Placards. This document, tailored for veterans displaying a service-connected disability, requires comprehensive details reminiscent of those in the VI-4, such as personal identification, vehicle information, and medical verification. The focus is on providing benefits to individuals with specific health-related needs, including exemption privileges and recognition of their unique status through a formal application process.

The Prescription Drug Monitoring Program (PDMP) Request forms, while targeted towards tracking controlled substances, similarly require detailed personal and professional verification. Both the PDMP requests and the VI-4 form necessitate a healthcare provider's input—demonstrating a regulated process that relies on professional expertise to approve a request, be it for medical exemption for window tint or for managing prescription medications.

Custom License Plate Application forms also share a parallel with the VI-4 form in terms of personalizing a vehicle based on user requirements or preferences. Although one focuses on aesthetic or identification changes and the other on medical exemptions, both involve submitting specific vehicle details and justifications for the request, underpinned by official approval processes to meet regulatory standards or personal needs.

Medical Marijuana Card applications, prevalent in states where medicinal cannabis is legalized, resemble the VI-4 form's structure and purpose. Applicants must disclose personal health information, obtain a healthcare provider's endorsement, and demonstrate a qualifying condition—similarly to how the VI-4 mandates documentation of a qualifying medical necessity for window tint exemptions, underscoring the regulated linkage between health conditions and legal exemptions.

Lastly, the International Fuel Tax Agreement (IFTA) License Application, despite its distinct focus on fuel tax licensing for commercial vehicles, requires detailed business and vehicle information, paralleling the VI-4 form's detailed submission criteria. Both involve regulatory compliance, verification procedures, and the need to substantiate the reason for the application—whether for tax purposes or medical exemptions—through a structured, official process.

Dos and Don'ts

When filling out the Texas Vehicle Inspection Window Tint Medical Exemption Application (Form VI-4), it is important to adhere to the following do's and don'ts to ensure your application is processed smoothly and efficiently.

Do's:

  • Ensure the form is typed: As per the instructions, the form must be filled out using a typewriter or a computer to ensure legibility and compliance with the Texas Department of Public Safety’s requirements.
  • Use the most current form: Always check that you are using the most current version of the form, which can be found on the Texas Department of Public Safety website, to avoid any delays in processing.
  • Include all required documentation: A letter on physician letterhead or an original prescription must accompany the completed application, detailing the medical necessity for the exemption. Ensure these documents are signed and dated within a year of the exemption request.
  • Review all entered information for accuracy: Before submission, double-check all entries and supporting documents for accuracy. This verification helps prevent the application from being denied due to errors or omissions.

Don'ts:

  • Submit incomplete applications: Failing to provide all the necessary information or documentation can lead to the rejection of your application. Make sure every required field is filled out and all necessary documents are included.
  • Use outdated forms: Submitting an application on an outdated form can result in processing delays. Always verify that you are using the most recent form available from the Texas Department of Public Safety.
  • Forget to sign the certification: The applicant or legal guardian must sign the vehicle owner certification section to affirm that all information provided is true and correct. An unsigned application is considered incomplete and will not be processed.
  • Provide false information: Knowingly making false statements or representations on this application is a criminal offense. Ensure all provided information and documents are genuine and accurate.

Following these guidelines will help ensure your Texas Window Tint Medical Exemption application is processed without unnecessary delay, allowing for a smoother and more efficient exemption request process.

Misconceptions

Misunderstandings about forms and regulations, such as the Texas Vi 4 form for window tint medical exemptions, can lead to confusion and incorrect applications. Below are ten misconceptions about the Texas Vi 4 form corrected for clarity.

  • The form can be handwritten: Every application must be typed to ensure readability and accuracy in processing.
  • Any physician's note will suffice: The documentation provided must either be an original prescription or a letter on the physician's letterhead, specifically stating the medical need for the exemption and must be signed by the physician.
  • Exemptions last indefinitely: Letters and prescriptions submitted as part of the exemption request must be dated within one year of the exemption request. It implies that exemptions are subject to review and renewal processes, ensuring that they remain current and valid.
  • The application process is immediate: Applicants are advised to allow up to 15 working days for the application to be processed and approved, indicating that there is a processing time which could extend based on various factors.
  • Any medical reason is acceptable: The medical reason for the exemption must meet specific criteria established by the Texas Department of Public Safety and must be clearly indicated by a healthcare professional.
  • Applying costs money: There is no mention of an application fee in the instructions, which implies that the application process for a window tint medical exemption does not require a payment.
  • The exemption applies to any vehicle: The form requires detailed information for up to three vehicles, indicating that the exemption is specific to the vehicle(s) listed in the application and not to any vehicle the applicant might use.
  • Approval is guaranteed: The requirement to provide substantial medical documentation and the certification that information is true under penalty of perjury suggest that not all applications will be automatically approved. Each application is subject to verification and approval based on its merits.
  • Exemption information is private: Applicants must disclose personal and vehicle information which may be subject to review by the Department of Public Safety for the purpose of verifying and processing the exemption request.
  • Lack of a physical mailing address disqualifies the applicant: While the form does mention a mailing address for correspondence, there are also provisions to submit the completed form online or via fax, offering alternatives for those who may not have a fixed mailing address.

Correcting these misconceptions optimizes the chances of a successful application by ensuring applicants are well-informed about the requirements and process involved in obtaining a window tint medical exemption in Texas.

Key takeaways

Filling out and using the Texas Vehicle Inspection Form VI-4 for a window tint medical exemption requires specific steps and documentation to ensure compliance with the Department of Public Safety. Understanding these requirements can simplify the application process. Here are five key takeables:

  • The form must be completed using the most current version and typed, not handwritten, to ensure clarity and compliance with the Texas Department of Public Safety's standards.
  • Applicants must provide detailed information, including the applicant's name as it appears on the driver's license, vehicle information for up to three vehicles, and the physician, optometrist, or ophthalmologist's contact details. This comprehensive data collection ensures that the exemption request is accurately processed and tied to both the applicant and the specific vehicles.
  • Verification of the medical need for a window tint exemption is mandatory. This can be provided through a letter on the physician’s letterhead or an original prescription. Both need to be signed by the practicing physician and include the medical reason for the exemption. This requirement underscores the medical basis for the exemption and ensures that it is verifiably needed for health reasons.
  • The application must be accompanied by appropriate verification documents dated within one year of the exemption request. This currency requirement ensures that the medical condition necessitating the exemption is current and still necessitates the window tint.
  • Applicants should allow up to 15 working days to process the application. This timeline gives applicants a clear expectation for planning and submitting applications in a timely manner to ensure compliance with vehicle inspection regulations without unnecessary delay.

Compliance with these guidelines not only facilitates the application process but also ensures that the exemption is legally obtained and recognized by the Texas Department of Public Safety. Prospective applicants should carefully review and adhere to these instructions when seeking a medical exemption for window tinting on their vehicles.

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