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Verification Form

In accordance with section 3304.23 of the Ohio Revised Code (R.C.), this form may be completed and submitted to add or remove persons/license plate numbers from the database of those who have been diagnosed with a communication disability or a disability that can impair communication.

R.C. 3304.23 defines a communication disability as a human condition involving an impairment in the human's ability to receive, send, process, or comprehend concepts or verbal, nonverbal, or graphic symbol systems that may result in a primary disability or may be secondary to other disabilities.

R.C. 3304.23 defines a disability that can impair communication as a human condition with symptoms that can impair the human's ability to receive, send, process, or comprehend concepts or verbal, nonverbal, or graphic symbol systems.

R.C. 5502.08 specifies that information in the communication disability database is not a public record. 

Instructions

Completed by: The individual with a communication disability or disability that can impair communication, or parent or guardian, must complete and sign Sections A and B of the document.

Section C must be completed and signed by a physician, psychiatrist, or psychologist.

  • Any person diagnosed with a communication disability or a disability that can impair communication who is eighteen years of age or older
  • Any parent or guardian of a minor child or a ward diagnosed with a communication disability or a disability that can impair communication

To request removal: Complete and sign Sections A and B only.

Payment: THIS SERVICE IS OFFERED AT NO COST.

Return Promptly: Completed forms may be mailed to the Ohio Bureau of Motor Vehicles, Attention: Remittance/DPU, P.O. Box 16521, Columbus, Ohio 43216-6521, scan and email to VIS-Administration@dps.ohio.gov or deliver to any Deputy Registrar/Ohio Bureau of Motor Vehicle office. For additional information, call: Opportunities for Ohioans with Disabilities (614) 438-1203 or go to Frequently Asked Questions

Please allow 15 business days for processing.

Attention: Incomplete, illegible, or unsigned forms cannot be processed