Access Services
Applying for Access
> Applying for Access
> In-person Evaluation Required
> Submitting The Application
> Other Transportation Resources
Applying for Access
An in-person evaluation is required to
determine your eligibility with Access
Services. In order to ensure that Access has
the necessary information to process your
application, complete the following steps:
Access Rider ID number is required.
If you do not have an Access ID Number,
please contact Customer Service
at 1.800.827.0829 (TDD 1.800.827.1359)
or visit eligibility.accessla.org to have one
issued (application will not be processed
if ID number is missing).
1
Complete and mail the application
portion in the enclosed envelope to:
Access Eligibility Center
5747 Rickenbacker Rd
Commerce, CA 90040 or via email
to: EligDept@accessla.org
If you have other questions related
to the application or need assistance,
filling out the form, please call
1.800.827.0829 (TDD 1.800.827.1359).
2
Allow seven (7) calendar days
after you send in your application
form to call the Access Eligibility
Scheduling Center.
3
Schedule your in-person evaluation at
626.532.1616 (TDD 626.532.1620),
Monday through Friday from
8am-5pm. Please do not call before
the seven (7) calendar day period.
Access provides free transportation to
and from your in-person evaluation.
Applicants also have the option to
provide their own transportation.
Required In-person Evaluation
> A photo will be taken. We will ask to
remove articles that obscure your face.
> If applicable, bring your primary
mobility device that you intend to
use while out in the community.
> If you need assistance, please bring a
personal care assistant (PCA).
> Bring a valid photo ID. Access
accepts the following form(s) of
photo ID (required):
a. State issued Driver’s License or ID
b. Military ID
c. U.S. Passport
d. LACTOA Reduced Fare ID card
e. Other transit operator reduced
fare ID card
> Children under 18 years of age:
a. School ID
b. Birth Certificate with parent’s
photo ID
> Bring any documentation that
will support the information in
your application (optional).
> Eligibility is based on your functional
abilities to use fixed route bus or
train services.
> The evaluation will include an
interview as well as a functional and/
or a cognitive evaluation, if necessary.
The Evaluator will be looking at your
functional skills which are needed
to ride buses and trains.
> If the Evaluator needs verification
from your healthcare professional,
they will contact them.
The application process will be
considered complete with the following:
a. Completed application including
a copy of your photo ID
b. Completed in-person evaluation
c. Completed healthcare professional
verification (if applicable)
You will receive a letter within 21 days
after the completion of the application
process informing you of your
eligibility status.
This application is available in alternative
formats. If you require an accessible
format of this application, please
contact Access Customer Service:
1.800.827.0829 (TDD 1.800.827.1359)
between the hours of 8am and 5pm
Monday through Friday.
If you have a concern about what
information you need or what to do to
prepare, the Disability Rights Education
and Defense Fund (DREDF) has
published “ADA Paratransit Eligibility:
How To Make Your Case.” You can get
a copy of this helpful guide online at
dredf.org or by calling Access Customer
Service Center at 1.800.827.0829
(TDD 1.800.827.1359).
Other Transportation Resources
Los Angeles County has fixed route
bus and train services that are equipped
with ADA accessible features such
as lifts or ramps, securement spaces,
designated priority seating, stop
announcements, audio announcements,
handrails, lighting, and operators
who are trained to assist passengers
with disabilities. These modes of
transportation do not require
prior reservation.
For more information about bus and
train routes, schedules, and/or reduced
fares in Los Angeles County, please
visit metro.net or call 323.GO.METRO
(323.466.3876). Riders with hearing
or speech impairments can use the
California Relay Service. Dial 711 and
the number you need.
Access can assist with your search for
transportation options including Travel
Training which provides assistance with
learning how to use the fixed route bus
or train services. For more information
call Access Customer Service at
1.800.827.0829 (TDD 1.800.827.1359)
or visit accessla.org.
Questions? Please call
Customer Service:
1.800.827.0829
(TDD 1.800.827.1359)
Access ID number required:
To request an ID number, please call
Customer Service at 1.800.827.0829
or visit eligibility.accessla.org.
*Application will not be processed without ID#.
In-person Evaluation Application
Personal Information
1
Applicant’s primary language (if other than English)
Date of birth Gender:
Male Female Non-binary
Home street address Apt number
City State Zip
Mailing address (if different from your home address) Apt number
City State Zip
Primary phone number Alternate phone number
Cell TDD Cell TDD
Email
1
I do not have a
Medi-Cal number
Medi-Cal ID number (optional):
Last name
First name MI
Access ID number (6 or 7-digit number)
Access Services accessla.org
When was the last time you rode the fixed route bus or train independently?
How frequently do you ride the fixed route bus or train?
Daily Weekly Monthly Not currently using Never used
What is the farthest that you can travel outdoors without the help of another
person (using mobility device/aid, if applicable)?
Less than 1 block 1-4 blocks More than 4 blocks
How far do you live from your nearest bus stop?
Less than 1 block 1-4 blocks More than 4 blocks Do not know
When using fixed route bus or train do you travel?
Independently With assistance Not applicable
Are there any physical barriers or environmental conditions that prevent you
from using public transportation?
Yes No
Current Use of Public Transportation
3
2
Emergency Contact
2
Name Relationship to applicant
Primary phone number Alternate phone number
Access ID number
Disability / Health Condition Information
4
Please describe the disability or health condition which prevents your ability
to travel on a bus or train independently. You may attach more documentation
on a separate page.
Is this a permanent disability or health condition?
Yes No
If no, how long do you expect it to prevent you from using fixed route buses
or trains?
Week(s) Month(s)
Disability/Health Condition Information
3
Mobility Devices / Aids
5
Do you require assistance when traveling on the bus or train? Yes No
Sometimes Not applicable
Do you use a service animal?
Yes No
What function is it trained to perform?
What is your primary mobility device/aid? (If applicable)
Powered wheelchair Manual wheelchair White cane
Walker Cane Portable oxygen
Brace Prosthesis
Crutches Powered scooter
Other:
Access ID number
4
Access ID number
Mobility Devices / Aids (cont.)
What is your secondary mobility device/aid? (If applicable)
Powered wheelchair Manual wheelchair White cane
Walker Cane Portable oxygen
Brace Prosthesis
Crutches Powered scooter
Other:
You will be assessed with the primary mobility device/aid that you bring to the
eligibility center at the time of your appointment. If you change your mobility
device following your evaluation, you may be required to return for a new
evaluation in your new device. Use of a different mobility device may change
your functional ability to use accessible fixed route transit.
IMPORTANT: Most of the accessible vehicles in our fleet are designed to
accommodate a mobility device no larger than 30 inches wide by 48 inches
long and/or weighing with its passenger up to 600 pounds. While we make
all reasonable efforts to accommodate our riders, if your mobility device is
larger than this, we may be unable to transport you either because it would
damage the vehicle or to do so would impose an unreasonable safety hazard.
Please provide the contact information of your treating healthcare professional
who is familiar with your condition and, if needed, could be contacted for
clarifying information.
The following licensed healthcare professionals are authorized to provide
clarifying information:
> Physician (MD or DO) > Registered nurse > Psychologist
> Psychiatrist > Ophthalmologist > Optometrist
> Physical therapist > Occupational therapist
> Other licensed provider familiar with your condition
Healthcare Professional Contact Information
6
5
I hereby certify that, to the best of my knowledge, the information given in this
application is correct. I authorize my healthcare professional to release any and
all information about my disability or health condition and its effects on my
functional ability to travel. I understand that all medical information will be kept
strictly confidential. I agree to undergo an in person assessment of my functional
abilities and limitations for the purpose of making a determination regarding my
eligibility for ADA paratransit service.
Print name Signature Date
Certification and Authorization for Release of Information
7
Healthcare professional’s name Specialization
Institution/facility/agency name
Street address Suite number
City State Zip
Primary phone number Alternate phone number
Fax number Email
Healthcare Professional Contact Information (cont.)
Access ID number
6
Person That is Authorized to Complete This Form on Behalf
of the Applicant (optional)
8
Name Relationship to applicant
Primary phone number Alternate phone number
Referring agency (if applicable)
Signature of person, other than applicant, completing form Date
Access ID number
Access Eligibility Center
5747 Rickenbacker Rd
Commerce, CA 90040
Your Access
Application is here.
20-0362 ©2020 Access Services
