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					C. SCOTT VANDERHOEF
County Executive

COUNTY OF ROCKLAND
DEPARTMENT OF PUBLIC TRANSPORTATION
The Dr. Robert L. Yeager Health Center
Building T Pomona, New York 10970 (845) 364-2064 Fax: (845) 364-2074

SALVATORE CORALLO
Acting Commissioner

DR. JAMES J. YARMUS, P.E.
First Deputy Commissioner

MICHAEL J. GURSKI
Transit Administrator

Dear Customer: Thank you for inquiring about eligibility for our "ADA Paratransit" service. Enclosed is a copy of an "ADA Paratransit Application Form." Please read this and the enclosed material carefully before completing the application. Rockland County residents have two types of municipal public transportation bus systems. One is a fixed-route system and the other is demand responsive. The fixed-route system is comprised of Transport of Rockland (TOR), Clarkstown MiniTrans (CMT) and Spring Valley Jitney (SVJ). The demand-responsive system – T.R.I.P.S. – is a curbside-to-curb, shared-ride paratransit bus service for Rockland residents with physical or mental disabilities or senior citizens over the age of 60 who find it difficult or impossible to use fixedroute bus service. T.R.I.P.S. is operated by the Rockland County Department of Public Transportation (RCDPT). Under the Americans with Disabilities Act (ADA), the County has modified the T.R.I.P.S. system to accommodate two different levels of service. The highest priority service is called “ADA Paratransit Service.” To be eligible for this level of service a rider must, because of a disability, be prevented from using fixed-route bus service, and must be certified by T.R.I.P.S. as an ADA Paratransit Customer. The other level of service is regular T.R.I.P.S. service for those residents who are eligible for T.R.I.P.S. but not for ADA service. There are three types of ADA Paratransit eligibility. These are: • Unconditional - this eligibility is granted if your disability prevents you from using fixed-route public bus service for any trips that you might need to make.

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• Conditional - this eligibility is granted if you can use fixed-route public bus service under certain circumstances, but need paratransit service for certain trips. • Temporary - this eligibility is granted if you will only be unable to use fixedroute bus service for a short period. For example, if you have suffered a broken leg. Temporary eligibility can be either unconditional or conditional. If you do not meet these criteria, you can still use the regular T.R.I.P.S. service on a space available basis, after ADA Paratransit Customers’ requests have been met. (For regular T.R.I.P.S. service, you will need to complete a different application. For a regular application form, please call 364-8747 or go to www.rocklandgov.com and click on “Transportation” and then “T.R.I.P.S.”) To enable us to accurately determine your eligibility for ADA Paratransit Service, please fill out the enclosed application form as completely and thoroughly as possible. The questions are meant to determine the specific limitations you have in using standard bus service. They are also meant to determine when and under what circumstances you can use standard buses or when shared-ride service is required. After you have completed Parts 1-6, please have an appropriate medical, certified, or licensed professional (a list of which is attached) complete the last page and then submit the entire document together with a 1 inch wide by 1¼ inch tall photograph (for your ID card if you are determined to be eligible). It is important that all sections of the application form are completed. If any sections are left blank, the form will be returned to you. Information about your disability that you provide in the application will be kept strictly confidential. Material is also available in large print, and can be provided in another format, such as audiotape, if needed. Please call 364-8747 for optional format requests. Completed applications will be processed within 21 days of receipt. Please note that in some instances, we may not be able to determine your eligibility without further information. In this case, we may schedule an appointment with you for an in-person interview to allow us to better understand your functional abilities and transportation needs. Transportation to the interview and costs associated with the interview will be covered by RCDPT. If it is determined that you are able to use fixed-route bus service and, therefore, are not eligible for ADA service, we will notify you in writing of the exact reasons for this determination. An opportunity to appeal the eligibility decision in person will also be provided.
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List of Appropriate Medical, Certified or Licensed Professionals for ADA Eligibility Applications
The following professionals may complete the Professional Verification section of the ADA Paratransit Service application, provided that their qualifications are relevant to the applicant’s disability. Physician Psychologist Psychiatrist Registered Nurse Nurse Practitioner Physical Therapist Occupational Therapist Chiropractor Vocational Rehabilitation Counselor Mental Health Counselor Respiratory Therapist Social Worker Mental Health Worker Orientation and Mobility Instructor

A full-face recent photograph measuring one inch wide by one-and-one-quarter inches high must be included with your application for an A.D.A. card
Note: DON'T

FORGET TO SIGN THE CARD BELOW

PLACE PHOTO HERE
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County of Rockland A.D.A. Eligibility Card

The County of Rockland (NYS) has certified this individual for paratransit service under the Americans with Disabilities Act
Expires: Eligibility: P.C.A.

T.R.I.P.S. (845) 364-8747 www.rocklandgov.com (click on transportation)

Sign Here

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ADA PARATRANSIT APPLICATION FORM
In compliance with the Americans with Disabilities Act of 1990 (ADA), the Rockland County Department of Public Transportation (RCDPT) provides "ADA Paratransit" (i.e., shared-ride, mini-bus) service to people with a disability who cannot use standard, fixed-route municipal bus service in Rockland County, such as Transport of Rockland (TOR), Clarkstown Mini-Trans (CMT) and Spring Valley Jitney (SVJ), and who are traveling in an area served by these buses. This shared-ride service is provided by RCDPT’s T.R.I.P.S. bus service and is intended only for travel when an individual is unable to use standard buses. This application form is intended to determine when and under what circumstances the applicant can use standard buses and when ADA shared-ride, mini-bus service is required. Before completing this application form, please read the enclosed letter and information that describe eligibility for T.R.I.P.S. ADA Paratransit service in more detail. INSTRUCTIONS FOR COMPLETING THIS FORM: Be sure to read the enclosed letter and all information before you complete this form. The applicant (or someone assisting them) must complete PARTS 1 - 6. A medical or certified or licensed appropriate professional (a list of which is available upon request) must complete and sign the MEDICAL VERIFICATION section. All questions must be answered. Incomplete forms will be returned. Copies of this form are available in large print, audiotape or other accessible media upon request. If you have questions or need assistance completing this form, call any of the following agencies: Rockland County Dept. of Public Transportation Association for the Visually Impaired Rockland County Office for People with Disabilities Jawonio Rockland County Office for the Aging 364-8747 (TRIPS) 574-4950 364-2758 364-4648 364-2110

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WHEN COMPLETED, PLEASE RETURN THE ENTIRE FORM TO: Rockland County Department Transportation ADA Paratransit Services 50 Sanatorium Road Building T P.O. Box 350 Pomona, New York 10970 of Public

PART 1. GENERAL INFORMATION
Last Name:___________________ First Name:______________ MI:______ Street Address:__________________________ Apt/Bldg #:________ City:_____________________ State:_________ Zipcode:_______

Telephone: __________________ Date of Birth:________ If you want us to contact someone other than the applicant regarding this application, please identify him or her below: Name: Phone:_________________

Do you need to have information and material given to you in any of the following ways (check all that you need)? Audio Tape Braille Other:

Please give us the name and telephone number of someone we can call in an emergency. Name: Phone:______________

Relationship: ________________________________________

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PART 2. APPLICANT'S CERTIFICATION
Please indicate below the reasons why you are seeking ADA Paratransit eligibility (check all that apply): I can use standard buses to go some places, but in some instances I cannot get to or from the bus stops. I would be able to use a standard bus sometimes, but only if it was to be equipped with a wheelchair-lift. Because of my disability, I can never use standard bus service. ! I understand that the purpose of this evaluation form is to determine if there are times when I am unable to use the standard bus service provided by RCDPT (i.e., TOR buses), the Town of Clarkstown and the Village of Spring Valley and must therefore use the T.R.I.P.S. ADA shared-ride, minibus service. I understand that the information about my disability contained in this application will be kept confidential and shared only with professionals involved in evaluating my eligibility. I certify that, to the best of my knowledge, the information in this evaluation form is true and correct. I understand that providing false or misleading information could result in my eligibility status being re-examined as well as other actions by RCDPT. Applicant's signature: Date:____________

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PART 3. INFORMATION ABOUT THE APPLICANT'S DISABILITY
3a. What type or types of disabilities prevent you from using standard bus service (check all that apply)? physical disability developmental disability other visual impairment/blindness mental illness none

Please describe your disability in more detail:

3b. Is the disability described above temporary or permanent? Temporary, I expect it to last for another Permanent I don't know months

3c. Please indicate below if you use any of the following equipment or mobility aids. support cane long white cane leg braces crutches walker picture board manual wheelchair powered wheelchair alphabet board powered scooter/cart large wheelchair (over 30” wide or 48” long) other:__________________________ service animal (describe)_____________________________ I don't use any of the above aids or equipment 3d. Do you require the assistance of a (PCA) Personal Care Attendant (someone who assists you with daily life functions)? YES, I need assistance. NO SOMETIMES

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PART 4. QUESTIONS ABOUT USING STANDARD BUSES

4a.

Have you ever used standard buses (e.g., TOR, Spring Valley Jitney, Clarkstown Mini-Trans)? YES, I typically use standard buses times a week YES, I used to but stopped because________________________ NO

4b. Is there something that might help you to ride the buses (check all that apply)? YES, route and schedule information YES, learning to use the buses YES, being able to get buses with lifts YES, a communication aid YES, if bus stops were closer to where I live and where I need to go YES, (describe)___________________________________________ NO, none of these would help 4c. Can you ask for and follow written or oral instructions to use standard buses? YES NO SOMETIMES I don't know because I have never tried to use the buses If NO or SOMETIMES, please check all that apply I get too confused and might get lost Other people cannot understand me I probably could with instruction other:___________________________________________________

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4d. Using a mobility aid or on your own, how far can you travel? I cannot travel outside my house/apartment I can get to the curb in front of my house/apartment I can travel up to ¼ mile I can travel up to ½ mile I can travel up to ¾ mile 4e. Are you able to get to and from bus stops on your own? YES NO SOMETIMES I don't know because I have never tried 4f. Can you wait up to 30 minutes for a standard bus at a bus stop? YES YES, but only if the stop has a bench and shelter YES, but I don't like to wait that long NO (explain)_____________________________________________ 4g. Can you get on and off a standard bus? YES NO SOMETIMES I don't know because I have never tried If NO or SOMETIMES, please check all that apply I could if the bus had a wheelchair lift I cannot climb the stairs I probably could with instruction other:________________________________________________________

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4h. If you are able to get on and off standard buses, can you get to a seat or wheelchair position by yourself and ride the bus? YES NO SOMETIMES I don't know because I have never tried If NO or SOMETIMES, please check all that apply I need someone to help me I have a balance problem I have trouble finding a seat I need the seat nearest the door other:________________________________________________________ 4i. If you are able to get on and off standard buses, do you know where to get off the bus or can you find out by yourself? YES NO SOMETIMES I don't know because I have never tried If NO or SOMETIMES, please check all that apply I get confused and can't remember where I am going I can if the driver calls out the stops I probably could with instruction other: 4j. Are there any other conditions, which limit your ability to use the standard buses? YES (Please describe them):_______________________________ _______________________________________________________________ ________________________________________________________________ NO
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PART 5. CURRENT TRAVEL INFORMATION

5a.

Please list the three trips that you will make most frequently using the ADA service.

SAMPLE From (Address) (1) 35 Palm Drive From (Address) (1) (2) (3)

To (Place and Address) SHOPRITE, 150 Main Street To (Place and Address) _____________________ _____________________ _____________________

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PART 6. INFORMATION ABOUT TRAVEL TRAINING
NOTE: Travel training is personal (one-on-one) instruction that teaches an individual how to use standard buses.

6a.

Have you ever had any personal instruction to use standard buses? NO, I have not received any personal instruction YES, I received personal instruction through an agency. (name of agency): YES, I received personal instruction from a friend/relative If yes, indicate below all of the skills you learned: to travel to and from bus stops to cross streets to ride on the following routes (please list them): Route# Route# Route# reading bus schedules and planning trips Other: Did you complete the above described instruction? YES NO

6b. RCDPT can arrange instruction for anyone interested in learning how to ride the standard buses. Would you be interested in getting information about this service? YES NO

THIS ENDS THE PORTION OF THE FORM TO BE COMPLETED BY THE APPLICANT. THE LAST SECTION MUST BE COMPLETED AND SIGNED BY AN APPROPRIATE MEDICAL, CERTIFIED OR LICENSED PROFESSIONAL.

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PROFESSIONAL VERIFICATION

THIS PORTION OF THE FORM MUST BE COMPLETED AND SIGNED BY AN APPROPRIATE MEDICAL, CERTIFIED OR LICENSED PROFESSIONAL WHO IS TREATING THE APPLICANT. The Americans with Disabilities Act of 1990 (ADA) requires that the Rockland County Department of Public Transportation (RCDPT) provide "ADA paratransit" (i.e., shared-ride mini-bus) service to anyone who as a result of a disability cannot use standard buses and who is traveling in an area served by buses, and only to these individuals. The applicant who has asked you to review and sign this form is applying to RCDPT to be considered eligible for this service. This application form is intended to determine when and under what circumstances the applicant can use standard bus service and when they require shared-ride, mini-bus service. ADA shared-ride mini-bus service is intended only for those trips that the person cannot make on the standard bus system as a result of a disability. Please carefully review the information provided by the applicant in PARTS 2-4 of this form and then answer the questions below. (a) Has the applicant accurately described his or her disability and use of mobility aids in Part 3 of the application (Questions 1-4)? YES NO (Note exceptions or additions below) __________________________________________________________________________ __________________________________________________________________________ (b) Please provide a more detailed diagnosis of the disability or disabilities which functionally prevents the applicant from using standard bus service: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ (c) To the best of your knowledge, is the information provided by the applicant in Parts 2-4 of this application form consistent with the above diagnosis? YES NO (Note exceptions or additions below) __________________________________________________________________________ __________________________________________________________________________

Signature:

Date:_______________

Print Name and Title:_________________________________________________________________________ Professional License, Registration or Certification #: Business Address:____________________________________________________________________________ City/State: Telephone Number:_______________________
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Zip Code:_______________

WHAT IS ADA PARATRANSIT SERVICE?
ADA Paratransit Service is a curbside to curbside shared-ride bus service for Rockland County residents who, because of a disability, are prevented from using standard bus service -- Transport of Rockland (TOR), Clarkstown MiniTrans (CMT) or Spring Valley Jitney (SVJ). ADA Paratransit Service is operated by the Department of Public Transportation, through its T.R.I.P.S. service. It is a shared-ride transportation system. Passengers may or may not go directly to their destination and there can be several pick-ups and drop-offs along the way. This service operates only in Rockland County.
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ADA Paratransit Service is currently provided throughout Rockland County six days a week, Monday through Saturday, and on selected holidays. Hours of operation are from 7:00 a.m. to 7:00 p.m., Monday through Friday; Saturdays: 8:00 a.m. to 5:00 p.m. Please call for holiday hours, (845) 364-8747,OR 364TRIP.

HOW MUCH DOES IT COST?
The fare is $2.00 each way. You have the right to have one aide travel with you, and may have one additional guest if there is space available; however, guests pay a fare of $2.00 each way. If you need a personal care attendant, the attendant is not required to pay a fare.

HOW DO I REQUEST A RIDE WITH THE ADA PARATRANSIT SERVICE?
Call the Department of Public Transportation’s T.R.I.P.S. service at least one business day, or up to two weeks in advance to request a ride. When you call (845) 364-8747 to request transportation, please specify that you are requesting ADA Paratransit Service and have the following information ready: 1) Your full name 2) Date of trip 3) The time you need to arrive at your destination and approximately how long you will be there 4) The complete address of your destination, and doctor’s name and phone number, if applicable 5) If you need assistance boarding or if you use a wheelchair or other mobility device 6) If an aide or personal assistant will be traveling with you

IMPORTANT!
! If you use a mobility device, please be sure to specify the type (manual wheelchair, motorized wheelchair, scooter, walker, etc…) and any special needs you may have
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! T.R.I.P.S. ADA Paratransit Service does not provide emergency service. ! Same day rides can sometimes be arranged by calling the T.R.I.P.S. office. If there is space and time available, your request will be fulfilled. ! If you have a consistent request for the same destination at least three days per week, it can be placed once and kept on file with the same pickup and return times for each trip. ! We develop routes for our vehicles each day for the following day. While ADA Paratransit Service riders have priority for service, we cannot guarantee a ride prior to developing routes. Therefore, we will contact you mid-afternoon the day before to let you know whether we can fulfill your request. ! During inclement weather, many doctor’s offices, schools and places of business cancel appointments or close. It is important during these times to confirm that the appointment at your destination is still scheduled. During bad weather, call your destination location to confirm and let us know right away if you need to cancel your ride. Delays and cancellations are also often announced on WRCR 1300 AM or WHUD 100.7 FM.

WHAT ARE MY RESPONSIBILITIES AS A RIDER?
! Please be ready at least 20 minutes, and outside at least five minutes, before your scheduled pick-up time. ADA Paratransit Service is only able to wait two minutes beyond your scheduled pick-up time in order to remain on schedule. If the T.R.I.P.S. bus does not arrive within 15 minutes of your scheduled pick-up time, please call the T.R.I.P.S. office at 364-8747. On Saturdays, please call cell phone #1(406-1016), #2(4061017), or #3(406-1018). ! It is recommended that passengers wear seatbelts at all times. ! There is NO SMOKING, eating or drinking aboard T.R.I.P.S. buses. ! Please have your ID card available when boarding. ! No pets are permitted, with the exception of service animals (i.e. guide dogs). ! Packages are permitted, but only what you can carry. Drivers are not allowed to assist you with your packages. ! If you have an aide or personal care attendant, or if you want to bring a guest, please let us know when requesting your ride.

WHAT DO I DO IF I NEED TO CANCEL MY RIDE?
Call as soon as possible if you must cancel your ride. If you call less than two (2) hours prior to your scheduled pick-up time, it will be considered a "no show" unless there was good cause for the late call. Three "no shows" within a 30-day period may lead to suspension.
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WHAT ELSE DO I NEED TO KNOW?
CONDUCT T.R.I.P.S. ADA Paratransit Service is a public transit service. Passengers are expected to act appropriately when using the service. Individuals who engage in or threaten to engage in violent, seriously disruptive, illegal, unsafe or seriously inappropriate conduct will be suspended from the service. Seriously inappropriate behavior includes, but is not limited to: acts of vandalism; physical assault of a driver or other passenger; verbal assault of a driver or passenger; inappropriate sexual behavior; illegal behavior while on the bus; refusing to wear a seatbelt; or eating, drinking or smoking on the bus. DRIVER ASSISTANCE Drivers may only provide assistance to passengers with boarding or leaving the vehicle and by fastening seatbelts and other securement devices. Drivers are not allowed to assist a passenger in traveling between the curb and their home or destination. If a passenger finds it difficult to get on or off the bus, they should tell the driver they need to use the lift. SUSPENSION POLICY If a passenger violates any safety or conduct policy or has a medical problem affecting safety, the Department of Public Transportation may suspend the passenger if it deems it necessary. The Department will notify the passenger with the reasons for the suspension and the length of the suspension. T.R.I.P.S. ADA PARATRANSIT SERVICE SUSPENSION AND GRIEVANCE POLICIES ARE AVAILABLE UPON REQUEST.

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FREQUENTLY ASKED QUESTIONS ABOUT T.R.I.P.S. ADA PARATRANSIT SERVICE REQUEST VS. RESERVATION When you call T.R.I.P.S. and ask for a ride, please note that you have made a REQUEST – not a RESERVATION. No guarantee can be made that the requested ride will be accommodated. Riders will be notified the day before their requested ride as to whether or not the ride can be given. WHY ARE SOME RIDES ACCOMMODATED AND OTHERS NOT? It can sometimes be difficult to understand why some days T.R.I.P.S. is able to accommodate requests and other days we cannot. There are many determining factors for this: The number of requests for transportation varies from day to day. Other determining factors include how many drivers and buses are available for that operating day. EXAMPLE: Buses may be unavailable because they are being repaired or scheduled for preventive maintenance; Operators could be attending mandatory driver education training, or could be sick or on vacation. WHY ARE THE BUSES SOMETIMES NOT CROWDED? We route our buses for maximum efficiency. This means we are constantly picking up and dropping off passengers. Remember, we are a curb-to-curb service. This means that we are not picking up people along a specific route or at a specific time. Each request is combined with other requests, which makes a route for each bus every day.
CALLED TWO WEEKS AGO. TAKE ME?

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WHY

DIDN’T YOU TELL ME THEN THAT YOU COULD NOT

As noted above, the number of ride requests vary from day to day, so until we do the actual routing, which is always done the day before the requested ride, we cannot be sure that we will be able to fulfill your request.
AS RIDERS, HAVE TO WAIT FOR THE BUS IF IT IS LATE, BUT YOU CANNOT WAIT FOR US IF WE ARE LATE?

WHY DO WE,

T.R.I.P.S. does run late at times due to reasons such as: traffic, detours, accidents, breakdowns, weather and road conditions. The reason we are only able to wait two (2) minutes beyond your pick-up time is to prevent the rest of the route from falling behind schedule. If we had to
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wait for each rider that is running 5 to 10 minutes late, the bus would fall severely behind schedule which would be unfair to other riders who are waiting for the bus at their pre-arranged times. I
LEARNED ON THE DAY OF MY SCHEDULED TRIP THAT MY MEDICAL APPOINTMENT WAS MOVED FROM MORNING TO AFTERNOON. CAN I CHANGE MY TRIP TIMES?

We will try, but unfortunately, we probably cannot. Routes are developed with each and every person’s request in mind regarding the destination location and arrival time. It is not possible to change an arrival time after a route has already been developed because it would affect the times for other riders. We do, however, encourage riders to advise if their arrival time is flexible when making their request. OTHER CONSIDERATIONS? We know that there are times when riders must cancel a trip due to sickness or a change of plans. However, it is extremely important that you call us as soon as possible to let us know if you do not need to be picked up. By calling right away, we may be able to transport someone else whose request could not otherwise be accommodated. The most serious problem T.R.I.P.S. encounters is when a ride is confirmed and the rider is not there when the bus comes for them. This not only inconveniences drivers and other T.R.I.P.S. staff, but also adversely affects fellow riders. T.R.I.P.S. strives to use valuable driving time and available seating capacity as effectively as possible. We waste both when we go to a requested location only to find no customer there. We ask riders to please be courteous and remember to call us at 364-TRIP (8747) when you need to cancel a ride. This information has addressed the most commonly asked questions about T.R.I.P.S. We hope that this has helped you understand how we operate. If you have any further questions, please call us at 364-TRIP (8747).

T.R.I.P.S. Mission Statement To provide safe, courteous, efficient public paratransit services to meet the needs of the people of Rockland County.
Revised April 2005

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