How to Fill Out California Form REG 195 (w/Examples) + FAQs

California Form REG 195 is the California Department of Motor Vehicles’ Application for Disabled Person Placard or Plates (REV. 7/2023), and any California resident with a qualifying disability — or an organization that transports disabled people — files it to receive a placard or DP plate that grants special parking rights under California Vehicle Code §22511.55. The form has three parts: applicant information, the type of placard or plate requested, and a medical professional’s certification of disability.

A small mistake on REG 195 — a missing license number from the certifying doctor, an unchecked disability code, or a name that does not match the applicant’s ID — is the leading reason the California DMV rejects the form, and the DMV reports that more than 2.7 million disabled person placards are active in California at any given time, with thousands of applications denied each year for paperwork errors alone.

Here is what you will learn in this guide:

📝 How to complete every section, box, and signature line on REG 195 the right way
🏥 What the medical professional must sign, and which license types the DMV accepts
🚗 The differences between permanent placards, temporary placards, travel placards, and DP plates
💵 Fees, processing times, and the exact mailing address and DMV portal you need
⚖️ The criminal penalties under CVC §4461 and §4463 for misuse, fraud, or lending a placard

What Form REG 195 Is and Who Must File It

Form REG 195 is the only form California uses to request a new disabled person parking placard, a replacement placard, or disabled person license plates. It is published by the California DMV and authorized under California Vehicle Code §22511.55 and §22511.59. The revision date printed in the lower-left corner of the current form is REV. 7/2023, and you should confirm that date before you sign so you are not using an outdated version.

You file REG 195 if you are a California resident with a qualifying disability listed in CVC §295.5. Qualifying disabilities include the loss of one or more lower limbs, an inability to walk 200 feet without stopping, severe heart or lung disease, blindness in both eyes, and other conditions a licensed medical professional certifies in Section 3. Veterans with service-connected disabilities may also qualify, but they often use the DMV Disabled Veteran License Plate process in addition to or instead of REG 195.

Organizations that regularly transport disabled people — such as nursing homes, group homes, and senior centers — also file REG 195 to receive organizational placards or plates for the vehicles they own. The same form serves all four placard types: permanent, temporary, travel, and the DP license plate. Choose only one box in Section 2; checking more than one will cause the DMV to return your application unprocessed.

Before You Start: Documents and Information You Need

Gather every item below before you open the form, because a half-finished application that sits on your kitchen table for weeks risks expired medical signatures and lost paperwork. The medical certification in Section 3 is only valid for the date the doctor signs it, and the DMV expects the form to arrive within a reasonable window of that signature.

Your full legal name as it appears on your California driver license or ID. A name mismatch triggers a manual review and can delay your placard by 4–6 weeks.
Your California driver license or ID card number. Without it, the DMV cannot link your placard to your record under CVC §1808.
Your date of birth in MM/DD/YYYY format. This must match DMV records exactly.
Your current residence address. P.O. boxes alone are not accepted for the residence line; use a street address.
A separate mailing address if different. The DMV mails the placard to this address, so accuracy matters.
The vehicle license plate number if you are applying for DP plates rather than a placard. The vehicle must be registered to the disabled person or to a co-owner.
The certifying medical professional’s full name, license type, license number, and signature. Section 3 cannot be filled out by you.
Payment for the $6 temporary placard fee if applying for a temporary placard; permanent placards, travel placards for permanent placard holders, and the first set of DP plates are free under CVC §22511.55.
A photocopy of valid government-issued ID if you are submitting in person at a DMV field office.
Proof of veteran status (DD-214 or VA letter) if you check the disabled veteran box.

If any of these items is missing, the DMV will mail back a Statement of Facts request, and you will lose 3–5 weeks while the paperwork bounces back and forth.

Where to Get the Form and How to Access It

You can download REG 195 directly from the DMV’s official forms library or grab the direct PDF link. The form is fillable on screen, which means you can type your answers into the PDF, save it, and print a clean copy with no handwriting errors. Many readers find the typed version easier for the DMV to process because handwritten entries that drift outside the boxes can be misread by scanning equipment.

You can also pick up a paper copy at any DMV field office free of charge. Field office staff will hand you the current revision and a pre-addressed envelope on request. If you cannot leave home, call the DMV at 1-800-777-0133 and ask for REG 195 to be mailed to you; expect 7–10 business days for delivery.

A small number of renewal scenarios can be completed through the DMV online portal once your record is on file, but new applications and any application that requires fresh medical certification must be filed on paper. Do not try to email a scanned REG 195 to the DMV; emailed forms are not accepted and will be deleted unread.

Print REG 195 single-sided on standard 8.5×11 white paper. Double-sided prints sometimes confuse DMV scanners, and the form is short enough that two pages are not a burden.

Step-by-Step: How to Fill Out California Form REG 195 Line by Line

The form is divided into three numbered sections plus a fee chart at the bottom. Work through them in order, and never sign Section 2 until Section 3 has been completed by your medical professional.

Section 1: Type of Placard or Plate Requested

Box: Permanent Disabled Person Parking Placard

This box asks whether you want the standard red placard that lasts two years and renews automatically by mail. Check it if your disability is permanent — meaning a doctor has determined it will not improve.

To answer it, place a single clear X inside the box; do not circle the box, and do not check more than one placard type. For example, Maria Lopez, a 72-year-old with severe arthritis and a doctor’s certification that her condition is permanent, marks an X in the permanent placard box.

A common nuance is the renewal cycle: permanent placards expire on June 30 of every odd-numbered year, and the DMV mails a new one automatically if your address is current. The most common mistake is checking both permanent and temporary, which causes the DMV to reject the form and start your wait over. A misconception filers carry is that “permanent” means lifelong; it actually means renewable indefinitely as long as your address stays on file and you do not surrender the placard.

Box: Temporary Disabled Person Parking Placard

This box is for short-term disabilities expected to last six months or less, such as recovery from surgery or a broken leg. The temporary placard is red on one side and is valid for up to 180 days or until the date the doctor specifies, whichever comes first.

Place an X in the temporary box and confirm the doctor lists an expiration date in Section 3. Carlos Reyes, recovering from knee replacement surgery, checks the temporary box and his surgeon writes 11/30/2026 as the expected end date.

The nuance here is the $6 fee, which is the only placard type that costs money up front. The most common mistake is forgetting to enclose the $6 check or money order, which causes the DMV to mail the application back. A misconception is that you can extend a temporary placard by phone — you cannot; you must file a brand-new REG 195 with a fresh medical certification.

Box: Travel Parking Placard

A travel placard is a 30-day placard for California residents with permanent placards who plan to travel and want a backup, or for non-residents visiting California who already hold a placard from another state or country. It is free for permanent placard holders.

Mark the travel box with an X and indicate your travel dates if requested. Janet Park, a permanent placard holder visiting family in Oregon, checks the travel box so she has a second placard for her trip.

The nuance is that non-residents must attach a copy of their out-of-state placard or a doctor’s letter. The most common mistake is requesting a travel placard instead of a permanent one — the travel placard is a supplement, not a replacement. A misconception is that the travel placard works in every U.S. state; it does, but only for the 30-day window printed on it.

Box: Disabled Person License Plates

DP plates attach to a vehicle owned or co-owned by the disabled person and grant the same parking rights as a placard. Check this box only if the vehicle is registered to you.

Place an X in the DP plates box and write the current license plate number on the line provided. Marcus Johnson, a disabled veteran whose Toyota Camry is registered in his name, checks the DP plates box and writes 8ABC123.

The nuance is that DP plates stay with the vehicle, so if you sell the car you must surrender the plates within five days under CVC §5101. The most common mistake is requesting plates for a vehicle owned only by a relative; the DMV will deny this. A misconception is that DP plates replace your need for a placard — they don’t, because plates only work on the vehicle they are bolted to.

Section 2: Applicant Information

True Full Name

The form asks for your true full legal name, last name first, then first name, then middle name. Write it exactly as it appears on your California driver license or ID.

Print clearly in block letters or type into the fillable PDF. Lopez, Maria, Elena is the right format for a filer named Maria Elena Lopez.

The nuance is hyphenated and compound names: include the hyphen exactly. The most common mistake is writing a nickname or a married name that does not match DMV records, which causes a name-mismatch hold. A misconception is that initials are acceptable; they are not — write the full middle name or leave it blank if you have none.

Driver License or ID Card Number

This field asks for your eight-character California driver license or ID number. Enter it with no spaces or dashes.

Type it carefully — N1234567 is a typical format. Carlos Reyes enters his ID number as it appears on the front of his card.

The nuance is that out-of-state license holders must instead provide their out-of-state license number and state. The most common mistake is transposing two digits, which causes the DMV to fail to match your record. A misconception is that the number on the back of the card works; only the front-of-card number is correct.

Date of Birth

The form asks for your date of birth in MM/DD/YYYY format.

Write each piece in two-digit or four-digit form as marked. Maria Lopez writes 03/14/1953.

The nuance is that the DMV cross-checks this against its records, so any deviation triggers a manual review. The most common mistake is writing the year in two digits, like 53, which can be read as 1953 or 2053. A misconception is that you can leave this blank if your ID number is correct; you cannot — both are required.

Residence Address

This line asks where you actually live, not where you receive mail. Enter the street number, street name, apartment number if any, city, state, and ZIP code.

Print one line for the street and one line for the city/state/ZIP. Marcus Johnson writes 4421 Pine Street, Apt 7B, Sacramento, CA 95814.

The nuance is that a P.O. box alone is not acceptable here — you must give a physical address. The most common mistake is using a relative’s address you don’t actually live at, which can be considered fraud under CVC §4463. A misconception is that out-of-state addresses are fine; they are not — REG 195 is only for California residents.

Mailing Address (if different)

If you receive mail somewhere other than your residence — a P.O. box, a relative’s home, or a business — enter that address here.

Leave it blank if your residence address is also your mailing address. Janet Park enters PO Box 221, Bishop, CA 93514 because her cabin is rural and the post office does not deliver there.

The nuance is that the DMV mails your placard to this address, so a typo means the placard is lost. The most common mistake is writing the same address twice, which clutters the form. A misconception is that the DMV will use the address from your driver license file; it uses what you write here.

Telephone Number and Email

These fields are optional but help the DMV reach you if there is a problem with your application.

Enter a 10-digit phone number with area code, and a working email if you have one. Carlos Reyes writes (916) 555-0142 and [email protected].

The nuance is that providing an email may speed up communication on rejected forms. The most common mistake is writing an old phone number that goes to voicemail you never check. A misconception is that the DMV will spam these contacts; the DMV uses them only for application issues.

Applicant’s Signature and Date

You sign and date this line only after the medical professional has completed Section 3, and your signature certifies under penalty of perjury that everything you wrote is true.

The nuance is that organizational applicants sign on behalf of the organization and add their title. The most common mistake is signing in pencil or with a stamp, which the DMV rejects. A misconception is that a family member can sign for you; they cannot, unless they have a recorded power of attorney filed under Probate Code §4000.

Section 3: Doctor’s Certificate of Disability

Disability Code (Boxes A through I)

Section 3 lists the qualifying disability codes from CVC §295.5, labeled A through I, covering conditions like loss of a lower limb, inability to walk 200 feet, lung disease, heart disease, and blindness.

The medical professional checks one or more codes that apply to you. Maria Lopez’s doctor checks code B for inability to move without an assistive device.

The nuance is that more than one code can be checked when the disability is multi-factor. The most common mistake is leaving every code blank, which voids the certification. A misconception is that the patient can suggest the code; only the medical professional may select it.

Permanent or Temporary

The doctor marks whether your disability is permanent or temporary, and if temporary, writes the expected end date.

The doctor writes the date in MM/DD/YYYY format inside the temporary box if applicable. Carlos Reyes’s surgeon checks temporary and writes 11/30/2026.

The nuance is that “permanent” is a medical judgment, not a guess. The most common mistake is checking both boxes, which makes the form ambiguous. A misconception is that “permanent” can be revoked later; it can be, when the patient surrenders the placard.

Medical Professional’s Name, License Type, License Number, Address, Phone, and Signature

The certifier must list a full name, the license type (M.D., D.O., physician assistant, nurse practitioner, certified nurse midwife, chiropractor for limb-related disabilities only, optometrist for vision only, podiatrist for foot disabilities only), license number, office address, phone number, and signature.

Each field gets the doctor’s actual data — for example, Dr. Anita Shah, M.D., License A123456, 1500 Oak Ave Ste 200, Sacramento CA 95816, (916) 555-0199.

The nuance is that out-of-state medical professionals are accepted only if licensed in the United States and willing to provide their state license number. The most common mistake is missing the license number, which voids the form. A misconception is that any healthcare worker can sign — only the license types named in CVC §295.5 qualify, and chiropractors, optometrists, and podiatrists are limited to disabilities within their scope.

Three Filled-Out Examples Using Real Scenarios

Scenario 1: Maria Lopez, Senior with a Permanent Mobility Impairment

Maria is a 72-year-old retired teacher in Sacramento with severe osteoarthritis. Her physician has determined her condition is permanent.

Form Section	What Maria Enters
Section 1 placard type	X in Permanent Disabled Person Parking Placard
True full name	Lopez, Maria, Elena
Driver license number	N1234567
Date of birth	03/14/1953
Residence address	812 Elm Street, Sacramento, CA 95814
Mailing address	(left blank — same as residence)
Phone / email	(916) 555-0188 / [email protected]
Applicant signature and date	Signs in blue ink, dates 09/12/2026
Section 3 disability code	Doctor checks code B and marks Permanent
Medical professional info	Dr. Anita Shah, M.D., A123456, 1500 Oak Ave, Sacramento CA 95816

Scenario 2: Carlos Reyes, Post-Surgery Temporary Placard

Carlos is 45 and recovering from knee replacement surgery. His surgeon expects him to walk normally again within 90 days.

Form Section	What Carlos Enters
Section 1 placard type	X in Temporary Disabled Person Parking Placard
True full name	Reyes, Carlos, Mateo
Driver license number	D7654321
Date of birth	07/22/1981
Residence address	2210 Mission Blvd, Apt 4, San Diego, CA 92109
Mailing address	(left blank)
Phone / email	(619) 555-0142 / [email protected]
Applicant signature and date	Signs in black ink, dates 09/02/2026
Section 3 disability code	Doctor checks code F and marks Temporary, end date 11/30/2026
Medical professional info	Dr. Marcus Lin, M.D., G987654, 100 Hospital Way, San Diego CA 92103
Fee enclosed	$6 check made payable to DMV

Scenario 3: Marcus Johnson, Disabled Veteran Applying for DP Plates

Marcus is a 58-year-old Army veteran with a service-connected disability rating from the VA. He owns his Toyota Camry outright.

Form Section	What Marcus Enters
Section 1 placard type	X in Disabled Person License Plates; vehicle plate 8ABC123
True full name	Johnson, Marcus, David
Driver license number	V2345678
Date of birth	05/04/1968
Residence address	4421 Pine Street, Apt 7B, Sacramento, CA 95814
Mailing address	(left blank)
Phone / email	(916) 555-0177 / [email protected]
Applicant signature and date	Signs in blue ink, dates 09/15/2026
Section 3 disability code	Doctor checks code A (loss of use of lower limb) and marks Permanent
Medical professional info	Dr. Linda Reyes, M.D., B654321, 200 VA Way, Sacramento CA 95828
Attachment	Copy of VA disability rating letter

How to File the Completed REG 195

You may file REG 195 by mail, in person at a DMV field office, or in limited renewal cases through the DMV online portal. Each channel has different timelines and proof-of-filing methods.

By mail. Send the original signed form, the $6 fee if filing for a temporary placard, and any attachments to Department of Motor Vehicles, Special Processing Unit MS D238, P.O. Box 932345, Sacramento, CA 94232-3450. Use a check or money order payable to DMV; cash is not accepted by mail. Expected processing time is 3–4 weeks. Keep a photocopy of the signed form and your mailing receipt as proof.

In person. Bring the completed form and a valid photo ID to any DMV field office. The clerk will accept cash, check, money order, debit card, or credit card. Processing is usually same-day for the receipt and 2–3 weeks for the placard to arrive by mail. Your stamped receipt is your proof of filing.

Online (renewals only). If you are renewing an existing permanent placard with no medical change and your record is current, you may use the DMV online portal. The portal accepts debit and credit cards, and a confirmation email is your proof of filing.

Do not fax REG 195. The DMV no longer accepts faxed disabled person applications, and any fax you send will be discarded.

What Happens After You File

After the DMV receives your REG 195, the Special Processing Unit reviews Section 3 first to confirm the medical professional is licensed and the disability code is valid. If anything is missing, the DMV mails you a Statement of Facts (REG 256) request and pauses your application.

If everything checks out, the DMV mails the placard or plates to the address you listed in Section 2. Permanent placards arrive in 3–4 weeks; temporary placards in 2–3 weeks; DP plates in 4–6 weeks because they are manufactured to order. Each shipment includes a wallet-sized identification card you must carry whenever you use the placard, under CVC §22511.55(a)(2).

If your application is denied, the DMV will mail a written explanation. You may correct the listed error and resubmit, or you may appeal under CVC §14400 by requesting an administrative hearing within 60 days of the denial notice.

Permanent placards renew by mail every two years on June 30 of odd years. The DMV mails the new placard automatically as long as your address is current; if you have moved, file a Change of Address (DMV 14) before the renewal cycle.

Mistakes to Avoid When Filling Out REG 195

Checking more than one placard type in Section 1. The DMV will reject the form and you must restart.
Writing a nickname instead of your true legal name. This causes a name-mismatch hold for 4–6 weeks.
Leaving the driver license or ID number blank. Without it, the DMV cannot link the placard to your record.
Using a P.O. box for the residence address line. The DMV requires a physical address.
Forgetting the $6 fee for a temporary placard. The application bounces back unprocessed.
Letting the doctor sign before you do. That order is fine, but the patient must never sign before reading Section 3 in full.
Submitting a form with no disability code checked. Section 3 is invalid and the placard is denied.
Using an unlicensed signer for Section 3. Only the license types listed in CVC §295.5 qualify.
Faxing or emailing the form. Neither channel is accepted; the form will be discarded.
Using an outdated revision of the form. Confirm REV. 7/2023 in the lower-left corner before signing.
Borrowing or lending a placard. This is a criminal offense under CVC §4461 carrying fines up to $1,000 and possible jail time.

Do’s and Don’ts

Do’s:

Do confirm REV. 7/2023 in the corner of your form, because old versions get rejected.
Do print or type clearly in blue or black ink so the DMV scanner reads your entries.
Do double-check that your name and date of birth match your DMV record exactly.
Do enclose the $6 fee for a temporary placard as a check or money order made out to DMV.
Do keep a photocopy of the signed form and any payment receipt as proof of filing.
Do call 1-800-777-0133 if your placard does not arrive within four weeks.

Don’ts:

Don’t sign Section 2 before the medical professional completes Section 3.
Don’t use white-out — line through any error, initial it, and write the correction beside it.
Don’t lend your placard to friends or family; misuse can lead to criminal charges under CVC §4461.
Don’t list a friend’s home as your residence to qualify for a California placard.
Don’t fax or email the form; the DMV does not accept either channel.
Don’t continue using an expired temporary placard — penalties apply under CVC §4463.

Pros and Cons of Filing on Your Own vs. With Help

Pros of filing REG 195 on your own:

It is free except for the $6 temporary placard fee, so there is no attorney or service cost.
You control the timing and can submit as soon as your doctor signs.
The form is short and the fillable PDF reduces handwriting errors.
You build a direct relationship with the DMV’s Special Processing Unit if you need to follow up.
Most filers complete it in under 30 minutes once Section 3 is signed.

Cons of filing on your own:

A single missing field can delay the placard by 4–6 weeks.
Medical certifiers sometimes refuse to sign without an office visit, costing time and copay dollars.
You bear the burden of proving disability if Section 3 is questioned.
Mistakes on the residence address can route the placard to the wrong place.
If the DMV denies the application, you must navigate the appeals process under CVC §14400 yourself.

REG 195 vs. Disabled Veteran Plate Application Compared

Feature	REG 195 (DP Placard/Plates)	Disabled Veteran Plates
Eligibility	Anyone with qualifying disability under CVC §295.5	Veterans with VA-rated service-connected disability
Medical proof required	Yes, Section 3 by licensed professional	VA letter only
Fee	$6 temporary; rest free	Free for first set
Renewal	Two-year cycle for permanent	Annual registration only

FAQs

Do I need to fill out REG 195 if I already have a placard from another state?

No. California recognizes valid out-of-state placards under CVC §22511.5 for visiting drivers, so a non-resident does not need REG 195 unless requesting a 30-day travel placard.

Can my chiropractor sign Section 3?

Yes. A licensed chiropractor may sign, but only for disabilities involving the lower extremities, spine, or limbs as listed in CVC §295.5; they cannot certify heart, lung, or vision disabilities.

Do I write my maiden name or married name in the True Full Name field?

No. Use whichever name appears on your current California driver license or ID, because a mismatch causes the DMV to flag the application for manual review.

Is a P.O. box acceptable for the residence address?

No. The residence line must be a physical California street address; a P.O. box is allowed only on the separate mailing address line.

Can someone else sign the applicant signature for me?

No. Only the disabled person signs, unless a properly recorded power of attorney under Probate Code §4000 authorizes a representative to sign and is attached.

Do I check both Permanent and Temporary if I’m not sure?

No. Only one placard type may be checked; checking both makes the form ambiguous and the DMV will reject it.

Is there a fee for a permanent placard?

No. Permanent placards are free under CVC §22511.55, as are travel placards for permanent placard holders and the first set of DP plates.

Can I use REG 195 to renew a permanent placard?

No. Permanent placards renew automatically by mail every two years; you only file REG 195 again if you lost the placard, your medical condition changed, or the DMV requests it.

Will the DMV reject the form if my doctor forgets the license number?

Yes. A missing license number voids Section 3, and the DMV will return the application unprocessed until the certifying professional supplies the number.

Can I write the date of birth in two-digit year format?

No. Always use four-digit year format (MM/DD/YYYY) so 1953 is not confused with 2053 by the scanner.

Is lending my placard to a family member legal?

No. Loaning a placard is a misdemeanor under CVC §4461 and may carry a fine up to $1,000 and revocation of the placard.

Can I file REG 195 online?

No. New applications must be filed by mail or in person; only certain renewals can be processed through the DMV online portal.

How long is the temporary placard valid?

No longer than 180 days, and never longer than the end date the certifying professional writes in Section 3.

Do disabled veterans need to file REG 195 or use a different form?

Yes, veterans may file REG 195 for a placard, but those wanting Disabled Veteran license plates use the separate REG 256A form with VA documentation.

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