Section 410 IAC 36-2-1 - Application requirementsAuthority: IC 16-32-4-4
Affected: IC 16-32-4
Sec. 1.
(a) Persons wishing to obtain an Indiana developmental disability bracelet or identification card pursuant to IC 16-32-4 shall complete an application form provided by the department.(b) The application can be made by the individual who has been medically diagnosed with a developmental disability, including autism spectrum disorder, or by the parent or guardian acting on behalf of such a person who is a minor, or by the parent or guardian acting on behalf of an individual who is medically diagnosed with a developmental disability including autism spectrum disorder and is an incapacitated person.(c) The application shall include the following: (1) The applicant's legal name.(2) The applicant's address.(3) The last four (4) digits of the person's Social Security number.(4) The applicant's gender.(5) The applicant's hair color.(6) The applicant's eye color.(7) The applicant's date of birth.(8) Specific developmental disability qualifying the applicant for the bracelet or identification card.(9) Contact information for parent or guardian filing on behalf of the incapacitated person.(d) The fee may be paid by money order or cashier's check made out to the department in the following amounts: (1) Ten dollars ($10) for an identification card.(2) Twenty dollars ($20) for a bracelet.(3) Twenty-five dollars ($25) for both an identification card and bracelet.Indiana State Department of Health; 410 IAC 36-2-1; filed 9/20/2018, 3:25 p.m.: 20181017-IR-410170445FRA