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Fill Your Texas Vi 4 Form

The Texas Vi 4 form is an application for a medical exemption from the state's vehicle window tint regulations. This form is designed for individuals who require darker window tinting for medical reasons, allowing them to legally obtain an exemption. To begin the process, complete the form accurately and submit it as instructed below.

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Dos and Don'ts

When filling out the Texas Vi 4 form, it is essential to ensure accuracy and completeness to avoid delays. Here are seven important dos and don’ts to consider:

  • Do use the most current version of the form to ensure compliance with the latest regulations.
  • Do type all information clearly to enhance readability and prevent misunderstandings.
  • Do include all required vehicle information, such as VIN, make, model, and year for each vehicle.
  • Do provide accurate contact information, including phone numbers and email addresses, for any follow-up communication.
  • Don't leave any sections blank; ensure that all applicable fields are filled out completely.
  • Don't submit the form without the necessary supporting documentation, such as a physician's letter or prescription.
  • Don't forget to sign and date the form, as this certification is crucial for processing your application.

By adhering to these guidelines, applicants can facilitate a smoother process when seeking a window tint medical exemption in Texas.

Sample - Texas Vi 4 Form

Texas Department of Public Safety Regulatory Services Division www.dps.texas.gov

MUST USE MOST CURRENT FORM

FORM MUST BE TYPED

VEHICLE INSPECTION WINDOW TINT

 

 

FOR DPS USE ONLY

APPLICATION FOR WINDOW TINT MEDICAL EXEMPTION

 

 

APPLICANT (PLEASE USE NAME AS IT APPEARS ON DRIVER LICENSE)

 

 

 

Name

DL #

State

Expiration

Patient Name

Relationship to Applicant

(IF DIFFERENT FROM APPLICANT)

 

Residence

City

State

 

 

County

ZIP

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing

City

State

 

 

County

ZIP

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth

Email

Home Phone

Cell Phone

Business Phone

Other Phone

VEHICLE INFORMATION

Vehicle #1

VIN

Year

Make

Model

VEHICLE #2

VIN

Year

Make

Model

VEHICLE #3

VIN

Year

Make

Model

PHYSICIAN, OPTOMETRIST OR OPHTHALMOLOGIST

Name

Address

Email

 

 

License #

 

 

 

 

 

 

 

 

City

State

 

 

Zip

 

 

 

 

 

 

Phone

Fax

 

 

 

 

 

 

 

Vehicle Owner Certiication

I certify and afirm that all information presented in this form is true and correct, that any documents I have presented to DPS are genuine, and that the information included in all supporting documentation is true and accurate. I make this certiication and afirmation under penalty of perjury and I understand that knowingly making a false statement or representation on this form is a criminal violation.

Applicant / Legal Guardian’s Signature

 

Date

Completed application must be accompanied by one of the following:

Letter, on physician letterhead, signed by the physician, indicating the medical reason for the exemption.

An original prescription including the applicant’s name, physician’s signature and indicating the medical reason for the exemption.

Letters and prescriptions must be dated within one year of exemption request. If the exemption is approved, an exemption letter will be sent to the applicant listed above.

SUBMIT completed form with required documentation:

Online Secured Email

Contact Us, select “Vehicle Inspection” and complete the online form.

http://www.txdps.state.tx.us/rsd/contact/default.aspx

Fax to (512) 424-2774

Mailing Address: Texas Department of Public Safety

Regulatory Services Division, Compliance & Enforcement Service

Window Tint Medical Exemption

P. O. Box 4087

Austin, Texas 78773-0543

Please allow up to 15 working days for your application to be processed, approved and to receive your exemption certiicate.

VI-4 (Rev. 3/16)

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Documents used along the form

When applying for a medical exemption for window tint in Texas, several additional forms and documents may be required or helpful. Each of these documents serves a specific purpose in supporting your application. Here’s a brief overview of some commonly used forms alongside the Texas Vi 4 form.

  • Physician's Letter: This document must be on the physician's letterhead and signed by them. It should clearly state the medical reason for the window tint exemption. The letter needs to be dated within one year of the application.
  • Prescription: An original prescription from the physician is another option. It must include the applicant's name, the physician's signature, and a clear indication of the medical reason for the exemption. Like the letter, it should be dated within one year.
  • Application for Vehicle Registration: This form is necessary if the vehicle is newly purchased or if there are changes to the ownership. It helps ensure that the vehicle is registered correctly with the appropriate window tint exemption noted.
  • Proof of Residency: Documents like utility bills or lease agreements may be required to verify the applicant's address. This helps confirm that the applicant resides at the address listed on the Vi 4 form.
  • Identification Documents: A copy of the applicant's driver’s license or state ID may be needed. This verifies the identity of the applicant and ensures that the information matches the Vi 4 form.
  • Vehicle Title: If the vehicle is not registered in the applicant's name, a copy of the vehicle title may be necessary to show ownership. This helps link the exemption request to the correct vehicle.
  • Medical Records: In some cases, providing additional medical records may support the exemption request. These records should relate to the medical condition that necessitates the window tint.
  • Application for Exemption Certificate: This form is often submitted to request the actual exemption certificate after approval of the Vi 4 form. It outlines the specifics of the exemption granted.

Collecting and submitting these documents can help streamline the process of obtaining your window tint exemption. Make sure to double-check that all forms are completed accurately and include the necessary supporting documentation to avoid delays.

Common mistakes

Filling out the Texas VI-4 form can be straightforward, but many people make common mistakes that can delay their application for a window tint medical exemption. One frequent error is failing to use the most current version of the form. The Texas Department of Public Safety regularly updates its forms, and using an outdated version may result in rejection or processing delays.

Another mistake is neglecting to type the form. The instructions clearly state that the form must be typed, yet some applicants still submit handwritten versions. Handwriting can be difficult to read, leading to misunderstandings or errors in processing.

Many applicants also forget to use their name exactly as it appears on their driver’s license. This inconsistency can cause confusion and potentially delay the approval process. It’s essential to double-check this detail before submitting the application.

Inaccurate vehicle information is another common issue. When listing multiple vehicles, applicants sometimes provide incorrect VINs or fail to include all required details, such as the year, make, and model. Each vehicle must be listed correctly to ensure the exemption applies to the right one.

Additionally, some applicants overlook the requirement for supporting documentation. The form must be accompanied by either a letter from a physician or an original prescription. Failing to include these documents can result in an outright denial of the application.

Another mistake is not ensuring that the supporting documents are dated within one year of the exemption request. Submitting outdated letters or prescriptions can lead to complications and further delays in processing.

Applicants may also forget to sign the certification section of the form. This signature confirms that the information provided is true and correct. Without a signature, the application cannot be processed.

In some cases, individuals submit the application without providing complete contact information. Missing phone numbers or email addresses can hinder communication between the applicant and the Texas Department of Public Safety, leading to unnecessary delays.

Lastly, not following the submission guidelines can create issues. Whether submitting online, by fax, or by mail, applicants must adhere to the specified methods to ensure their application is received and processed correctly. Each method has its own requirements, and overlooking these can lead to complications.

By being aware of these common mistakes, applicants can improve their chances of a smooth application process for the Texas VI-4 form. Taking the time to carefully review each section and ensuring all requirements are met can make a significant difference.

Misconceptions

  • Misconception 1: The Texas Vi 4 form can be filled out by anyone.
  • Only individuals who meet specific medical criteria can apply for a window tint exemption using this form.

  • Misconception 2: Handwritten forms are acceptable.
  • The form must be typed to ensure clarity and legibility. Handwritten submissions will not be accepted.

  • Misconception 3: You don’t need a physician's letter for the application.
  • A physician, optometrist, or ophthalmologist must provide a letter or prescription that clearly states the medical reason for the exemption.

  • Misconception 4: Any doctor can sign the exemption letter.
  • The letter must be signed by a licensed physician, optometrist, or ophthalmologist to be valid.

  • Misconception 5: There is no time limit for submitting medical documentation.
  • Documentation must be dated within one year of the exemption request. Older documents will not be accepted.

  • Misconception 6: The exemption is automatically granted upon application.
  • Approval is not guaranteed. Each application is reviewed, and a decision is made based on the provided documentation.

  • Misconception 7: You can submit the form via any method.
  • The form can be submitted online, by fax, or by mail, but not through other channels.

  • Misconception 8: You don’t need to provide personal information.
  • The form requires detailed personal information, including your name, contact details, and vehicle information.

  • Misconception 9: You can apply for multiple vehicles on one form.
  • Each vehicle requires its own section on the form, and additional vehicles may need separate submissions.

  • Misconception 10: You will receive the exemption certificate immediately.
  • Processing may take up to 15 working days. Patience is necessary while waiting for approval and the certificate.

Key takeaways

Key Takeaways for Using the Texas Vi 4 Form

  1. The Texas Vi 4 form must be filled out using the most current version available from the Texas Department of Public Safety.
  2. All information should be typed, ensuring clarity and accuracy throughout the application process.
  3. Supporting documentation is essential. Include a letter from a physician or an original prescription that states the medical reason for the window tint exemption.
  4. Submit the completed form via secured email, fax, or mail. Be aware of the specific contact details provided for each submission method.
  5. Allow up to 15 working days for processing. Applicants will receive an exemption certificate if approved.

File Characteristics

Fact Name Details
Governing Law The Texas Vi 4 form is governed by Texas Transportation Code, Section 547.613 regarding window tint exemptions.
Form Requirement The form must be typed to ensure clarity and legibility.
Applicant Information Applicants must provide their name as it appears on their driver’s license, along with various contact details.
Medical Documentation Submission of a physician's letter or an original prescription is required to support the medical exemption request.
Processing Time Applicants should allow up to 15 working days for processing and approval of their exemption application.
Submission Methods The completed form can be submitted online, via fax, or by mail to the Texas Department of Public Safety.

How to Use Texas Vi 4

Filling out the Texas Vi 4 form is an important step for those seeking a medical exemption for window tint on their vehicles. Once you have completed the form, you'll need to submit it along with the required documentation to the Texas Department of Public Safety. Below are the steps to help you accurately fill out the form.

  1. Begin by typing your name as it appears on your driver’s license in the Applicant section.
  2. Enter your driver’s license number (DL #), state, and expiration date.
  3. Provide the name of the patient (if different from the applicant) and their relationship to you.
  4. Fill in your residence address, including city, state, county, and ZIP code.
  5. Complete the mailing address section, which may be the same or different from your residence address.
  6. Input your date of birth, email address, and phone numbers (home, cell, business, and any other). Make sure to provide accurate contact information.
  7. For each vehicle, fill out the vehicle information, including the vehicle number, VIN, year, make, and model. You can list up to three vehicles.
  8. In the Physician, Optometrist or Ophthalmologist section, enter the name, address, email, license number, city, state, ZIP code, phone, and fax number of the medical professional.
  9. Read the vehicle owner certification statement carefully. By signing, you affirm that all information is true and accurate.
  10. Sign and date the application as the applicant or legal guardian.

After completing the form, remember to gather the necessary documentation, such as a letter from your physician or an original prescription. Submit your application online, via fax, or by mail, and be prepared to wait up to 15 working days for processing. Good luck!