Form 486 template
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VOLUNTARY DISABILITY DESIGNATOR
Form 486 is a Voluntary Disability Designator application for an ID card or driver’s license issued by the Alaska Division of Motor Vehicles. The applicant, named in Part 1, must be a person with a cognitive, mental, neurological, or physical disability as defined in AS 18.65.310(m) and AS 28.15.111(d). The document requires the full legal name of the applicant, mailing address, date of birth, sex, daytime telephone number, and ID or driver license number. Part 2 is to be completed by an Alaskan physician, physician assistant, nurse practitioner, naturopath, or psychologist, attesting that the patient meets the criteria for a disability designator. The document asks if the patient has a commercial driver license (CDL) and if they meet the physical requirements under 49 CFR 391.41 to retain it. The authorized signature of the healthcare professional, their title, date, printed name, occupation, and contact information must be provided in Part 2.
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