Form BMV 6316 template
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Application for an ID Card for Hearing Impaired
This document is an application form for a hearing-impaired identification card issued by the Ohio Department of Public Safety's Bureau of Motor Vehicles. The form is to be completed by hearing-impaired individuals who have a hearing loss of forty decibels or more in one or both ears, as per Ohio Revised Code 4507.141. The applicant must provide their name, social security number (optional), address, Ohio zip code, county driver license number, and signature. A physician's certification is also required, which includes the physician's name, license number, address, city, state, and zip code. The physician must certify the hearing impairment of the applicant and indicate the type and degree of the hearing loss in decibels for each ear. The card can be original, a replacement, or a renewal, depending on the status of the previous card. Reasons for replacement or renewal include loss, damage, or theft.
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