D9381 - Authority to Install/Modify - Vehicle Modifications

Form ID
D9381
Audience
For providers
Occupational therapist (general)

This form is used in conjunction with a request for Rehabilitation Appliances Program (RAP) vehicle modifications.

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.

How can I access this form?
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Form (PDF or Word)