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Adobe PDF Adobe PDF document  Application for Funding of Changes/ Modifications/New Options to ADP Approved Devices Wheelchairs, Positioning and Ambulation AidsThe file you are about to download will ONLY work properly if opened with an Adobe Reader 10 or later client. Please do not open this file in a browser.Fill, Print & Save1108.0 kb

Form Classification
Classification / Identification:
 Form Number:014-3437-67EEdition date: 2016/05 
 Title:Application for Funding of Changes/Modifications/New Options to ADP Approved Devices
 Branch/ABC:Assistive Devices  
 Program:Assistive Devices  
 Purpose of Form:This form is used by manufacturers/distributors of mobility equipment (wheelchairs and wheeled walkers) for the purpose of making application to the Assistive Devices Program requesting approval to list their respective products on the list of approved devices.  

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