Application for Free Library Service: 

Institutions

National Library Service 

for the Blind and 

Physically Handicapped

(202) 707-5100 

www.loc.gov/nls ________________________________________________

Notice: Records relating to recipients of Library of Congress reading material 

are confidential except for those portions defined by local law as public information. 

To find out the extent to which the information provided on this application form 

may be released to other individuals, institutions, or agencies, consult the agency 

to which you are submitting this application. This completed application should 

be sent to the library for the blind and physically handicapped in the state where 

your agency is located. If you do not know the address, send the application to 

the National Library Service for the Blind and Physically Handicapped, which will 

forward it to the appropriate library.

Please print or type:

Name of institution

Street address

City County State ZIP

Telephone (Daytime)

E-mail address

Number of persons unable to read or use regular printed material who will be served: 

Talking-book readers Braille readers

73-101a (rev 10/10)
Books, Magazines, Materials, and Equipment Accessories

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Please check the box provided for any of the following items and/or services that 

you wish to receive and indicate the quantity needed. (Consult the enclosed Facts: 

Playback Machines and Accessories Provided on Free Loan to Eligible Individuals and 

Institutions for a full description of machines and accessories.)

Description Quantity 

Books and magazines

Books recorded on digital 

cartridge with digital player

Braille and Audio Reading 

Download (BARD)

Books recorded on 

audiocassette with standard 

cassette player

Magazines recorded on 

audiocassette

Braille books

Braille magazines

Accessories for digital 

talking book machine

Amplifier (solely for use by 

readers with profound 

hearing loss; ask for 

separate application)

Headphones (solely for use 

where speakers are not 

permitted)

Pillow speaker (solely for 

readers confined to bed)

Description Quantity 

Accessories for cassette 

book machines

Amplifier (solely for use 

by readers with profound 

hearing loss; ask for 

separate application)

Breath switch

Extension levers

Headphones (solely for 

use where speakers are 

not permitted)

Pillow speaker (solely for 

readers confined to bed)

Remote control unit 

(issued for readers confined 

to bed or who have difficulty 

with mobility; ask for 

separate application)

Return of Equipment

Playback equipment and special accessories are supplied to eligible institutions 

on extended loan. If this equipment is not being used in conjunction with recorded 

reading material provided by the Library of Congress and its cooperating libraries, 

it must be returned to the issuing agency. 
To Be Completed by Certifying Authority (see Sections B and C, next page, for definitions)

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I hereby certify that the institution named serves patrons who are unable to read 

or use regular printed materials because of blindness, visual disabilities, or physical 

limitations. I further certify that reading materials and equipment borrowed will 

be used by such persons only. 

Please print or type:

Name of administrator

Street address Telephone

City State ZIP

Signature of administrator _______________________________________________________

Staff member who will be responsible for this service (person to be contacted by the library):

Name Title

Eligible applicants

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Nursing homes, hospitals, schools for the blind, public and private schools, and 

college university disability centers may borrow equipment and reading materials 

for use by eligible patrons in either a group setting or for individual use. 

The institution is responsible for keeping a record of the serial numbers of all 

machines assigned to the institution. Eligible residents, not the institution, are 

responsible for equipment borrowed directly using individual applications (Form 73-101). 

 

Public or private schools and college university centers where handicapped students 

are enrolled are encouraged to submit individual applications (Form 73-101) but may 

use this form (73-101a) accompanied by certification of eligibility for each applicant. 

 

For music materials, e.g., scores, instructional recordings, and music magazines, 

the individual application (Form 73-101) must be submitted. 

 

In the case of a reading disability from organic dysfunction, certification must 

be made by a doctor of medicine or doctor of osteopathy who may consult with 

colleagues in associated disciplines. 
Eligibility of blind and other physically handicapped persons for issue of library materials

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A. The following persons are eligible for 

loan service: 

 

1. Blind persons whose visual 

acuity, as determined by 

competent authority, is 20/200 or 

less in the better eye with 

correcting lenses, or whose 

widest diameter of visual field 

subtends an angular distance no 

greater than 20 degrees. 

 

2. Other physically handicapped 

persons as follows: 

 

(a) Persons whose visual 

disability, with correction 

and regardless of optical 

measurement, is certified 

by competent authority as 

preventing the reading of 

regular printed materials. 

 

(b) Persons certified by 

competent authority as 

unable to read or unable to 

use regular printed 

material as a result of 

physical limitations. 

(c) Persons certified by 

competent authority as 

having a reading disability 

resulting from organic 

dysfunction and of 

sufficient severity to 

prevent their reading 

regular printed material in 

a normal manner. 

 

B. In cases of blindness, visual disability, 

or physical limitation, the administrator 

of the institution may serve as the 

certifying authority. 

 

C. In the case of reading disability from 

organic dysfunction, competent 

authority is defined as doctors of 

medicine and doctors of osteopathy 

who may consult with colleagues in 

associated disciplines. 

D. Eligible readers must be residents of the 

United States, including the several 

states, territories, insular possessions, 

and the District of Columbia, or 

American citizens domiciled abroad.

Lending of Materials and Classes of Borrowers

Veterans. In the lending of books, recordings, playback equipment, musical scores, 

instructional texts, and other specialized materials, preference shall be given at 

all times to the needs of the blind and other physically handicapped persons who 

have been honorably discharged from the armed forces of the United States.

 

Institutions. Institutions such as schools, residential care facilities, hospitals, 

and other establishments regularly attended by blind and/or physically handicapped 

individuals may borrow special format reading materials and playback equipment 

solely for the use of persons certified as eligible, who must be the direct and only 

recipients of the materials and equipment provided by NLS.

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