Information Collection

National Registry Certified Medical Examiners

IC 201967 under ICR 201204-2126-002 · OMB 2126-0006.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2126-0006 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MCSA-5850 National Registry Certified Medical Examiners	Form
MCSA-5850 CMV Driver Examination Results Form MCSA-5850 CMV Driver Exam Results_20110510.Use.doc	Form
49 CFR 391.doc 49 CFR 391.41	IC Document
49 U.S.C. 31149.doc 49 U.S.C. 31149	IC Document

IC Title:

National Registry Certified Medical Examiners

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 391.41

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	MCSA-5850	CMV Driver Examination Results Form	MCSA-5850 CMV Driver Exam Results_20110510.Use.doc		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,333

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,333	13,333
Annual IC Time Burden (Hours)	434,095	434,095
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
49 CFR 391.41	49 CFR 391.doc	04/18/2012
49 U.S.C. 31149	49 U.S.C. 31149.doc	04/18/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.