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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.