Form MCSA-5894 Request for Data to State Driver Licensing Agencies

FORM MCSA-5894  Revised 03/17/2015

NOT YET 508!

OMB No.: 2126-0000 Expiration: 00/00/0000

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with
a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB
Control Number. The OMB Control Number for this information collection is 2126-00XX. Public reporting for this collection of information is estimated
to be approximately 6.5 hours per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the
collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety
Administration, MC-RRA, 1200 New Jersey Avenue, SE, Washington, D.C. 20590.

United States Department of Transportation
Federal Motor Carrier Safety Administration

REQUEST FOR DATA TO STATE
DRIVER LICENSING AGENCIES
Please complete the form below for a recent 12-month period and e-mail a PDF copy to:
no later than:

(e-mail address)
(due date)

This information is needed as soon as possible for Federal rulemaking
purposes, as approved by the Office of Management and Budget, No.:
If unable to provide any requested items, please substitute where possible and attach
an explanation of the substituted data. (CDL = Commercial Driver’s License)
Please direct questions to:

Section

A

PERMITS AND CDLs (annually)
1. Commercial learners’ permits issued:
2. Class A CDLs issued to first-time holders:

3. Other Class A CDLs issued:
(renewals, transfers, etc.)

4. Class B CDLs issued to first-time holders:

5. Other Class B CDLs issued:
(renewals, transfers, etc.)

6. Class C CDLs issued to first-time holders:

7. Other Class C CDLs issued:
(renewals, transfers, etc.)

8. Restricted CDLs issued (FRSI/Pyrotechnic):
(if possible, do not include in totals above)

Section

B

ENDORSEMENTS (annually)
1. First-time Passenger endorsements issued:
2. First-time School Bus endorsements issued:
3. First-time Hazmat endorsements issued:

FORM MCSA-5894 • Page 1 of 3

NOT YET 508!

FORM MCSA-5894  Revised 03/17/2015

Section

C

UPGRADES (annually)
1. Upgrades from Class B to Class A:
2. Upgrades from Class C to Class A or B:

Section

D

RESTRICTIONS (annually)
1. F
 irst-time intrastate-only limited CDLs issued:
(please include in Section A totals above)
2. O
 ther intrastate-only CDLs issued (renewals, etc.):
(please include where appropriate in Section A above)

Section

E

REINSTATEMENTS
1. Number of times commercial driving privileges reinstated:

Section

F

CDL HOLDERS (aggregate)
1. Valid Class A CDLs in existence:
2. Valid Class B CDLs in existence:
3. Valid Class C CDLs in existence:

Section

G

CDL SKILLS TESTS
“Failed” tests are also to be included in the “Administered” total.
1. Number of Class A skills tests ADMINISTERED:
2. Number of Class A skills tests FAILED:
3. Number of Class B skills tests ADMINISTERED:
4. Number of Class B skills tests FAILED:

FORM MCSA-5894 • Page 2 of 3

OMB No.: 2126-0000 Expiration: 00/00/0000

NOT YET 508!

FORM MCSA-5894  Revised 03/17/2015

Section

H

STATE
Enter the name of your state:

Section

I

American
Alaska
Alabama
District
Delaware
Connecticut
Colorado
California
Arkansas
Arizona
Marshall
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
North
Northern
Puerto
Pennsylvania
Palau
Oregon
Oklahoma
Ohio
Rhode
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Wyoming
Wisconsin
Hampshire
Jersey
Mexico
York
Virginia
Carolina
Dakota
Carolina
Dakota
Island
Islands
Rico
ofIslands
Marianas
Samoa
Columbia

12-MONTH PERIOD BEING REPORTED:
From:

Section

J

Section

K

To:

CONTACT PERSON FOR
DATA ON THIS FORM:
Name:

Agency:

E-mail:

Phone:

EXPLANATION OF DATA PROVIDED
(including any estimates or substituted data, if needed):

FORM MCSA-5894 • Page 3 of 3

OMB No.: 2126-0000 Expiration: 00/00/0000