Form MCSA-5896 FMCSA Entry-Level Driver Training Provider Identificatio

Form MCSA-5896

OMB Control Number: 2126-00XX
Expiration Date

U.S. Department of Transportation
Federal Motor Carrier
Safety Administration

FMCSA Entry-Level Driver
Training Provider Identification Report
Reason for Filing
(mark only one)

☐ New Request for Listing on the Training Provider Registry (TPR)
☐ Out of Business Notification

☐ Biennial Update or Changes
☐ Reapplication (After Removal from TPR)

Training Provider Business Information
1. Legal Name:
2. DBA:
3. Location of Business (Street, City, State, and Zip Code):
4. Mailing Address (Street or P.O. Box, City, State, and Zip Code):
5. Principal Telephone Number:

6. Principal Fax Number:

7. Website:

8. E-mail Address:

Training Facility Information (fill out if different from the above information for each facility)
9. Legal Name:
10. Location of Training Facility (Street, City, State, and Zip Code):
11. Mailing Address (Street or P.O. Box, City, State, and Zip Code):
12. Principal Telephone Number:

13. Principal Fax Number:

Additional Training Provider Identification Information
14. Dun & Bradstreet Number (if applicable):

15. IRS/Taxpayer Identification No.:

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16. Training
Provider
Registry
Identification
No.
(if applicable):

17. USDOT
Identification No.
(if applicable):

18. State Motor
Carrier Identification
No. (if applicable):

19. Federal Transit
Administration,
National Transit
Database (NTD)
Transit Agency ID No.
(if applicable):

20. U.S. Department of
Education, National
Center for Education
Statistics (NCES), Public
School NCES District ID
No. (if applicable):

Training Provider Type

21.

(Answer ALL five questions marking either “Yes” or “No”.
More than one ”Yes” response will usually apply)

Small
Yes:
No:

☐
☐

In-House
Yes:
No:

22.

Not In-House

☐
☐

Yes:
No:

For-Hire

☐
☐

Not-for-Hire

☐
☐

Yes:
No:

Yes:
No:

☐
☐

Types of CDL Training Offered

CDL Class or
Endorsement
(Check all the
applicable boxes)

Class A

Class B

☐ ☐

23.

Passenger

School Bus

H/M

Refresher

☐

☐

☐

☐

Training Hours Planned/Provided for Each Student
(for Training Providers Delivering theory, behind the wheel (BTW), or both)
Class A

Class B

Passenger
Endorsement

School Bus
Endorsement

HM
Endorsement

Refresher

Average
Theory
Hours
Average
BTW Range
Hours
Average
BTW Public
Road Hours

24.

Third-Party Quality Control

Is this training location a member of one or more third-party certification or accreditation organizations (check
all that apply):
National Association of Publicly Funded Truck Driving Schools (NAPFTDS)
Commercial Vehicle Training Association (CVTA)
Professional Truck Driver Institute (PTDI) Certified Course
Other accreditation or certification organizations (please specify)

☐
☐
☐
☐

Name: _______________________________________________

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Government Oversight (Identify any Federal, State or
local government oversight that your training program is
subject to, e.g., a State education department, a State or
local professional and/or vocational licensing board, or a
SDLA, etc.):

25.

Joint Labor-Management Training or Union Oversight
(Identify any standards established by a union):

Additional Information
Class A

Class B

Passenger
Endorsement

School Bus
Endorsement

HM
Endorsement

Refresher

Average
Tuition
(this information
will NOT be
displayed to the
public)

Estimated
Number of
Students
Trained Per
Calendar
Year
Number of
Instructors
with CDLs

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26.

Description of Training Program (Narrative)
1. Please provide a description of by what means the classroom or theory portion of your training
program will be delivered (e.g., in person and/or through the internet).

2. Please describe how you will train students (e.g., behind-the-wheel training in a parking lot or
other area away from traffic, etc.) for the range portion of the training program.

3. Please describe how you will conduct the behind-the-wheel training on public roads and
provide an example of a typical planned route (e.g. master trip sheet).

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27. Enter Name(s) of Authorized Officials for the Training Provider (e.g., president, treasurer,
general partner, limited partner):
1.________________________________
(Name)
2. _____________________________
(Name)
3.________________________________
(Name)
4. _____________________________
(Name)
28.

_____________________________
(Title)
_____________________________
(Title)
_____________________________
(Title)
_____________________________
(Title)

Training Provider Certification Statement
(to be completed by authorized official)

I, __________________________, certify that I am knowledgeable of FMCSA’s Entry-Level Driver
Training regulations under 49 CFR Part 380, will deliver training that covers all the required modules
in the applicable FMCSA curriculum, that the training entity I represent meet all applicable eligibility
requirements, and that I can document compliance with such requirements to the Agency upon
request. ______________(Insert name of entity) agrees to allow FMCSA or its representatives to:
visit my training facilities and observe theory, range, and/or road instruction; interview current and
former students concerning the quality of the training provided; and review and copy records that I
am required to maintain. I understand that failure to: deliver training that covers the required
modules in the FMCSA’s curriculum; meet the requirements of 49 CFR 380 Subpart G, Registry of
Entry-Level Driver Training Providers; and allow FMCSA or its representatives to have access to my
facilities, students, and records, could result in the Agency removing my company from the Training
Provider Registry.
Under penalties of perjury, I declare that the information entered on this report is, to the best of my
knowledge and belief, true, correct, and complete.

Signature: __________________________

Printed Name: _________________

Title: ______________________________

Date: ________________________

Name of Entity/Training Provider: ___________________________

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