391.41 CMV Driver Medication Form

Forms and Documents

Document Name	Status
Form MCSA 5895 391.41 CMV Driver Medication Form Form and Instruction	New
PRA-2126NEW.SS.391.41_1.1_FINAL_CMV Driver MedicationForm.docx Supporting Statement A	2016-07-08

IC Document Collections

IC ID	Document Title	Status
220971	391.41 CMV Driver Medication Form Form and Instruction	New

ICR Details

OMB Control No: 2126-0064	ICR Reference No: 201604-2126-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOT/FMCSA	Agency Tracking No:
Title: 391.41 CMV Driver Medication Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/06/2017
	Date Received in OIRA: 08/04/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	36 Months From Approved
Responses	1,082,200	0	0
Time Burden (Hours)	144,293	0	0
Cost Burden (Dollars)	15,127,678	0	0

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Abstract: This information collection request is voluntary and may be utilized by medical examiners (MEs) responsible for issuing Medical Examiner’s Certificates (MECs) to commercial motor vehicle (CMV) drivers to communicate with treating healthcare professionals who are responsible for prescribing certain medications, to fully understand the reasons the medications have been prescribed. The information obtained by utilizing the IC will assist the ME in determining whether the underlying medical condition and the prescribed medication will impact the safe operation of a CMV.

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Authorizing Statute(s): US Code: 49 USC 31136(a)(3) and 31502(b) Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 73871	11/25/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 44675	07/08/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
391.41 CMV Driver Medication Form	MCSA 5895	391.41 CMV Driver Medication Form MCSA 5895

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,082,200	0	0	1,082,200	0	0
Annual Time Burden (Hours)	144,293	0	0	144,293	0	0
Annual Cost Burden (Dollars)	15,127,678	0	0	15,127,678	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This new collection will ensure that certified Medical Examiners responsible for issuing MECs to CMV drivers, communicate with healthcare professionals responsible for prescribing the use of certain medications, fully understand the reasons the medications have been prescribed and to determine whether or not the use of the medications and the underlying condition being treated preclude the issuance of a MEC. Because there is moderate evidence to support the contention that the licit use of opioids increases the risk of a motor vehicle crashes and impacts indirect measures of driver performance negatively, the collection of this information will assist certified MEs in determining whether a CMV driver is physically qualified to drive a CMV.

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Annual Cost to Federal Government: $15,127,678

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/04/2016

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