Medical Qualification Requirements

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form MCSA-5876 Medical Examiner's Certificate	Form	Modified	Available
Form MCSA-5875 Medical Examination Report Form	Form and Instruction	Modified	Available
Form MCSA-5850 CMV Driver Medical Examination Results Form	Form	Modified	Repair queued
PRA-2126-0006.Justification NonSubstantive Change final 032916.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-03-30	Available
PRA-2126-0006.SS.NRII.Final Rule.042315.Use1.docx	Supporting Statement A	Uploaded 2015-04-24	Available
Section4116 of SAFETEA-LU(Public Law 109-59) 081005.doc	Supplementary Document	Uploaded 2012-04-18	Available
Section 4129 of SAFETEA-LU(PubLaw109-59.doc	Supplementary Document	Uploaded 2012-04-18	Available
Section 4129 of SAFETEA-LU(PubLaw109-59.doc	Supplementary Document	Uploaded 2010-01-22	Available
Diabetes Exemption Qualifications of Drivers (70FR67777)110805.pdf	Supplementary Document	Uploaded 2010-01-22	Available
Diabetes Exemption Applications Qualifications of Drivers (68FR52441)090303.pdf	Supplementary Document	Uploaded 2010-01-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
26039	Physical Qualification Standards		Unchanged
220813	IC-6, Medical Examiner's Certification Integration Final Rule	Form	Modified	Medical Examiner's Certificate
220813	IC-6, Medical Examiner's Certification Integration Final Rule	Form and Instruction	Modified	Medical Examination Report Form
216256	Skill Performance Evaluation (SPE) Certificate Program		Unchanged
216253	Medical Exemptions		Unchanged
216251	Resolution of Medical Conflict		Unchanged
201967	National Registry Certified Medical Examiners	Form	Modified	CMV Driver Medical Examination Results Form

ICR Details

OMB Control No: 2126-0006	ICR Reference No: 201604-2126-006
Status: Historical Active	Previous ICR Reference No: 201603-2126-002
Agency/Subagency: DOT/FMCSA	Agency Tracking No:
Title: Medical Qualification Requirements
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/19/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/15/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2018	08/31/2018	08/31/2018
Responses	34,722,151	0	34,722,151
Time Burden (Hours)	2,633,702	0	2,633,702
Cost Burden (Dollars)	0	0	0

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Abstract: Commercial motor vehicle drivers who are subject to the Federal Motor Carrier Safety Regulations must meet certain medical requirements. This revision is due to a final rule entitled, "Medical Examiner's Certification Integration," which would require medical examiners who conduct medical examinations for interstate commercial motor vehicle (CMV) drivers to complete certain training concerning Federal Motor Carrier Safety Administration (FMCSA) physical qualifications standards, pass a certification test and maintain competence through periodic retraining and retesting.

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Authorizing Statute(s): PL: Pub.L. 109 - 59 4116 Name of Law: Safe, Accountable, Flexible, Efficent Transportation Equity Act:: A legacy for Users (SAFETEA-LU)
   PL: Pub.L. 109 - 59 4129 Name of Law: Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 59 4129 Name of Law: Safe, Accountable, Flexible and Efficient Transporataion Equity Act: A Legacy for Users
PL: Pub.L. 106 - 159 215 Name of Law: Motor Carrier Safety Improvement Act of 1999 (MCSIA)

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2126-AB40	Final or interim final rulemaking	80 FR 22790	04/23/2015

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
IC-6, Medical Examiner's Certification Integration Final Rule	MCSA-5876, MCSA-5875	Medical Examination Report Form ,   Medical Examiner's Certificate
Medical Exemptions
National Registry Certified Medical Examiners	MCSA-5850	CMV Driver Medical Examination Results Form
Physical Qualification Standards
Resolution of Medical Conflict
Skill Performance Evaluation (SPE) Certificate Program

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ICR Summary of Burden

table that charts list 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	34,722,151	34,722,151	0	0	0	0
Annual Time Burden (Hours)	2,633,702	2,633,702	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $3,434,443

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: 04/15/2016

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