Information Collection

C-7, Qualifications of Drivers: Diabetes Standard

IC 228839 under ICR 201710-2126-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form MCS 5870 C-7, Qualifications of Drivers: Diabetes Standard	Form
MCS 5870 Insulin Treated Diabetes Mellitus Assessment Form 10-19-17 Insulin Use Form.docx	Form

IC Title:

C-7, Qualifications of Drivers: Diabetes Standard

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 49 CFR 391.41

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	MCS 5870	Insulin Treated Diabetes Mellitus Assessment Form	10-19-17 Insulin Use Form.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 252,117

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	252,117	252,117
Annual IC Time Burden (Hours)	33,616	33,616
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.