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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.