Information Collection Request

Medical Qualification Requirements

ICR 201807-2126-001 · OMB 2126-0006 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form MCSA-5876 Medical Examiner's Certificate Revised Form Modified Available
Form MCSA-5875 Medical Examination Report Form Revised Form and Instruction Modified Available
Form MCSA-5850 CMV Driver Medical Examination Results Form Form Modified Available
PRA-2126-0006 SS Renewal update 30 day final 081718 submission.doc Supporting Statement A Uploaded 2018-08-29 Available
30-Day FR for 2126-0006.pdf Supplementary Document Uploaded 2018-07-30 Available
60-Day FR for 2126-0006 04.27.18.pdf Supplementary Document Uploaded 2018-07-30 Available
PRA-2126-0006 Justification NonSubstantive Change 061416.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-07-18 Available
PRA-2126-0006.Justification NonSubstantive Change final 032916.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-03-30 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 IDCollectionTypeStatusForm
26039 IC1 - Physical Qualification Standards Modified
220813 IC6 - Medical Examiner's Certification Integration Final Rule Form ModifiedMedical Examiner's Certificate Revised
220813 IC6 - Medical Examiner's Certification Integration Final Rule Form and Instruction ModifiedMedical Examination Report Form Revised
216256 IC4 - Skill Performance Evaluation (SPE) Certificate Program Modified
216253 IC3 - Medical Exemptions Modified
216251 IC2 - Resolution of Medical Conflict Modified
201967 IC5 - National Registry Certified Medical Examiners Form ModifiedCMV Driver Medical Examination Results Form

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2019 36 Months From Approved 09/30/2018
31,581,609 0 34,722,151
2,395,315 0 2,633,702
0 0 0





Reginfo record details
6
table that charts list of burden
IC Title Form No. Form Name
IC1 - Physical Qualification Standards
IC2 - Resolution of Medical Conflict
IC3 - Medical Exemptions
IC4 - Skill Performance Evaluation (SPE) Certificate Program
IC5 - National Registry Certified Medical Examiners MCSA-5850
IC6 - Medical Examiner's Certification Integration Final Rule MCSA-5875 , MCSA-5876 ,  

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 31,581,609 34,722,151 0 0 -3,140,542 0
Annual Time Burden (Hours) 2,395,315 2,633,702 0 0 -238,387 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No