Information Collection

IC5 - National Registry Certified Medical Examiners

IC 201967 under ICR 201809-2126-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 MCSA-5850 IC5 - National Registry Certified Medical Examiners	Form
MCSA-5850 CMV Driver Medical Examination Results Form DataentryscreenfornewCMVDriverExamresultforms.png	Form
49 CFR 391.doc 49 CFR 391.41	IC Document
49 U.S.C. 31149.doc 49 U.S.C. 31149	IC Document

IC Title:

IC5 - National Registry Certified Medical Examiners

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	MCSA-5850	CMV Driver Medical Examination Results Form	DataentryscreenfornewCMVDriverExamresultforms.png		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 680,009

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	14,747,847	0	14,747,847
Annual IC Time Burden (Hours)	495,460	0	495,460
Annual IC Cost Burden (Dollars)	11,103,877	11,103,877	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
49 CFR 391.41	49 CFR 391.doc	04/18/2012
49 U.S.C. 31149	49 U.S.C. 31149.doc	04/18/2012

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