IC5 - National Registry Certified Medical Examiners

Medical Qualification Requirements

⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.