Form MCSA-5889 Motor Carrier Records Change Form

FORM MCSA-5889 

OMB No.: 2126-0060  Expiration: 8/31/2021

Please note, the expiration date as stated on this form relates to the process for renewing the Information Collection Request for this
form with the Office of Management and Budget. This requirement to collect information as requested on this form does not expire.
For questions, please contact the Office of Registration and Safety Information, Registration, Licensing, and Insurance Division.
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with
a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB
Control Number. The OMB Control Number for this information collection is 2126-0060. Public reporting for this collection of information is estimated
to be approximately 15 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the
collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety
Administration, MC-RRA, 1200 New Jersey Avenue, SE, Washington, D.C. 20590.
FMCSA — Office of Registration & Safety Information
6th Floor, 1200 New Jersey Ave. SE, Washington, DC
Fax: (202) 366-3477 (Licensing)
(202) 385-2422 (Insurance)
Customer Service: (800) 832-5660

United States Department of Transportation
Federal Motor Carrier Safety Administration

FMCSA Office of Registration and Safety Information
Motor Carrier Records Change Form

FORM MCSA-5889

Name and address changes and reinstatements of operating authority can be requested on our web site at https://li-public.fmcsa.dot.gov/LIVIEW/PKG_
REGISTRATION.prc_option (supporting documents must be submitted separately). You may submit this form to the above address, via our web form at https://ask.
fmcsa.dot.gov/app/ask, or fax it to 202-366-3477. There is no fee for an address change, but name changes cost $14 and reinstatements $80. For more assistance with
these transactions and other Registration, Licensing and Insurance functions (including transfers of operating authority), see the FAQs at https://ask.fmcsa.dot.gov.
Please submit all the requested data in Section A as represented in your current USDOT records. Changes can be indicated in Section B for address changes, Section C for
name changes, and Section D for Reinstatements. Credit card information can be submitted in Section E. Any partially-submitted data will be kept for 30 days. If the rest
of the information is not submitted within that time, the submitted data will be discarded. FMCSA cannot make any changes until all required data is supplied.

Section

A

ALL MUST COMPLETE

TODAY’S DATE

REQUESTOR’S FAX NUMBER (include area code)

REQUESTOR’S E-MAIL ADDRESS (if any)

MOTOR CARRIER IDENTIFICATION INFORMATION:
CURRENT LEGAL NAME (personal, partnership, or corporation)
DOCKET/MC NUMBER

USDOT NUMBER

CURRENT “DOING BUSINESS AS NAME” (if different from legal name)

MX NUMBER: (MX only)

RFC NUMBER: (MX only)

FF NUMBER: (freight forwarders only)

ADDRESSES (as currently listed in FMCSA systems):
STREET ADDRESS

CITY

STATE/PROV. ZIP CODE

PHONE (include area code)

PHONE NUMBERS:
CURRENT BUSINESS NUMBER
(include area code)

CURRENT CELL PHONE
NUMBER (include area code)

AFFILIATION WITH FMCSA-LICENSED ENTITIES OR OTHER APPLICANTS APPLYING FOR USDOT NUMBER REGISTRATION
Do you currently have, or have you had within the last three years of the date of this application, relationships involving common stock, common ownership,
common management, common control or familial relationships with any FMCSA-regulated entities?
Yes

No

If yes, provide the name of the company, USDOT Number, MC/FF/MX Number, and the company’s latest USDOT safety rating.
Applicant must indicate whether these entities are currently disqualified from operating commercial motor vehicles anywhere in the United States pursuant to
section 219 of the Motor Carrier Safety Improvement Act of 1999 (MCSIA) (Public Law 106-159, 113 Stat. 1748 (Dec. 9, 1999)).

FORM MCSA-5889 • Page 1 of 3

Rev 01/05/2021

FORM MCSA-5889 

OMB No.: 2126-0060  Expiration: 8/31/2021

USDOT NUMBER*

MC/FF/MX
NUMBER

LEGAL NAME*

DBA NAME

CURRENT
SAFETY RATING*

USDOT NUMBER*

MC/FF/MX
NUMBER

LEGAL NAME*

DBA NAME

CURRENT
SAFETY RATING*

US NUMBER*

MC/FF/MX
NUMBER

LEGAL NAME*

DBA NAME

CURRENT
SAFETY RATING*
*These are required fields.

APPLICANT’S OATH
I verify under penalty of perjury, under the laws of the United States of America, that all information supplied on this form or relating to this application
is true and correct. Further, I certify that I am qualified and authorized to file this application. I know that willful misstatements or omissions of material
facts constitute Federal criminal violations punishable under 18 U.S.C. § 1001 by imprisonment of up to 5 years and fines up to $250,000 for each offense.
Additionally these statements are punishable as perjury under 18 U.S.C. § 1621, which provides for fines of up to $250,000 or imprisonment of up to 5 years
for each offense.
I further certify under penalty of perjury, under the laws of the United States, that I have not been convicted, after September 1, 1989, of any Federal or
State offense involving the distribution of possession of a controlled substance, or that if I have been so convicted, I am not ineligible to receive Federal
benefits, either by court order or operation of law, pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, formerly Pub. L. 100-690, Title V, Section
5301, Nov. 18, 1988, 102 Stat. 4310, renumbered and amended Pub. L. 101-647, Title X, Section 1002 (d), Nov. 29, 1990, 104 Stat. 4827 (21 U.S.C. 862).
APPLICANT NAME (print or type)

Section

B

APPLICANT TITLE

APPLICANT SIGNATURE

ADDRESS CHANGES ONLY

MX Carriers only:
I am enclosing a copy of my Tarjeta de Circulacion (required).

Submit Address Change Requests via our web form at
https://ask.fmcsa.dot.gov/app/ask or fax to (202) 366-3477.

NEW STREET ADDRESS

NEW CITY

NEW STATE/COUNTRY

PHONE (include area code) ZIP CODE

Check if new physical and mailing addresses are the same. Otherwise, complete mailing address information below.
NEW MAILING ADDRESS

Section

C

MAILING CITY

MAIL STATE/COUNTRY

PHONE (include area code) ZIP CODE

NAME CHANGES ONLY

Submit Name Change Requests and documentation via our web form at
https://ask.fmcsa.dot.gov/app/ask or fax to (202) 366-3477.
IS THERE ANY CHANGE IN OWNERSHIP, MANAGEMENT, OR CONTROL OF THE COMPANY? ARE YOU A MEXICAN CARRIER?
Yes — if you answer yes to one of the questions, you must report a transfer of
authority or select one of the options in the next box:

No — there is no change in ownership; skip the next box and enter new
name below it:

I am making one of the following changes which does not require a transfer (select one) but does require documentation (include with form submission):
Hand-over to or addition/deletion of close blood relatives, i.e., child,
spouse, or sibling (notarized letter enclosed)
Addition of partner through marriage (marriage license enclosed)
Changes to existing corporation (copy of articles of incorporation from
the state government enclosed)
Deletion of partner through death (copy of death certificate enclosed)

NEW LEGAL NAME (personal, partnership, or corporation)
I authorize the Federal Motor Carrier Safety Administration to
charge $14 to the credit card below for this name change.

Deletion of spouse due to divorce (copy of divorce agreement enclosed)
Incorporating (copy of articles of incorporation from the state
government enclosed)
I am an MX carrier and am also enclosing a copy of my Tarjeta de
Circulacion

NEW “DOING BUSINESS AS NAME” (if different from legal name)
I have attached payment in the amount of $14 in the form of a check
or money order, payable to FMCSA, to the address in Section E.

FORM MCSA-5889 • Page 2 of 3

FORM MCSA-5889 

Section

D

OMB No.: 2126-0060  Expiration: 8/31/2021

REINSTATEMENT OF OPERATING AUTHORITY ONLY

Submit Reinstatement Requests via our web form at
https://ask.fmcsa.dot.gov/app/ask or fax to (202) 385-2422.

I WOULD LIKE TO REINSTATE THE FOLLOWING AUTHORITY(s):
Motor carrier operating authority
Broker authority
Freight Forwarder authority
PLEASE CHECK THE BOX TO INDICATE YOUR ASSENT TO THIS STATEMENT:
I understand that reinstatements may not be processed immediately. It is the responsibility of the motor carrier to ensure that they are in full
compliance with all FMCSA regulations prior to beginning interstate operations. Authority will not be reinstated until BOC-3 Form (Designation of
Process Agent) and required insurance are on file. More instructions can be found at http://www.fmcsa.dot.gov/registration/insurance-requirements.
and CHECK ONE OF THE FOLLOWING OPTIONS:
I authorize the Federal Motor Carrier Safety Administration to reinstate the operating authority of the Motor Carrier/Broker/Freight Forwarder
identified above. I understand that the credit card below will be charged $80, and that this Authorization will be stored electronically with the credit
card number obscured, except for the last four numbers.
I authorize the Federal Motor Carrier Safety Administration to reinstate the operating authority of the Motor Carrier/Broker/Freight Forwarder
identified above. I have attached payment of $80 in the form of a check or money order, payable to FMCSA, to the address in section E.

Section

E

PAYMENT: NAME CHANGES
AND REINSTATEMENTS ONLY
Pursuant to 49 CFR 360.3(c), fees are not refundable. After the application or document has been accepted for filing by the FMCSA, the
filing fee will not be refunded, regardless of whether the document is granted or approved, denied, rejected, dismissed or withdrawn.
CREDIT CARD NUMBER

VISA
American Express

MasterCard
Discover

NAME ON CARD

BILLING ADDRESS

American
Alberta
Alaska
Alabama
British
Arkansas
Arizona
District
Delaware
Connecticut
Colorado
California
Marshall
Manitoba
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
Newfoundland
North
Northern
Northwest
Nova
Prince
Pennsylvania
Palau
Oregon
Ontario
Oklahoma
Ohio
Nunavut
Puerto
Rhode
Quebec
Saskatchewan
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Yukon
Wyoming
Wisconsin
Brunswick
Hampshire
Jersey
Mexico
York
Virginia
Scotia
Carolina
Dakota
Carolina
Dakota
Edward
Island
Islands
Columbia
Rico
ofIslands
Marianas
Samoa
Columbia
Territories
Island
and Labrador
STATE/PROVINCE

ZIP CODE

EXPIRATION DATE

PAYMENT:

$14 (Name Change)
$80 (Reinstatement)

CITY
SIGNATURE

DATE

CHECKS/MONEY ORDERS ONLY: I am NOT paying by credit card, but with a check or money order, which I will send with this form to:
Regular mail: Federal Motor Carrier Safety Administration
P.O. Box 6200-33
Portland, OR 97228-6200

Overnight express mail: U.S. Bank Government Lockbox
Attn: Federal Motor Carrier Safety Admin., 6200-33
17650 NE Sandy Blvd.
Portland, OR 97230

FORM MCSA-5889 • Page 3 of 3