Information Collection Request

Medical Qualification Requirements

ICR 202109-2126-001 · OMB 2126-0006 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form MCSA 5870 Insulin-Treated Diabetes Mellitus Assessment Form Form Modified Available
Form MCSA 5870 IC7 -Qualification of Driver; Diabetes Standard Form Modified Repair queued
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-5875 IC6 - Medical Examiner's Certification Integration Final Rule Form and Instruction Modified Repair queued
Form MCSA-5850 CMV Driver Medical Examination Results Form Form Modified Available
Form MCSA-5850 IC5 - National Registry Certified Medical Examiners Form Modified Repair queued
30-day FR for 2126-0006 10.14.21.pdf Supplementary Document Uploaded 2021-10-14 Repair queued
PRA-2126-0006 Supporting Statement 09.08.21.docx Supporting Statement A Uploaded 2021-09-08 Repair queued
60-day FR for 2126-0006 05.06.21.pdf Supplementary Document Uploaded 2021-09-06 Repair queued
Justification of Non-substantive Changes for MCSA-5875 07.08.20.docx Supplementary Document Uploaded 2020-07-08 Repair queued
PRA-2126-0006 Justification NonSubstantive Change to MCSA-5875 031920.docx Supplementary Document Uploaded 2020-04-22 Repair queued
60-day FR for Insulin-Treated Diabetes Mellitus Assessment Form.pdf Supplementary Document Uploaded 2018-09-18 Repair queued
PRA-2126-0006 Justification NonSubstantive Change 061416.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-07-18 Repair queued
PRA-2126-0006.Justification NonSubstantive Change final 032916.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-03-30 Repair queued
Section4116 of SAFETEA-LU(Public Law 109-59) 081005.doc Supplementary Document Uploaded 2012-04-18 Repair queued
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 Repair queued
Diabetes Exemption Qualifications of Drivers (70FR67777)110805.pdf Supplementary Document Uploaded 2010-01-22 Repair queued
Diabetes Exemption Applications Qualifications of Drivers (68FR52441)090303.pdf Supplementary Document Uploaded 2010-01-22 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
26039 IC1 - FMCSA Physical Qualification Standards Modified
233017 IC7 -Qualification of Driver; Diabetes Standard Form ModifiedInsulin-Treated Diabetes Mellitus Assessment Form
233017 IC7 -Qualification of Driver; Diabetes Standard Form 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
220813 IC6 - Medical Examiner's Certification Integration Final Rule Form and Instruction Modified
216256 IC4 - Skill Performance Evaluation (SPE) Certificate Program Modified
216253 IC3 - Exemptions - Vision, Hearing, Seizure Exemptions Modified
216251 IC2 - Resolution of Medical Conflict Modified
201967 IC5 - National Registry Certified Medical Examiners Form ModifiedCMV Driver Medical Examination Results Form
201967 IC5 - National Registry Certified Medical Examiners Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2024 36 Months From Approved 12/31/2021
35,544,723 0 31,582,513
2,707,479 0 2,393,370
0 0 155,302,782





Reginfo record details
7
table that charts list of burden
IC Title Form No. Form Name
IC1 - FMCSA Physical Qualification Standards
IC2 - Resolution of Medical Conflict
IC3 - Exemptions - Vision, Hearing, Seizure 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 ,  
IC7 -Qualification of Driver; Diabetes Standard MCSA 5870

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 35,544,723 31,582,513 0 0 3,962,210 0
Annual Time Burden (Hours) 2,707,479 2,393,370 0 0 314,109 0
Annual Cost Burden (Dollars) 0 155,302,782 0 0 -155,302,782 0


Reginfo record details
  No