IC6 - Medical Examiner's Certification Integration Final Rule

Medical Qualification Requirements

OMB: 2126-0006

IC ID: 220813

Information Collection (IC) Details

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IC6 - Medical Examiner's Certification Integration Final Rule
 
No Modified
 
Mandatory
 
49 CFR 391.43

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction MCSA-5875 Medical Examination Report Form Revised MCSA-5875 2-27-21 508 (1).pdf https://www.fmcsa.dot.gov/ Yes Yes Fillable Fileable Signable
Form MCSA-5876 Medical Examiner's Certificate Revised MCSA-5876 Form 2-27-2021 508.pdf https://www.fmcsa.dot.gov/ Yes Yes Fillable Fileable Signable

Transportation Ground Transportation

 

1 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1 0 0 0 0 1
Annual IC Time Burden (Hours) 0 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Justification for Nonsubstantive Change to MCSA-5875 PRA-2126-0006 Justification NonSubstantive Change to MCSA-5875 031920.docx 04/22/2020
Justification for Nonsubstantive Change to MCSA-5875 07.08.20 Justification of Non-substantive Changes for MCSA-5875 07.08.20.docx 07/08/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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