Information Collection Request

Medical Qualification Requirements

ICR 202201-2126-005 · OMB 2126-0006 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form MCSA 5871 Vision Evaluation Report Form and Instruction New Available
Form MCSA 5871 IC8 - Qualification of Drivers: Vision Standard Form and Instruction New Repair queued
Form MCSA-5850 CMV Driver Medical Examination Results Form Form and Instruction New Available
Form MCSA-5850 IC5b - National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results Form and Instruction New Repair queued
Form MCSA 5870 Insulin-Treated Diabetes Mellitus Assessment Form Form Modified Repair queued
Form MCSA 5870 IC7 -Qualification of Driver; Diabetes Standard Form Modified Repair queued
Form MCSA-5876 Medical Examiner's Certificate Revised Form Removed Available
Form MCSA-5875 Medical Examination Report Form Revised Form and Instruction Removed Available
Form MCSA-5875 IC6 - Medical Examiner's Certification Integration Final Rule Form and Instruction Removed Repair queued
Form MCSA-5850 CMV Driver Medical Examination Results Form Form Removed Available
Form MCSA-5850 IC5 - National Registry Certified Medical Examiners Form Removed Repair queued
PRA-2126-0006 Vision Final Rule SS Vision Evaluation Report 01.21.22 final.docx Supporting Statement A Uploaded 2022-01-27 Repair queued
30-day FR for 2126-0006 10.14.21.pdf Supplementary Document Uploaded 2021-10-14 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 Repair queued
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 Unchanged
251311 IC8 - Qualification of Drivers: Vision Standard Form and Instruction NewVision Evaluation Report
251311 IC8 - Qualification of Drivers: Vision Standard Form and Instruction New
251310 IC5d - National Registry of Certified Medical Examiners - Verification of National Registry Number New
251309 IC5c - National Registry of Certified Medical Examiners - Providing Medical Examination Reports to FMCSA Upon Request New
251308 IC5b - National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results Form and Instruction NewCMV Driver Medical Examination Results Form
251308 IC5b - National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results Form and Instruction New
251303 IC5a - National Registry of Certified Medical Examiners - Registering and Testing New
251302 IC3 - Seizure Exemptions New
251301 IC3b - Hearing Exemptions New
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 RemovedMedical Examiner's Certificate Revised
220813 IC6 - Medical Examiner's Certification Integration Final Rule Form and Instruction RemovedMedical Examination Report Form Revised
220813 IC6 - Medical Examiner's Certification Integration Final Rule Form and Instruction Removed
216256 IC4 - Skill Performance Evaluation (SPE) Certificate Program Unchanged
216253 IC3 - Exemptions - Vision, Hearing, Seizure Exemptions Removed
216251 IC2 - Resolution of Medical Conflict Unchanged
201967 IC5 - National Registry Certified Medical Examiners Form RemovedCMV Driver Medical Examination Results Form
201967 IC5 - National Registry Certified Medical Examiners Form Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2025 36 Months From Approved 12/31/2024
35,545,790 0 35,544,723
2,705,862 0 2,707,479
0 0 0





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 35,545,790 35,544,723 0 4,640 -3,573 0
Annual Time Burden (Hours) 2,705,862 2,707,479 0 619 -2,236 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No