Information Collection Request
391.41 CMV Driver Medication Form
ICR 202206-2126-004 · OMB 2126-0064 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2126-0064 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form MCSA 5895 391.41 CMV Driver Medication Form |
Form and Instruction | Modified | Repair queued |
 Justification for non-substantive change for form for 2126-0064.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2022-07-19 | Repair queued |
| PRA-2126-0064 Renew SS for 30 day notice 102419 final for use.docx |
Supporting Statement A | Uploaded 2019-11-06 | Repair queued |
 30-Day FR for 2126-0064.pdf |
Supplementary Document | Uploaded 2019-11-06 | Repair queued |
| 60-Day FR for 2126-0064.pdf |
Supplementary Document | Uploaded 2019-11-05 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 220971 |  391.41 CMV Driver Medication Form |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOT/FMCSA |
| OMB Control No | 2126-0064 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 201911-2126-001 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |