391.41 CMV Driver Medication Form

391.41 CMV Driver Medication Form

OMB: 2126-0064

IC ID: 220971

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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391.41 CMV Driver Medication Form
 
No Modified
 
Voluntary
 
49 CFR 391.43 49 CFR 391.41

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction MCSA 5895 391.41 CMV Driver Medication Form MCSA 5895 MCSA-5895 Form 2-27-2021 508.pdf https://www.fmcsa.dot.gov/regulations/medical/39141-cmv-driver-medication-form-mcsa-5895-optional Yes Yes Fillable Printable

Transportation Ground Transportation

Privacy Act of 1974  80 FR 73871

1,163,160 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   50 %

  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 2,095,990 0 0 128,984 0 1,967,006
Annual IC Time Burden (Hours) 279,465 0 0 17,198 0 262,267
Annual IC Cost Burden (Dollars) 0 0 0 -27,396,411 0 27,396,411

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