Information Collection Request

Medical Qualification Requirements

ICR 202507-2126-009 · OMB 2126-0006 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form MCSA-5876 Medical Examiner's Certificate (MEC) Form Modified Available
Form MCSA-5875 Medical Examination Report (MER) Form Form and Instruction Modified Available
Form MCSA-5875 IC6 - Medical Examiner's Certification Integration Final Rule Form and Instruction Modified Repair queued
Form MCSA 5871 Vision Evaluation Report Form and Instruction Modified Available
Form MCSA 5871 IC8 - Qualification of Drivers: Vision Standard Form and Instruction Modified Repair queued
Form MCSA-5850 CMV Driver Medical Examination Results Form Form and Instruction Modified Available
Form MCSA-5850 IC5b - National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results Form and Instruction Modified Repair queued
Form MCSA 5870 Insulin-Treated Diabetes Mellitus Assessment Form Form Modified Available
Form MCSA 5870 IC7 -Qualification of Driver; Diabetes Standard Form Modified Missing upstream
Justification for Non-Substantive Change for 2126-0006 September 2025.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-09-19 Available
Justification for Non-Substantive Change for 2126-0006 September 2025.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-09-19 Repair queued
30-day FR 2126-0006.pdf Supplementary Document Uploaded 2025-01-08 Available
30-day FR 2126-0006.pdf Supplementary Document Uploaded 2025-01-08 Repair queued
PRA-2126-0006 Supporting Statement 11.25.24.docx Supporting Statement A Uploaded 2024-11-25 Available
PRA-2126-0006 Supporting Statement 11.25.24.docx Supporting Statement A Uploaded 2024-11-25 Repair queued
60-day FR for 2126-0006.pdf Supplementary Document Uploaded 2024-11-25 Available
60-day FR for 2126-0006.pdf Supplementary Document Uploaded 2024-11-25 Repair queued
PRA-2126-0006 Justification NonSubstantive Change to MCSA-5875 MCSA-5876 and MCSA-5850 030223.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-04-26 Available
PRA-2126-0006 Justification NonSubstantive Change to MCSA-5875 MCSA-5876 and MCSA-5850 030223.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-04-26 Repair queued
Justification of Non-substantive Changes for MCSA-5875 07.08.20.docx Supplementary Document Uploaded 2020-07-08 Available
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
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 Available
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 Available
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
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 Source copy available
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 2012-04-18 Available
Section 4129 of SAFETEA-LU(PubLaw109-59.doc Supplementary Document Uploaded 2010-01-22 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 Available
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 Available
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
259884 IC6 - Medical Examiner's Certification Integration Final Rule Form ModifiedMedical Examiner's Certificate (MEC)
259884 IC6 - Medical Examiner's Certification Integration Final Rule Form and Instruction ModifiedMedical Examination Report (MER) Form
259884 IC6 - Medical Examiner's Certification Integration Final Rule Form and Instruction Modified
251311 IC8 - Qualification of Drivers: Vision Standard Form and Instruction ModifiedVision Evaluation Report
251311 IC8 - Qualification of Drivers: Vision Standard Form and Instruction Modified
251310 IC5d - National Registry of Certified Medical Examiners - Verification of National Registry Number Unchanged
251309 IC5c - National Registry of Certified Medical Examiners - Providing Medical Examination Reports to FMCSA Upon Request Unchanged
251308 IC5b - National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results Form and Instruction ModifiedCMV Driver Medical Examination Results Form
251308 IC5b - National Registry of Certified Medical Examiners - CMV Driver Medical Examination Results Form and Instruction Modified
251303 IC5a - National Registry of Certified Medical Examiners - Registering and Testing Unchanged
251302 IC3a - Hearing Exemptions Unchanged
251301 IC3b - Seizure Exemptions Unchanged
233017 IC7 -Qualification of Driver; Diabetes Standard Form ModifiedInsulin-Treated Diabetes Mellitus Assessment Form
233017 IC7 -Qualification of Driver; Diabetes Standard Form Modified
216256 IC4 - Skill Performance Evaluation (SPE) Certificate Program Unchanged
216251 IC2 - Resolution of Medical Conflict Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2028 03/31/2028 03/31/2028
38,069,391 0 38,069,391
3,243,525 0 3,243,525
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 38,069,391 38,069,391 0 0 0 0
Annual Time Burden (Hours) 3,243,525 3,243,525 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No