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Updated Driver Examination Forms Posted

Notice from the DOT/FMCSA October 4, 2018:

Updated Driver Examination Forms Posted

The date found on the top right corner of the Medical Examination Report Form, MCSA-5875 and Medical Examiner's Certificate, MCSA-5876, is the date of expiration for the Office of Management and Budget (OMB) approved information collection 2126-0006, that includes the Medical Examination Report Form, MCSA-5875 and Medical Examiner's Certificate, MCSA-5876. FMCSA has received approval from OMB for the renewal of information collection 2126-0006. Therefore, the expiration date on the Medical Examination Report Form, MCSA-5875 and Medical Examiner's Certificate, MCSA-5876, has been updated to 09/30/2019, and the revised forms are posted on the FMCSA website.

Medical examiners must begin using the final approved forms with the 09/30/2019 expiration date as of today 10/04/2018, which is the date of notice to MEs, to remain in compliance with the Federal Motor Carrier Safety Regulations. State Driver's Licensing Agencies have been instructed to accept Medical Examiner's Certificates, Form MCSA-5876, with the previous OMB expiration date of 08/31/2018, that have been signed prior to or on 10/04/2018. The Agency published 60 and 30 day Federal Register notices informing the public of the Agency's intent to submit the information collection renewal request to OMB for approval. Although OMB allowed us to use the existing forms until they provided approval for the renewal, once they gave that approval, use of the forms with the new expiration date became required. Therefore, use of existing inventories of the previous versions of the forms will not be allowed past 10/04/2018, as the expiration date was printed on the form and should have been used to assist Medical Examiners in managing inventory and ordering forms. For those needing to reprogram electronic systems with the current approved versions of the forms, Medical Examiners and their staff are able to print, or electronically use, the fillable PDF forms found on the FMCSA website at https://www.fmcsa.dot.gov/regulations/medical.

Secondary Update to the Driver Examination Forms to be Posted

The Diabetes standard final rule that was published on 09/29/2018, stated that the Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870 is posted on the FMCSA and National Registry websites. However, the form has not been approved by OMB and is not yet posted. FMCSA has submitted, to OMB for approval, an information collection request for information collection 2126-0006 that now includes the Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870. Once approval is received, the Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870 will be posted on the FMCSA website and revised versions of the Medical Examination Report Form, MCSA-5875 and Medical Examiner's Certificate, MCSA-5876 with an updated expiration date will also be posted indicating that the collection has been approved. In anticipation of future publication of the revised versions with a new expiration date, Medical Examiners should plan accordingly in managing their inventory of existing forms dated 09/30/2019.



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