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Changes to MCSA-5875

FMCSA Statements

Minor Changes to the Medical Examination Report Form, MCSA-5875

Statement from the FMCSA:

Minor Changes to the Medical Examination Report Form, MCSA-5875

On July 7, 2021, FMCSA published a Technical Amendment that includes minor changes to the Medical Examination Report Form, MCSA-5875, which have been approved by the Office of Management and Budget (OMB). The current approved version of the Medical Examination Report Form, MCSA-5875, has been posted on the FMCSA website. The changes include the removal of the request for gender as FMCSA determined that the collection of this information is not necessary, corrections to punctuation and grammar, and minor formatting changes to correct errors and promote consistency in the style of bullet points, quotation and apostrophe marks, use of bolding and italics, and use of a forward slash instead of a comma. Use of the revised form will become effective on September 5, 2021 (60 days after publication of the Technical Amendment) to provide sufficient time for the public to make any necessary information technology changes.

Expiration Date on Diver Examination Forms

The date found on the top right corner of the Medical Examination Report Form, MCSA-5875, Medical Examiner's Certificate, MCSA-5876, and Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870, is the date of expiration for OMB approved information collection 2126-0006, that includes the Medical Examination Report Form, MCSA-5875, Medical Examiner's Certificate, MCSA-5876, and Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870. The current forms posted on the FMCSA website are scheduled to expire on November 30, 2021. However, FMCSA is in the process of submitting the information collection renewal request for approval. MEs should continue to use the forms that are currently posted on the FMCSA website until we receive notification from OMB. Once the information collection renewal has been approved, new versions of the Medical Examination Report Form, MCSA-5875, Medical Examiner's Certificate, MCSA-5876, and Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870, will be posted on the FMCSA website indicating that the collection has been renewed.

MEs that have purchased these forms in bulk, or require time to reprogram electronic system forms, may continue to use the old forms until stocks have been depleted or forms have been reprogrammed but should transition to use of the new forms as quickly as possible. However, based on the Technical Amendment, after September 5, 2021, instructions should be provided to the driver that they should leave the gender question blank on the Medical Examination Report Form, MCSA-5875.

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