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Message to MEs from the DOT/FMCSA

Message to the MEs - Expiration Date on Driver Examination Forms

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. The current forms posted on the FMCSA website are scheduled to expire on August 31, 2018. However, FMCSA has submitted the information collection renewal request for approval. Since the information collection renewal request has been submitted, we have approval to continue use of 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 and Medical Examiner's Certificate, MCSA-5876 will be posted on the FMCSA website indicating that the collection has been renewed.



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