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Completing Form MCSA-5875 and Certificate Form MCSA-5876

Forms

Completing Form MCSA-5875 and Certificate Form MCSA-5876

The FMCSA has been informed that some MEs are not using the approved versions of the required driver examination forms and others are not completing all the fields on the forms.

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What forms do you use?

Forms

What forms do you use?

The FMCSA creates and revises the forms that are required to be used for DOT medical examinations and..

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Updated Driver Examination Forms Posted

Forms

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...

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