Statement from the FMCSA - December 15, 2021:
The date found on the top right corner of the Medical Examination Report Form, MCSA-5875, Medical Examiner's Certificate, Form 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, Form MCSA-5876, and Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870. 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, Medical Examiner's Certificate, Form MCSA-5876, and Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870, has been updated to 12/31/2024, and all forms are posted on the FMCSA website. Please note that the only change to the forms is the change in the OMB expiration date from 11/30/21 to 12/31/24.
Medical Examiners should start using the forms with the 12/31/24 date as soon as possible. However, 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. Based on this guidance, SDLAs are encouraged to continue to accept these forms.
Medical Examiners can download current DOT FMCSA NRCME Medical Examiner applications and forms here: https://www.fmcsa.dot.gov/medical/driver-medical-requirements/medical-applications-and-forms
Enroll in the NRCME Training Institute today or purchase our $99 NRCME Exam Reference Materials. Call us at (941) 600-8411 for more program information and for any current single provider enrollment discounts.