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Form MCSA-5875 Medical Examination Report (MER) Form
Medical Qualification Requirements
MCSA-5875 2-28-23 508
IC6 - Medical Examiner's Certification Integration Final Rule
OMB: 2126-0006
OMB.report
DOT/FMCSA
OMB 2126-0006
ICR 202304-2126-005
IC 259884
Form MCSA-5875 Medical Examination Report (MER) Form
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2126-0006 can be found here:
2025-01-08 - Extension without change of a currently approved collection
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