IC7 -Qualification of Driver; Diabetes Standard

Medical Qualification Requirements

Documents and Forms

Document Name Document Type
Form MCSA 5870 IC7 -Qualification of Driver; Diabetes Standard Form
MCSA 5870 Insulin-Treated Diabetes Mellitus Assessment Form MCSA-5870 12-9-21 508.pdf www.fmcsa.dot.gov/regulations/medical/insulin-treated-diabetes-mellitus-assessment-form-mcsa-5870 Form
MCSA 5870 Insulin-Treated Diabetes Mellitus Assessment Form MCSA-5870 12-9-21 508.pdf www.fmcsa.dot.gov/regulations/medical/insulin-treated-diabetes-mellitus-assessment-form-mcsa-5870 Form

Information Collection (IC) Details

IC Title:	IC7 -Qualification of Driver; Diabetes Standard	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 49 CFR 391.46 49 CFR 391.41(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	MCSA 5870	Insulin-Treated Diabetes Mellitus Assessment Form	MCSA-5870 12-9-21 508.pdf	https://www.fmcsa.dot.gov/regulations/medical/insulin-treated-diabetes-mellitus-assessment-form-mcsa-5870	Yes	Yes	Paper Only

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,906	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,906	4,906
Annual IC Time Burden (Hours)	654	654
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.