Physical Qualifications and Examinations: Medical Examination Report and Medical Examiner's Certificate Forms, 74700-74711 [2016-25976]

Download as PDF 74700 § 1329.23 Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations Compliance reviews. (a) Centers receiving Part C funding shall be subject to periodic reviews, including on-site reviews, in accordance with sections 706(c), 722(g), and 723(g) of the Act and guidance set forth by the Administrator, to verify compliance with the standards and assurances in section 725(b) and (c) of the Act and the grant terms and conditions. The Administrator shall annually conduct reviews of at least 15 percent of the Centers. (b) A copy of each review under this section shall be provided, in the case of section 723(g), by the director of the DSE to the Administrator and to the SILC, and in the case of section 722(g), by the Administrator to the SILC and the DSE. § 1329.24 Training and technical assistance to Centers for Independent Living. The Administrator shall reserve between 1.8% and 2% of appropriated funds to provide training and technical assistance to Centers through grants, contracts or cooperative agreements, consistent with section 721(b) of the Act. The training and technical assistance funds shall be administered in accordance with section 721(b) of the Act. [FR Doc. 2016–25918 Filed 10–26–16; 8:45 am] BILLING CODE 4150–04–P DEPARTMENT OF TRANSPORTATION Federal Motor Carrier Safety Administration [Docket No. FMCSA–2012–0178] Physical Qualifications and Examinations: Medical Examination Report and Medical Examiner’s Certificate Forms Federal Motor Carrier Safety Administration (FMCSA), DOT. ACTION: Notice of decision on use of Medical Examination Report and Medical Examiner’s Certificate Forms. AGENCY: FMCSA announces its decision to allow certified Medical Examiners (MEs) to use the Medical Examination Report (MER) Form, MCSA–5875, and Medical Examiner’s Certificate (MEC), Form MCSA–5876, with October, November, and December, 2015 revision dates that are located in the top left corner of the forms until existing stocks are depleted. For MEs in an office where these forms have been programmed into an electronic system jstallworth on DSK7TPTVN1PROD with RULES VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 This decision is in effect on October 27, 2016. DATES: You may search background documents or comments to the docket for this rule, identified by docket number FMCSA–2012–0178, by visiting the: • Federal eRulemaking Portal: http:// www.regulations.gov. Follow the online instructions for reviewing documents and comments. Regulations.gov is available electronically 24 hours each day, 365 days a year; or • DOT Docket Management Facility (M–30): U.S. Department of Transportation (DOT), 1200 New Jersey Avenue SE., West Building, Ground Floor, Room 12–140, Washington, DC 20590–0001. Privacy Act: In accordance with 5 U.S.C. 553(c), DOT solicits comments from the public to better inform its rulemaking process. DOT posts these comments, without edit, including any personal information the commenter provides, to www.regulations.gov, as described in the system of records notice (DOT/ALL–14 FDMS), which can be reviewed at www.dot.gov/privacy. ADDRESSES: 49 CFR Part 391 SUMMARY: that will require IT programming, the current approved versions of the forms should be programmed as soon as practicable. FMCSA published sample versions of the forms in October and November 2015 prior to posting fillable Portable Document Format (PDF) versions in December 2015. Based on the fact that the October and November 2015 forms contain minor differences yet collect the same information as the fillable PDF version, FMCSA determined the October and November versions are acceptable. In addition, MEs are also allowed to continue to use the versions of the MER Form, MCSA– 5875, that include the Privacy Act Statement on page one until stocks are depleted. For MEs in an office where these forms have been programmed into an electronic system that will require IT programming, the current approved versions of the forms should be programmed as soon as practicable. The versions of the forms currently posted by FMCSA include nonsubstantive changes that were approved by the Office of Management and Budget (OMB) on April 7, 2016 and September 6, 2016, and no longer include the Privacy Act Statement or a revision date in the top left corner. State Driver’s Licensing Agencies (SDLAs) should not accept versions of the MEC that have not been approved by OMB, and do not display both the FMCSA form number (MCSA–5876) and the OMB expiration date of August 31, 2018. PO 00000 Frm 00044 Fmt 4700 Sfmt 4700 Ms. Christine A. Hydock, Chief, Medical Programs Division, Office of Policy, Federal Motor Carrier Safety Administration, 1200 New Jersey Avenue SE., Washington, DC 20590; telephone (202) 366–4001; fmcsamedical@dot.gov. If you have questions about viewing or submitting material to the docket, contact Docket Services, telephone (202) 366–9826. SUPPLEMENTARY INFORMATION: FOR FURTHER INFORMATION CONTACT: I. Background On April 23, 2015, FMCSA published a final rule adopting regulations to facilitate the electronic transmission of MEC information from FMCSA’s National Registry system to SDLAs for holders of Commercial Driver’s Licenses (CDL) and Commercial Learner’s Permits (CLP). The final rule also requires the use of the prescribed MER Form, MCSA–5875, in place of the MER and the prescribed MEC, Form MCSA– 5876, in place of the MEC. Medical Examiner’s Certification Integration (80 FR 22790, April 23, 2015). On August 5, 2015, FMCSA received approval from OMB, for use of the MER Form, MCSA– 5875, and MEC, Form MCSA–5876, in a fillable Adobe AcrobatTM format. FMCSA published sample versions of the MER Form, MCSA–5875, and MEC, Form MCSA–5876, with October and November, 2015 revision dates on the National Registry Web site with the intent and purpose of educating MEs regarding the use of new categories on the forms and assisting MEs in programming electronic medical records prior to the Agency’s posting of the fillable Adobe AcrobatTM versions. At that time, at least one company that produces regulatory compliance publications and forms began printing and selling the MER Form, MCSA–5875, and MEC, Form MCSA–5876, with October and November, 2015 revision dates. On December 14, 2015, FMCSA posted the fillable Adobe AcrobatTM versions of the MER Form, MCSA–5875, and MEC, Form MCSA–5876, with December 2015 revision dates on the FMCSA and National Registry Web sites. Based on the fact that the October and November, 2015 forms contain minor differences yet collect the same information as the fillable Adobe AcrobatTM versions posted by FMCSA on December 14, 2015, FMCSA made the decision to allow MEs to use any previously purchased existing stock of the MER Form, MCSA–5875, and MEC, Form MCSA–5876, with October or November, 2015 revision dates until stocks are depleted. For MEs in an office where these forms have been E:\FR\FM\27OCR1.SGM 27OCR1 Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations jstallworth on DSK7TPTVN1PROD with RULES programmed into an electronic system that will require IT programming, the current approved versions of the forms should be programmed as soon as practicable. On December 21, 2015, FMCSA published guidance providing a 120-day grace period during which MEs were allowed to use either the old MER and MEC or the newly prescribed MER Form, MCSA–5875, and MEC, Form MCSA–5876, until April 20, 2016 (80 FR 79273). Subsequently, after receiving OMB approval for nonsubstantive changes to the forms, FMCSA posted the current versions of the MER Form, MCSA–5875, and MEC, Form MCSA–5876, on the FMCSA and National Registry Web sites on April 13, 2016. The current versions include several OMB approved nonsubstantive and functional changes but no longer include a revision date in the top left corner. The specific OMB approved non-substantive and functional changes can be found on the Office of Information and Regulatory Affairs Web site by selecting the following link, http://www.reginfo.gov/ public/do/PRAViewDocument?ref_ nbr=201604-2126-006, and then selecting the link for ‘‘Justification of Nonmaterial/Non-substantive Change.’’ On June 7, 2016, the Department of Transportation’s Chief Privacy Officer and Office of General Counsel reviewed the requirements of the rulemaking and determined that the collection of information maintained and held by MEs does not constitute information protected by the Privacy Act. Therefore, FMCSA submitted to OMB for approval a request for additional nonsubstantive changes including removal of the Privacy Act statement on page one of the MER Form, MCSA–5875, and the VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 addition of disclaimer language regarding the protection of sensitive information that was approved on September 6, 2016. FMCSA has posted the current versions of the MER Form, MCSA–5875 and MEC, Form MCSA– 5876 on the FMCSA and National Registry Web sites. The additional OMB-approved non-substantive changes can be found on the Office of Information and Regulatory Affairs Web site by selecting the following link http://www.reginfo.gov/public/do/ PRAViewDocument?ref_nbr=2016042126-006, and then selecting the link for ‘‘Justification of Nonmaterial/Nonsubstantive Change.’’ II. Acceptable Versions of Forms All changes to the MER and MEC forms since the August 5, 2015, date on which OMB provided approval for use of the forms were nonsubstantive in nature. Therefore, MEs are allowed to use MER Form, MCSA–5875, and MEC, Form MCSA–5876, with October, November, and December, 2015 revision dates until existing stocks are depleted. This includes forms produced by the private sector with October or November, 2015 revision dates that FMCSA never intended to be published for use by the public and fillable forms posted on the FMCSA and National Registry Web sites on December 14, 2015, as well as the MER Form, MCSA– 5875, that includes the Privacy Act Statement on page one. For MEs in an office where these forms have been programmed into an electronic system that will require IT programming, the current approved versions of the forms should be programmed as soon as practicable. MEs are also encouraged to use the current versions of the forms that no longer include the Privacy Act PO 00000 Frm 00045 Fmt 4700 Sfmt 4700 74701 Statement or a revision date in the top left corner, and can be found on the FMCSA and National Registry Web sites. Under the provisions of 49 CFR 383.71(h), until June 22, 2018, commercial motor vehicle (CMV) drivers operating vehicles that require a CDL or CLP are required to provide SDLAs with an original or a copy of the MEC, Form MCSA–5876, for entry of the medical certification status on the driver record. FMCSA has learned that some SDLAs are refusing to accept from CMV drivers the MEC, Form MCSA–5876, with an October or November, 2015 revision date. In view of the clarification in this document of the status of the MEC, Form MCSA–5876, with various revision dates, FMCSA is directing SDLAs to accept the MEC, Form MCSA– 5876, with October, November, and December, 2015 revision dates until existing stocks are depleted. SDLAs should also be accepting the versions that were posted on April 13, 2016, on the FMCSA and National Registry Web sites that no longer include a revision date in the top left corner and the current version of the MER Form, MCSA–5875, that is posted on the FMCSA and National Registry Web sites that no longer includes the Privacy Act Statement on page one. On the other hand, SDLAs should not accept versions of the MEC that have not been approved by OMB and do not display both the FMCSA form number (MCSA–5876) and the OMB expiration date of August 31, 2018. The final versions of the forms published on the FMCSA and National Registry Web sites are shown below for your reference. BILLING CODE 4910–EX–P E:\FR\FM\27OCR1.SGM 27OCR1 74702 Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations Medical Examination Report Form, MCSA-5875 Posted September 20, 2016 -------------~ City: _ _ _ _ _ _ _ _ Stmtl'l'l'ovlnce:_._._ _ ZlpCodee _ _ _ _ 1 CLP/CDLApplicanti'Holdar": 0 ~ 0 No Cr1ver IDVertfitd Bt"": _____________ l I HlrsycMJrlJSOOT/FMi::SAmedical certifimeell!!fbeen denied or issued for less than 2year.51 0 Ys 0 No 0 Not SuN L'RIVER HEALTH HIS TOR\ Ovw ONo 0 Haw you -had sulgGI')I? If "yes." plaase listanci4111Cp!ain b"'-. ARt you curnmtlytakilg medications (presc~over-lhe,cwnter, herbalremedies.,dietwppkme:nts}l pleasedemibe below. If·~ Not Sure QV.QNoQNotSure '"'This doc1.1111erot «itttiolnssensltlvol inforiMllon and is forolllclalme only. lmpropo~t handling ofthis lnforiMllon could negativ<ilylffe.:t lndllllduals. Handle and secure this Wonnation appn>Pflahlyto PfE'Wnt inadwm.ntdi<clo<""' b)II<M>plng till! documents under the control ofautmriad PI!""M. Properlydlspooeofthlsdocumontwhl!n no lo"'!l"r requlrndto b•>~naOIVIoinnd bJ1 regulotoll' requirementS... VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 PO 00000 Frm 00046 Fmt 4700 Sfmt 4725 E:\FR\FM\27OCR1.SGM 27OCR1 ER27OC16.000</GPH> jstallworth on DSK7TPTVN1PROD with RULES Pagel Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations 008: First Name: DRIVER ~IEALTH HISTORY 74703 , Not Doyw have- haveyw- ..... I. Hudibrain injuriftorillnesses (eg.cooaJSSioti) 2. Seizure, epilepsy 3. Eye problams (~g~D=sorconttxts) 4. Ear and/or hearing pRlblem5 s. Hean disease; heart attack. bvpass.orotherheart problarns 6. Pacemaker, stents, Implantable devices, or other hurt procedUiti 7. High blood prusun~ s. High cholesterol 9. Chronic: llong"'lilm'i! cough, shortnfiS ofb-11. or other breathing problams I G. lung disease {e:g. asthma! 11. Kicbey pRlblems, kidney stone, or palnlpd>lems with urination I z. Stomach.llwr, or digestive problans I !1. Diabetes or blood sugar problems lmullnused 14. Anxitty, depression. MrVOUsness,other mental health problems IS. Ftintlng or pa,sslng out Not Ys No Sul'e Ys No Sul'e 000 00 0 00 0 00 0 00 0 00 0 00 0 000 00 0 00 0 00 0 00 00 00 00 0 0 0 0 00 0 16. Diulnes$, hudach..., numbnau, tingling. or mamory loss I 7. U,_p!ained weight loss !8; Strolal.minktrok» (TIA). paralysis, or weakness 19. Missing or limited use of a1111, hand, finger, leg. foot, toe 20. Neck or back problems 21. Bone. muscle. Joint or nerve problems 22. Blood clots or bi<Ndf1g pRlblams 23.Cancer 24. Chronic (long-term)lnfection or other chronic: dls8ses 25. Slap dis:ordGH, pauses in b-hingwhile asleep, daytlmesleepinau,loud snoring 26. Have you ever had a !IMp test (eg.,s/eepapt~e/1)1 27. HII\'IOyou- spent a night In the hospital!' 28. Have you ever had a broken bone? 29.Hawyou-usedordoyounowUHtobacc:o7 3tl. Do ycu CUINMiy drink alcchol7 31. Have ycu used an IUegal submnc• wllhln the past two yors? 32. H-you ever ailed a drug test or been dependent on lin lftegal substance? 00 0 00 0 000 00 0 00 0 00 0 00 0 000 00 0 00 0 00 0 000 00 0 00 0 00 0 00 0 00 0 ORo ONotSUH Olharholth condltlan(s) not dascribecl above: OM Did you answ«"Yes"toany of questiOns 1-32? If so. please comment further on those health conditions belcw. Ov- 0No ONotSUH Icertiljr that the aboveillfonnation is accul'lltaand complata.l understand that inamnta. false or missing infonnatiOn may invalidate the l!lfllmination and my Medical Examillel's Cettific:ata, tllllt submlsslon affrauclulllnt or intentionally false information in 'iiolation of§ CFR 3!!!l35, and tllllt submission offraudulent or intentionaUyalse: informlitiOn may subject me to civil or criminal penalties under42CFB39!!.37 and~ Appendices Aand a. Drivar's Signatu111: VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 PO 00000 Frm 00047 Fmt 4700 Sfmt 4725 E:\FR\FM\27OCR1.SGM 27OCR1 ER27OC16.001</GPH> jstallworth on DSK7TPTVN1PROD with RULES Paga2 74704 Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations I Exam Date: First Name: last Name: TESTING Pulseratil< · - - - Pulserhythmregular:OYes 0No Systolic Urin¥s Diastolic Sitting Se<cnd reading (optional) Sp, Gr. Protl!in Sugar Blood Urinalysis lnequlred. Num!!lkal readingS must be recorda<!. Plme/Jl llloc4 orwgarin the: urinemaybeanindicatior> forfilrthe:rtesting to Oth• tasting lflndlcatad lilleoutanyood.~medicaiPfO!;IIem. Htlring Vklon Stondard i$ «least 20140acuity(Sneffen) in each eye with orwilhwtcorreaia!.At Stat>dcrd:Must lil:st petee/vewhisperedvoice<ltoot less than 5feet0Ravetage least 70"fieldafvision in horizontal meridian meawredin each eye. The: use ofa:JF· hemingmofless thanorl!!qlalto4/ld8, in better.ear(with or without hearing ail$. red:ive /ensesshouldbenotedon theMedital&ominefs Cettifil::ate. AcUity Uncorrected 201_ 201_ 201_ Corrected 201_ 20/_ 201_ Horizontal Field ofVIslofl Checkifht~~~ringaidUSI!dfor-: ORightE'ar OlaftE'ar OHeither Right E'ar Laft EaT Record dis!ance (in ~from dl'lwratwhlch a foKI!d Whisper Test lleaults Aight Eye: _dagrMS LeftEye: _degrees whispe!'Uvoicecanflrstbeheard Yti1 No OH Applicant can recognizund distinguish among traffic control signals and devla!s shQwlng red, gra1n, and amber colors 0 0 A!ldl•etricTestllwula Mcnocularvision Referred to ophthalmologist or optometrist7 flecl!IV«< documentation frorn cphthalmologis! or optomMrlst? 0 0 flight Ear SOOHz 2000Hz 500Hz 1000Hz 2000Hz 00 Normal Abnormal llodyS,St.m Left Ear 1000Hz 1.General 2 Skin 0 0 0 Hyes 4. E'ars s. MoutMhroat Normal Abnormal Bod,S,St.m 0 0 10. Back/Spine 0 0 0 0 0 0 0 7. Lungs/chest 0 0 0 6. Cardiovascular 0 0 &Abdomen 9. Genfto.ur!Nl')l $)'Starn Including hemlas 0 0 0 11. Extremities/joints 12. Neurological system including~ 13. Gait 14. Vascular system 0 0 0 0 0 0 0 0 DlscJssanyabnarmal ~In derollin tht sprxebelow!llldindla!rrwtltthe:r itwoold affect.flledrlvers ablliry rooperarro CMv. Etlterappl/albklfein nurnberbe(Qr!teodlcomment VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 PO 00000 Frm 00048 Fmt 4700 Sfmt 4725 E:\FR\FM\27OCR1.SGM 27OCR1 ER27OC16.002</GPH> jstallworth on DSK7TPTVN1PROD with RULES Page a Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations I last Name: First Name; MEDICAl EXAMINER DETERMINATION 74705 0011: F"d"'"l' USe tha~·mmm~mtilwperfonnedln!l«l1td!itlcewltltthl!f!<deml ,«owrCoiritrSakf¥Regulation$ t49CFRW.4!:39J.421: 0 0 0 ~:leG$ not mtilt standards (specify 111!1!00): MlllltSstandaldsin49CFR 3!11 Al:qualiflts for 2-yurc~ Meets standardr, but periodic monitoring required (specify reasoo): Dr(wr qualified for: 0 3months 0 6months 0 1yaar Qothar(spt!<:lzyr. 0 W.rlng c:orrec~lve lenses 0 Wearing hearing aid 0 Accompanied by a waiver/exemption (spe.a1ji(JIPe): 0 A«ompanied by a Skill ParformancA> Evalilatioo (SPE) Cartificata 0 Qualified by oparatfl:m of49 CfB 3!U 64 l&:dggO 0 Driving within an exempt intracity zone (see49CFR39L@~ 0 Determination pending (spedfy111!1!00): 0 Return to medical acam officteforfolfow.upon (rOOSt be45 days orkss}: 0 Medical Examination Reporumended (spec:i/ytWS011}! llfamendet:JJ Medical Examlnet"sSignatune: 0 Data: Incomplete examfnatlon {sped(yreaSOil}! !lftl!ell'lvlrmHIIII!e~•llnlllln~mtmo!],lhencomplateaMeclkalbM!Ina's(lrtlftateassfilltdln~IJRDJ.dhl.asappreprlin.[ t haw performed this evaluation for certification. I have personally reviewed all.availablerecords and recorded Information pertaining to this evaluation, and attest that to the best of my lcnowle.clge, I believe It to be true and correct. Medical Examiner's Slgnatura: Medical Examlnal's Nama (please print or~ State _ _ ZipCodR:. Medical &aminal's Address: City: Medical ExaminenTelephone Number: DateO!I'tiflc:ate Signed: Issuing State: _ _ Medical EXaminer's State License. catiflcate. or Reglstratfl:m Number: 0MD Doo 0 l'tiysiclan AssiStant 0 OtherPmctitione.r (speclzyr. 0 Chiropractor 0 Advanced Praetlc:e Nu!'H 1Medical Examinel's Certificate: Expiration Date: National RegistiY Number: I VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 PO 00000 Frm 00049 Fmt 4700 Sfmt 4725 E:\FR\FM\27OCR1.SGM 27OCR1 ER27OC16.003</GPH> jstallworth on DSK7TPTVN1PROD with RULES Page4 74706 Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations I First Name: last Name: DOB: MEDICAl EXAM!NtR PEHRMINATION '$tot¢' /Jtethlsteaiol'lfMV~Jmfntltlons~ill~wltlt!MFedem!MotorCarrier&!fely~fftCFR3?l.4!-39U91wltltiHiy~State .vaflanas (which wi/JOnlybevalldfMiiltnJsttJteopetiJI»ns}: 0 0 0 0 0 Does not meet standards in 49 CFR391A1 with any appllcableStatevarianc:es (specify reasoni: Memstandardsln49 CFU!!1.41 with any applcableStatnarlances: Meets standards, but periodic monitcring required {spedfyMason}: err-qualll!ed for: Q3months Q6months Q!yur Q other (spocify): 0 waring h1111ring aid 0 Accompanied by a wai-/exA~tnption C;pedl'ytype;: Waaring ccrra:ti~lenAccompani.t by a Skill Performance Evaluation (SPE) Certificata 0 GrandfatMred from State requiram~~nts c;totl!) llfthdilnrllillllslhellaMar&tdlne41n~aB~I~,wfthapplaiMtStatt:'llllllal-, lhiR-JIIIttaMiilk:ll ~IRI'll Ce111caR.•Iplll'lllllaa.l I haU. parfonned this evaluation for Cllrtifrc:ation.l ha~ piiiSOnally re'llii!Wid all availableNCOrds and l'8alrded Information pertaining to this evaluation, and attest that to the best of my linowledge, I believe it to be true and correct. Medicall?xaminm Signature: Medio::tll?xamlnen Name (J>feaseptirot« type~ Medical !x~tmiMI's Address: City: Medicall?xaminmTalephona Number: Dlte~ificateSigMd: State--· Zfp Code: Issuing State _ _ Medlcall?xaminen State ll~ c.rtlficate, cr Registration Number: ODD 0 Physician Assistant 0 Chllopractor 0 Advanced Practice Num~ 0MD 0 Other Practitioner (specify): r,,-.. ,~",·~~"' Na!lional Registry Number. L ... ~. ~ •'~-~-~"-' -~ '"- -~- ---~ ~-- I ' Medical Examiner's Certificala Expiration Date l I VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 PO 00000 Frm 00050 Fmt 4700 Sfmt 4725 E:\FR\FM\27OCR1.SGM 27OCR1 ER27OC16.004</GPH> jstallworth on DSK7TPTVN1PROD with RULES PageS Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations 74707 Instru.ctions for Completing the Medical Examination Report Form (MCSA-5875) L Step-By-Step .lnstm.etiom Ddver: Semon 1: Driver information PenonaliJd'o:rmation: Please complete 1his section using your name as written on your driver's license. your outterJt address and phone number, your date ofbirlh. age, gender> driver's license number and issuing state. o CLPICDL Applicant/Holder: Check ''yes" if you are a commercial teamer's pennit (CLP) or com~ mercial driver's license (CDL) hOlder, or are applying for aCLP or CDL. CDLttteans a license issued by a State orlhe District of Cohmbia which authorizes the individual to operate a class of a commercial motor vehicle (CMV). A CMV that requires a CDL is one that: (l) has a gross combination weight rating or gross combination weight of 26.001 pounds or more inclusive of a towed unit with a gross vehicle weight rating (GVWR) or gross vehicle weight (GVW) of more than 10,000 pounds; or (2) bas a GVWR or GVW of26,001 pounds or more; or (3) is designed to transport 16 or more passengers, including the driver;. or (4) is used to transport either hazardous materials requiring hazardous materials placards on the vehicle or any quantity of a select agent or toxin. o Driver ID Verified By: The Medical Examiner/staff completes this item and notes the type of photo ID used to verifY the driver's identity sud~ as, commercial driver's license, driver's license, or pas!IJI'Od. etc. o Question: Has your USDOTIFMCSA medical certlfleate ever been denlecl or Issued for less than two years? Please check the correct box "yes" or "no" and ifyou aren't sure Check the ''not sure" box. Driver Health mstory: o Have yoo ever had ftll'lleJ'Y! Please check ''yes" ifyou have ever had surgery and provide a written explanation of the details (type of surgery, date of S\lrgel'y, etc.) o Are you c:u.rrently taking medleatiODS (pD!SCI'Iptlon., over-the-counter, herbal remedies, dJet supplements): Please check "yes" if you are taking any diet supplements, herbal remedies. or prescription or over the counter medications. In the box below the question, indicate the name of the medication and the dosage. o #l-32: .Please complete this sectioo by cbecldngthe "yes" box to indicate that you have, or have ever bad, the health oondit:ion listed or the "No" box if you have not. Check the "not sure" box if you are unsure. o other Health CondltiODS not tlescriiJed allove; Ifyou have. or have had, any other health conditions not listed in the section above. dleck:''Yes" and in the box provided and list those condition(s). o Any yes IIIISWers to qaestions #1-32 above: lfyou have answered "yes" to any ofthe questions in the Driver Health History section above, please explain your answers further in the box. below the question. For example, if you answered "yes" to question #5 regarding heart disease, heart attack. bypass, or other heart problem, indicate which type of heart condition. If you checked "yes" toquestion #23 regarding cancer, indicate the type of cancer. Please add any infonnation that win be heJpful to the Medical Examiner, VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 PO 00000 Frm 00051 Fmt 4700 Sfmt 4725 E:\FR\FM\27OCR1.SGM 27OCR1 ER27OC16.005</GPH> jstallworth on DSK7TPTVN1PROD with RULES CMV Driver Signature and Date: Please read the certification statement, sign and date it, indicating that the information you provided in Section 1 is accurate and complete. 74708 Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations Me4ieal Examiner: Section 2: Examination Report Driver Health History Review: .Review answers provided by the driver in the driver health history section and discuss any «yes" and "not sure" responses. In addition. be sure to oompare the medication list to the health history responses ensuring that the medication list matches the medical conditions noted. Explore with the driver any answers that seem unclear. Record any information that the driver omitted. As the Medical Examiner conducting the driver's physical examination you are required to complete the entire medical examination even if you detect a medical condition that you consider disqualifYing. such as deafuess. Medical Examiners are expected to determine the driver's physical qualification for operating a commercial vehicle safely. Thus, if you find a disqualifYing condition for which a driver may receive a Federal Motor Carrier Safety Administration medical exemption, please record that on the driver's Medical Examiner's Certificate, Form MCSA-5876. as well as on the Medical Examination Report Form. MCSA-5875. Testing: o Pulse rate and rhythm, JaeiPt, and wdght: record these as indicated on the form. o Blood Pressure: record the blood pressure (systolic and diastolic) ofthe driver being examined. A second reading is optional and should be recorded if found to be necessary. o Urinalysis: record the numerical readings for the speeific gravity. prolein. blood and sugar. o Vlsioa: The current vision standard is provided on the form. When other than the Snellen chart is used, give test results in SneHen•oomparable values. When recording distance vision, use 20 feet as normal. Record the vision acuity results and indicate if the driver can recognize and distinguish among traffic control signals and devices showing red, green. and amber colors; has monocular vision; has been referred to an ophthalmologist or optometrist; and if documentation has been received from an ophthalmologist or optometrist. o Bearing: The current hearing standard is provided on the form. Hearing can be tested using either a whisper lest or audiometric test. Record the test results in the corresponding section for the lest used. PhyUeal Examination: Check the body systems for abnormalities and indicate normal or abnormal for each body system listed. Discuss any abnormal answers in detail in the space provided and indicate whether it would affect the driver's ability to safely operate a commercial motor vehicle. ln. litis nut Bdtm, you will be contpleting either the FedJmll or Stllttl ~not IJotlt. Medieal Examiner Determination (Federal): Use this section for examinations performed in accordance with the FMCSRs (49 CFR 391.41-39:1.49). Complete the medical examiner determination sectionoompletely. When determining a driver's physical qualification. please note that English language proficiency (49 CFR part 391.11: General qualifications of drivers) is not factored into that determination. o Does not meet standards: Select this option when a driver is determined to be not qualified and provide an explanation of why the driver does not meet the standards in 49 CFR391.41. o Mods standa:nls in 49 CFR 391.41; qualities for l-year t:erliliadioa: Select this option when a driver is determined to be qualified and will be issned a 2-year Medical Examiner's Certificate. VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 PO 00000 Frm 00052 Fmt 4700 Sfmt 4725 E:\FR\FM\27OCR1.SGM 27OCR1 ER27OC16.006</GPH> jstallworth on DSK7TPTVN1PROD with RULES Page7 Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations 74709 o Meets standards, hut periodi~ monitoring is n:quired~ Select this option when a driver is determined to be qualified but needs periodic monitoring and provide an explanation ofwhy periodic monitoring is required. Select the corresponding time frame that the driver is qualified and if selecting other, specifY the time frame. Dderminatioa that driver meets standards: Select all categories that apply to the driver's certification (e.g., wearing coiTeCtive lenses, accompanied by a waiver/exemption, driving within an exempt intracity zone, etc.). o Ddemdnatlon pending: Select this option when more infonnation is needed to make a qualification decision snd specifY a date, on or before the 45 day expiration date, for the driver to return to the medical exam office for follow-up. This will allow for a delay of the qualification decision for as msny as 45 days. If1he disposition of the pending examination is not updated via 1he Nab.Onal Regis· tty on or before the 45 day expiration date, FMCSA will notifY the examining medical examiner snd 1he driver in writing that the examination is no longer valid snd that the driver is required to be reexamined. MER amended: .A Medical Examination Report Fonn (MER). MCSA-5875, may only be amended white in determination pending status for situations where new infonnation (e.g., test results. etc.) has been received or there has been a change in the driver's medical status since the initial examination. but prior to a fmal qualification determination. Select this option wherta Medical Examination Report Forttt, MCSA-5875, is being amended; provide the reason for the amendment, sign snd date. In addition_ initial and date any chsnges made on the Medical Examination Report Form, MCSA-5875. A Medical Examinatioo Report Forttt, MCSA-5875, cannot be amended after sn examination has been in determination pending stalus for more than 45 days or after a final qualification detetmination has been made. The driver is required to obtain a new physical examination snd auew Medical Examination Report Form. MCSA-5875, should be oompleted. o Ineomplete examinatlou: Select this when the physical examination is not completed for sny reason (e.g., driver decides they do not want to continue with the examinatloo snd leaves) other thsn situations outlined under determination pending. o Metlical Examiner illfonnation, signature and date: Provide your name. address. phone number. occupation. license, certificate. or registration number snd issuing state. national registty number. sigoature snd date. o Metlieal Examiner's CertUicate .Expiration Date: Enter the date the driver's Medical Examiner's Certificate (MEC) expires. Medieal Examiner Detennination (State)~ Use this section for examinations perfonned in accordance with the FMCSRs (49 CFR 391.41-391.49) with any applicable State varisnoes (which will ooly be valid for intrastate operations). Complete the medical examiner determination section completely. o Does not meet standanls in 49 CFR 391.41 with llftY applicable State variances: Select this option when a driver is determined to be not qualified and provide sn explanation of why the driver does not meet the standards in 49 CFR 391.41 with any applicable State variances. o Meets standards in 49 CFR 391.41 with IIDY .applleable State vadanees: Select this Option when a driver is determined to be qualified snd will be issued a 2-year Medical Examiner's Certificate. o Meets standanls,.llut periodic monitoring is required! Select this optioo when a driver is determined to be qualified but needs periodic mooitoring and provide an explanation of why periodic monitoring is required. Select the corresponding time frame that the driver is qualifted snd if selecting other, specifY the time frame. Determinatiou that driver meets stand.arcls: Select aU categories that apply to the driver's certification (e.g,. wearing corrective lenses, accompanied by a waiver/exemption, etc.). VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 PO 00000 Frm 00053 Fmt 4700 Sfmt 4725 E:\FR\FM\27OCR1.SGM 27OCR1 ER27OC16.007</GPH> jstallworth on DSK7TPTVN1PROD with RULES PageS 74710 Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations o Medkal Examinerinfonnation. signature and date; Provide your name. address. phone number, occupation, Hcense. certificate, or registration number and issuing state, national registty number, signature and date. o Medkal Examiner'sCerttfteate Expiratioo Date: Enterthe date the 41riverts Medical Examiner's Certificate (MEC) expires. n. Ifupdating an esfsting exam, you must l'elllbmit the new exam results, via the Medical Exandnatlou Results Fonn, MCSA-5850, to tbe National Registry, and the most neent dated exam wDI take precedence. m. To obtaill ad.ditlooal infonnation regarding tbis fonn go to the Medkal Program's page on tbe Federal Motor Carrier Safety Administration's website at http;/lmyw.fmqa.d.ot.&Qv!J:gulaflonslmedkal. VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 PO 00000 Frm 00054 Fmt 4700 Sfmt 4725 E:\FR\FM\27OCR1.SGM 27OCR1 ER27OC16.008</GPH> jstallworth on DSK7TPTVN1PROD with RULES Pagel! Federal Register / Vol. 81, No. 208 / Thursday, October 27, 2016 / Rules and Regulations pursuant to the Marine Mammal Protection Act (MMPA). This action is being taken as a result of a status review conducted by NMFS in response to a petition to designate a group of beluga whales in the western Sea of Okhotsk as a depleted stock. The biological evidence indicates that the group is a population stock as defined by the MMPA, and the stock is depleted as defined by the MMPA. [FR Doc. 2016–25976 Filed 10–26–16; 8:45 am] BILLING CODE 4910–EX–c DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration This final rule is effective November 28, 2016. DATES: 50 CFR Part 216 [Docket No. 151113999–6950–02] Designating the Sakhalin Bay-Nikolaya Bay-Amur River Stock of Beluga Whales as a Depleted Stock Under the Marine Mammal Protection Act (MMPA) National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Final rule. jstallworth on DSK7TPTVN1PROD with RULES AGENCY: We, NMFS, issue a final determination to designate the Sakhalin Bay-Nikolaya Bay-Amur River Stock of beluga whales (Delphinapterus leucas) as a depleted stock of marine mammals SUMMARY: VerDate Sep<11>2014 13:32 Oct 26, 2016 Jkt 241001 Copies of supporting documents, including the status review, the proposed rule, and a list of references cited in the final rule, are available via the Federal e-rulemaking Portal, at www.regulations.gov (search for Docket ID NOAA–NMFS–2015– 0154), or at http:// www.fisheries.noaa.gov/pr/species/ mammals/whales/beluga-whale.html. Those documents are also available from NMFS at the following address: Chief, Marine Mammal and Sea Turtle Conservation Division, Office of Protected Resources, National Marine Fisheries Service, 1315 East-West Highway, Silver Spring, MD 20910– 3226. ADDRESSES: RIN 0648–BF55 PO 00000 Frm 00055 Fmt 4700 Sfmt 4700 FOR FURTHER INFORMATION CONTACT: Shannon Bettridge, Shannon.Bettridge@ noaa.gov, Office of Protected Resources, 301–427–8402. SUPPLEMENTARY INFORMATION: Background Section 115(a) of the MMPA (16 U.S.C. 1383b(a)) allows interested parties to petition NMFS to initiate a status review to determine whether a species or stock of marine mammals should be designated as depleted. On April 23, 2014, we received a petition from the Animal Welfare Institute, Whale and Dolphin Conservation, Cetacean Society International, and Earth Island Institute (petitioners) to ‘‘designate the Sakhalin Bay-Amur River stock of beluga whales as depleted under the MMPA.’’ We published a notification that the petition was available (79 FR 28879; May 20, 2014). After evaluating the petition, we determined that the petition contained substantial information indicating that the petitioned action may be warranted (79 FR 44733; August 1, 2014). Following the determination that the petitioned action may be warranted, we convened a status review team and conducted a status review to evaluate E:\FR\FM\27OCR1.SGM 27OCR1 ER27OC16.009</GPH> Issued on: October 20, 2016. T.F. Scott Darling, III, Administrator. 74711

Agencies

[Federal Register Volume 81, Number 208 (Thursday, October 27, 2016)]
[Rules and Regulations]
[Pages 74700-74711]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-25976]


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DEPARTMENT OF TRANSPORTATION

Federal Motor Carrier Safety Administration

49 CFR Part 391

[Docket No. FMCSA-2012-0178]


Physical Qualifications and Examinations: Medical Examination 
Report and Medical Examiner's Certificate Forms

AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT.

ACTION: Notice of decision on use of Medical Examination Report and 
Medical Examiner's Certificate Forms.

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SUMMARY: FMCSA announces its decision to allow certified Medical 
Examiners (MEs) to use the Medical Examination Report (MER) Form, MCSA-
5875, and Medical Examiner's Certificate (MEC), Form MCSA-5876, with 
October, November, and December, 2015 revision dates that are located 
in the top left corner of the forms until existing stocks are depleted. 
For MEs in an office where these forms have been programmed into an 
electronic system that will require IT programming, the current 
approved versions of the forms should be programmed as soon as 
practicable. FMCSA published sample versions of the forms in October 
and November 2015 prior to posting fillable Portable Document Format 
(PDF) versions in December 2015. Based on the fact that the October and 
November 2015 forms contain minor differences yet collect the same 
information as the fillable PDF version, FMCSA determined the October 
and November versions are acceptable. In addition, MEs are also allowed 
to continue to use the versions of the MER Form, MCSA-5875, that 
include the Privacy Act Statement on page one until stocks are 
depleted. For MEs in an office where these forms have been programmed 
into an electronic system that will require IT programming, the current 
approved versions of the forms should be programmed as soon as 
practicable. The versions of the forms currently posted by FMCSA 
include nonsubstantive changes that were approved by the Office of 
Management and Budget (OMB) on April 7, 2016 and September 6, 2016, and 
no longer include the Privacy Act Statement or a revision date in the 
top left corner. State Driver's Licensing Agencies (SDLAs) should not 
accept versions of the MEC that have not been approved by OMB, and do 
not display both the FMCSA form number (MCSA-5876) and the OMB 
expiration date of August 31, 2018.

DATES: This decision is in effect on October 27, 2016.

ADDRESSES: You may search background documents or comments to the 
docket for this rule, identified by docket number FMCSA-2012-0178, by 
visiting the:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the online instructions for reviewing documents and comments. 
Regulations.gov is available electronically 24 hours each day, 365 days 
a year; or
     DOT Docket Management Facility (M-30): U.S. Department of 
Transportation (DOT), 1200 New Jersey Avenue SE., West Building, Ground 
Floor, Room 12-140, Washington, DC 20590-0001.
    Privacy Act: In accordance with 5 U.S.C. 553(c), DOT solicits 
comments from the public to better inform its rulemaking process. DOT 
posts these comments, without edit, including any personal information 
the commenter provides, to www.regulations.gov, as described in the 
system of records notice (DOT/ALL-14 FDMS), which can be reviewed at 
www.dot.gov/privacy.

FOR FURTHER INFORMATION CONTACT: Ms. Christine A. Hydock, Chief, 
Medical Programs Division, Office of Policy, Federal Motor Carrier 
Safety Administration, 1200 New Jersey Avenue SE., Washington, DC 
20590; telephone (202) 366-4001; fmcsamedical@dot.gov. If you have 
questions about viewing or submitting material to the docket, contact 
Docket Services, telephone (202) 366-9826.

SUPPLEMENTARY INFORMATION: 

I. Background

    On April 23, 2015, FMCSA published a final rule adopting 
regulations to facilitate the electronic transmission of MEC 
information from FMCSA's National Registry system to SDLAs for holders 
of Commercial Driver's Licenses (CDL) and Commercial Learner's Permits 
(CLP). The final rule also requires the use of the prescribed MER Form, 
MCSA-5875, in place of the MER and the prescribed MEC, Form MCSA-5876, 
in place of the MEC. Medical Examiner's Certification Integration (80 
FR 22790, April 23, 2015). On August 5, 2015, FMCSA received approval 
from OMB, for use of the MER Form, MCSA-5875, and MEC, Form MCSA-5876, 
in a fillable Adobe AcrobatTM format.
    FMCSA published sample versions of the MER Form, MCSA-5875, and 
MEC, Form MCSA-5876, with October and November, 2015 revision dates on 
the National Registry Web site with the intent and purpose of educating 
MEs regarding the use of new categories on the forms and assisting MEs 
in programming electronic medical records prior to the Agency's posting 
of the fillable Adobe AcrobatTM versions. At that time, at 
least one company that produces regulatory compliance publications and 
forms began printing and selling the MER Form, MCSA-5875, and MEC, Form 
MCSA-5876, with October and November, 2015 revision dates. On December 
14, 2015, FMCSA posted the fillable Adobe AcrobatTM versions 
of the MER Form, MCSA-5875, and MEC, Form MCSA-5876, with December 2015 
revision dates on the FMCSA and National Registry Web sites. Based on 
the fact that the October and November, 2015 forms contain minor 
differences yet collect the same information as the fillable Adobe 
AcrobatTM versions posted by FMCSA on December 14, 2015, 
FMCSA made the decision to allow MEs to use any previously purchased 
existing stock of the MER Form, MCSA-5875, and MEC, Form MCSA-5876, 
with October or November, 2015 revision dates until stocks are 
depleted. For MEs in an office where these forms have been

[[Page 74701]]

programmed into an electronic system that will require IT programming, 
the current approved versions of the forms should be programmed as soon 
as practicable.
    On December 21, 2015, FMCSA published guidance providing a 120-day 
grace period during which MEs were allowed to use either the old MER 
and MEC or the newly prescribed MER Form, MCSA-5875, and MEC, Form 
MCSA-5876, until April 20, 2016 (80 FR 79273).
    Subsequently, after receiving OMB approval for nonsubstantive 
changes to the forms, FMCSA posted the current versions of the MER 
Form, MCSA-5875, and MEC, Form MCSA-5876, on the FMCSA and National 
Registry Web sites on April 13, 2016. The current versions include 
several OMB approved nonsubstantive and functional changes but no 
longer include a revision date in the top left corner. The specific OMB 
approved non-substantive and functional changes can be found on the 
Office of Information and Regulatory Affairs Web site by selecting the 
following link, http://www.reginfo.gov/public/do/PRAViewDocument?ref_nbr=201604-2126-006, and then selecting the link 
for ``Justification of Nonmaterial/Non-substantive Change.''
    On June 7, 2016, the Department of Transportation's Chief Privacy 
Officer and Office of General Counsel reviewed the requirements of the 
rulemaking and determined that the collection of information maintained 
and held by MEs does not constitute information protected by the 
Privacy Act. Therefore, FMCSA submitted to OMB for approval a request 
for additional nonsubstantive changes including removal of the Privacy 
Act statement on page one of the MER Form, MCSA-5875, and the addition 
of disclaimer language regarding the protection of sensitive 
information that was approved on September 6, 2016. FMCSA has posted 
the current versions of the MER Form, MCSA-5875 and MEC, Form MCSA-5876 
on the FMCSA and National Registry Web sites. The additional OMB-
approved non-substantive changes can be found on the Office of 
Information and Regulatory Affairs Web site by selecting the following 
link http://www.reginfo.gov/public/do/PRAViewDocument?ref_nbr=201604-2126-006, and then selecting the link for ``Justification of 
Nonmaterial/Non-substantive Change.''

II. Acceptable Versions of Forms

    All changes to the MER and MEC forms since the August 5, 2015, date 
on which OMB provided approval for use of the forms were nonsubstantive 
in nature. Therefore, MEs are allowed to use MER Form, MCSA-5875, and 
MEC, Form MCSA-5876, with October, November, and December, 2015 
revision dates until existing stocks are depleted. This includes forms 
produced by the private sector with October or November, 2015 revision 
dates that FMCSA never intended to be published for use by the public 
and fillable forms posted on the FMCSA and National Registry Web sites 
on December 14, 2015, as well as the MER Form, MCSA-5875, that includes 
the Privacy Act Statement on page one. For MEs in an office where these 
forms have been programmed into an electronic system that will require 
IT programming, the current approved versions of the forms should be 
programmed as soon as practicable. MEs are also encouraged to use the 
current versions of the forms that no longer include the Privacy Act 
Statement or a revision date in the top left corner, and can be found 
on the FMCSA and National Registry Web sites.
    Under the provisions of 49 CFR 383.71(h), until June 22, 2018, 
commercial motor vehicle (CMV) drivers operating vehicles that require 
a CDL or CLP are required to provide SDLAs with an original or a copy 
of the MEC, Form MCSA-5876, for entry of the medical certification 
status on the driver record. FMCSA has learned that some SDLAs are 
refusing to accept from CMV drivers the MEC, Form MCSA-5876, with an 
October or November, 2015 revision date. In view of the clarification 
in this document of the status of the MEC, Form MCSA-5876, with various 
revision dates, FMCSA is directing SDLAs to accept the MEC, Form MCSA-
5876, with October, November, and December, 2015 revision dates until 
existing stocks are depleted. SDLAs should also be accepting the 
versions that were posted on April 13, 2016, on the FMCSA and National 
Registry Web sites that no longer include a revision date in the top 
left corner and the current version of the MER Form, MCSA-5875, that is 
posted on the FMCSA and National Registry Web sites that no longer 
includes the Privacy Act Statement on page one. On the other hand, 
SDLAs should not accept versions of the MEC that have not been approved 
by OMB and do not display both the FMCSA form number (MCSA-5876) and 
the OMB expiration date of August 31, 2018. The final versions of the 
forms published on the FMCSA and National Registry Web sites are shown 
below for your reference.
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    Issued on: October 20, 2016.
T.F. Scott Darling, III,
Administrator.
[FR Doc. 2016-25976 Filed 10-26-16; 8:45 am]
 BILLING CODE 4910-EX-c