KY TC 94-169 2017-2024 free printable template

Kentucky CDL Medical Self Certification is an online service offered by the Kentucky Transportation Cabinet that allows drivers with a Commercial Driver’s License (CDL) to self-certify their medical status. The self-certification process requires drivers to submit information about their medical certification status and health conditions.

A Kentucky Commercial Driver's License (CDL) holder is required to file a self-certification of their medical condition with the Kentucky Transportation Cabinet.

The purpose of the Kentucky CDL Medical Self-Certification is for commercial drivers to certify that they meet the medical requirements for operating a commercial vehicle, as required by the Federal Motor Carrier Safety Administration (FMCSA). This self-certification process is required by law and must be completed before a Kentucky Commercial Driver's License (CDL) can be issued.

The penalty for late filing of a Kentucky CDL Medical Self-Certification form is a fine of up to $100. In some cases, a driver may also be required to take a vision test or re-certify his or her physical condition.

To fill out the Kentucky CDL Medical Self-Certification form, follow these steps: 1. Obtain the form: You can download the form from the Kentucky Transportation Cabinet's website or pick up a physical copy at a local Kentucky DMV office. 2. Personal Information: Fill in your name, date of birth, social security number, and driver's license number in the designated fields. 3. CDL Information: Provide details about your CDL, including the state issuing your CDL, your CDL number, and the class of your CDL. If applicable, indicate any endorsements or restrictions on your CDL. 4. Self-Certification: Select the appropriate category that applies to you: - Interstate Non-Excepted: This category is for drivers who operate a commercial vehicle across state lines or transporting hazardous materials requiring a placard. - Interstate Excepted: Select this category if you operate a commercial vehicle across state lines but don't perform any safety-sensitive functions. - Intrastate Non-Excepted: Choose this category if you only operate a commercial vehicle within Kentucky and perform safety-sensitive functions. - Intrastate Excepted: If you only operate a commercial vehicle within Kentucky and don't perform any safety-sensitive functions, select this category. 5. Medical Certificate: If you have a current medical certificate, indicate the date it was issued and the medical examiner's name and address. If you don't have a valid medical certificate, leave this section blank. 6. Certification Statement: Read the certification statement carefully and sign and date the form. 7. Submission: Once the form is complete, submit it either in person at a Kentucky DMV office or by mail to the address provided on the form. Ensure that you have included all necessary information and signed the form before submitting it to avoid any processing delays.

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