Get Cdl Holder Self Certification Affidavit

Commercial Driver License Self-Certification, form TC 94-169. Download the form here from Kentucky Transportation Cabinet Division of Driver Licensing. Copy of your valid DOT medical card (Medical card only, not the long form). Provide a legible copy of both front and back of the medical card.

Mail the completed form to the Division of Driver Licensing, CDL Section, 200 Mero St., Frankfort, KY 40622, or submit the form electronically via My CDL Document Portal at: http://mycdl.ky.gov.

If you select either the EA or EI box, you will be able to keep your CDL without submitting a current medical card. If/When you return to driving a commercial vehicle and you need to carry a medical card, you must resubmit a DL-11CD, Self-Certification Form, along with a copy of your valid medical card.

Excepted Intrastate (EA), you operate or expect to operate in a city, county state or federal vehicle ONLY and are exempt from the FMCSA driver qualification requirements. Federal Motor Carrier Safety Regulations require self-certification.

CDL Holder Self-Certification Affidavit §383.73, the Tennessee Department of Safety and Homeland Security requires all commercial driver license holders to certify the type of driving they engage in and provide a copy of their medical examiner's certificate (form 5876) to the Department.

You will need to provide the CDL Section with a copy of your TWIC card. Upon verification of the card, it will be added to your Kentucky driving record. The email address for submission of a copy (front and back) of the TWIC document is kytc.twic@ky.gov and the fax number is 844-535-7272.

Go to the National Registry website: https://nationalregistry.fmcsa.dot.gov. Logon to your National Registry account. Select CMV Driver Exams from the blue bar at the top of the screen. Select Submit CMV Driver Exam Results

This category will NOT require a medical examiners certificate, but you are still required to meet Texas medical standards. This certification category is when you are operating a CMV only in intrastate commerce for excepted activities (oil/water well servicing and/or drilling or mobile crane operations).

Any driver with an updated certificate can submit it to DPS via email at CDLMedCert@dps.texas.gov or by fax at (512) 424-2002.