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In the realm of commercial driving within Kentucky, the Kentucky CDL Self-Certification form stands as a crucial document mandated by the Federal Motor Carriers Safety Regulations and the Kentucky Transportation Cabinet. This form, officially known as TC 94-169, is designed for all holders of a Commercial Driver's License (CDL) to self-certify the type of driving they perform or plan to perform. The certification process is essential as it dictates the medical certification requirement for drivers. Unlike the federal requirement, which only necessitates medical certification for drivers engaged in non-excepted, interstate operations, Kentucky's regulation broadens the scope to include all CDL holders, aligning with 601 KAR 1:005. Applicants and holders must choose from four specified categories related to their operation's nature – non-excepted interstate, excepted interstate, non-excepted intrastate, and excepted intrastate, each with its stipulations and implications, including potential restrictions on the individual's CDL or permit. Noteworthy is the stipulation that intrastate excepted applicants should not select this category, underscoring Kentucky's stance on ensuring all CDL drivers meet medical certification standards. Further elaborations on interstate commerce clarify the specific conditions under which a driver operates in excepted or non-excepted interstate commerce, impacting a driver's eligibility and operational boundary. As such, the self-certification process not only aligns drivers with state and federal regulations but also plays a pivotal role in ensuring the safety and regulation of commercial driving in and across the state of Kentucky.

Preview - Kentucky Cdl Self Certification Form

Kentucky Transportation Cabinet

TC 94169

Division of Driver Licensing

05/2017

COMMERCIAL DRIVER LICENSE SELF‐CERTIFICATION

Page 1 of 2

 

The Federal Motor Carriers Safety Regulations require all CDL holders to selfcertify as to what type driving he/she performs or expects to perform.

While FMCSA only requires medical certification for drivers operating in nonexcepted, interstate operations, Kentucky requires all CDL holders to be medically certified (601 KAR 1:005) regardless of category selected.

NAME (last)

(first)

(MI)

 

 

 

SSN

DLN

DOB

 

 

 

PHONE

EMAIL

 

 

 

 

There are four categories from which to choose; please select only one.

Non‐excepted interstate‐I certify that I operate or expect to operate in Kentucky and other states (interstate commerce).

Excepted interstate‐I certify that I operate or expect to operate in Kentucky and other states (interstate commerce) but, engage exclusively in transportation or operations excepted under 49 CFR 390.3(f), 391.2, 391.68, or 398.3 from all or parts of the qualification requirements of 49 CFR part 391

Non‐excepted intrastate‐I certify that I operate or expect to operate in Kentucky only (intrastate commerce). (This category requires a “K” restriction to be printed on your

CDL/permit.)

Excepted intrastate‐I certify that I operate or expect to operate in Kentucky only (intrastate commerce) but, engage in transportation or operations excepted from all or parts of the State driver qualifications requirements. (This category requires a “K” restriction be printed on your CDL/permit.)

NOTE: All Kentucky CDL applicants/holders must be medically certified. Therefore, no CDL holder/applicant is excepted intrastate and should never mark this category.

______________________________

Print Name

______________________________

Signature

______________________________

Date

Kentucky Transportation Cabinet

TC 94169

Division of Driver Licensing

05/2017

COMMERCIAL DRIVER LICENSE SELF‐CERTIFICATION

Page 2 of 2

 

INTERSTATE COMMERCE:

You operate in excepted interstate commerce when you drive a CMV in interstate commerce only for the following excepted activities:

To transport school children and/or school staff between home and school;

As Federal, State or local government employees;

To transport human corpses or sick or injured persons;

Fire truck or rescue vehicle drivers during emergencies and other related activities;

Primarily in the transportation of propane winter heating fuel when responding to an emergency condition requiring immediate response such as damage to a propane gas system after a storm or flooding;

In Response to a pipeline emergency condition requiring immediate response such as a pipeline leak or rupture;

In custom harvesting on a farm or to transport farm machinery and supplies used in the custom harvesting operation to and from a farm or to transport custom harvested crops to storage or market;

Beekeeper in the seasonal transportation of bees;

Controlled and operated by a farmer, but is not a combination vehicle (power unit and

towed unit), and is used to transport agricultural products, farm machinery or farm supplies (no placardable hazardous materials) to and from a farm and within 150 airmiles of the farm;

As a private motor carrier of passengers for nonbusiness purposes ; or

To transport migrant workers.

If you answered yes to one or more of the above activities as the only operation in which you drive, you operate in excepted interstate commerce.

If you answered no to all of the above activities, you operate in non‐excepted interstate commerce. Most CDL holders who drive CMVs in interstate commerce are non‐excepted interstate commerce drivers.

If you operate in both excepted interstate commerce and non‐excepted interstate commerce, you must choose non‐excepted interstate commerce to be qualified to

operate in both types of interstate commerce.

INTRASTATE COMMERCE:

You operate in non‐excepted intrastate commerce when you drive a CMV only in intrastate commerce and are required to meet your State of licensure’s medical certification requirements. (This category requires a “K” restriction to be printed on your CDL/permit.)

Form Data

Fact Name Description
Governing Document Kentucky Transportation Cabinet TC 94-169 Division of Driver Licensing 05/2017
Objective Requires all CDL holders to self-certify the type of driving they perform or expect to perform.
Federal Requirement FMCSA requires medical certification for drivers in non-excepted, interstate operations.
Kentucky Requirement All Kentucky CDL holders must be medically certified regardless of category selected, as mandated by 601 KAR 1:005.
Categories Available Non-excepted interstate, excepted interstate, non-excepted intrastate, and excepted intrastate.
Restriction for Certain Categories Categories "non-excepted intrastate" and "excepted intrastate" require a “K” restriction to be printed on the CDL/permit.

Instructions on Utilizing Kentucky Cdl Self Certification

Filling out the Kentucky CDL Self-Certification form is a critical step for Commercial Driver License (CDL) holders or applicants in Kentucky, ensuring compliance with both federal and state regulations regarding the type of commercial driving they perform. This process involves clearly stating their driving category, thus determining their medical certification requirements. The form is straightforward, but attention to detail is essential to select the correct category and accurately fill in personal information.

  1. Start by printing your last name, first name, and middle initial (MI) in the designated fields at the top of the form.
  2. Enter your Social Security Number (SSN) in the specified field.
  3. Provide your Driver's License Number (DLN).
  4. Fill in your Date of Birth (DOB) using the mm/dd/yyyy format.
  5. Include a reliable phone number where you can be reached.
  6. Add your email address for electronic communication.
  7. Read through the four categories of driving operations listed on the form. These include Non-excepted Interstate, Excepted Interstate, Non-excepted Intrastate, and Excepted Intrastate. It's important to note that all Kentucky CDL holders or applicants must be medically certified, and the option for Excepted Intrastate should not be selected as per the instructions on the form.
  8. Select only one of the appropriate categories by marking the corresponding checkbox. Your selection should accurately reflect the type of driving you perform or expect to perform.
  9. After reviewing the information provided and ensuring accuracy, print your name at the bottom of the form in the space provided.
  10. Sign the form next to where you printed your name.
  11. Record the date you are filling out the form next to your signature, adhering to the mm/dd/yyyy format.

Once you've completed these steps, your form is ready to be submitted according to the instructions provided by the Kentucky Transportation Cabinet or your employer. This certification is pivotal in ensuring you're properly recognized for the type of commercial driving you do, aligning with both health standards and regulatory requirements. Accurate completion and timely submission of this form help maintain the validity of your CDL and ensure uninterrupted professional driving activities within Kentucky and beyond.

Obtain Answers on Kentucky Cdl Self Certification

Below are answers to common questions regarding the Kentucky CDL Self-Certification Form:

  1. What is the purpose of the Kentucky CDL Self-Certification form?

    The form is designed to meet the Federal Motor Carriers Safety Regulations, which mandate all CDL holders to declare the type of driving they perform or expect to perform. It ensures that all commercial drivers in Kentucky are medically certified according to state regulations (601 KAR 1:005), regardless of their operation category. This self-certification is essential for determining if a driver needs to provide medical certification to maintain their CDL.

  2. What are the categories I can choose from on this form, and what do they mean?
    • Non-Excepted Interstate: You operate or expect to operate across state lines (interstate commerce) and are not engaging in activities specifically exempt from federal medical certification requirements.
    • Excepted Interstate: You operate in interstate commerce but are engaged in activities that are exempt from the federal qualifications of 49 CFR part 391, such as government employment or emergency transportation services.
    • Non-Excepted Intrastate: You operate solely within Kentucky (intrastate commerce) and must meet the state's medical certification requirements. This selection requires a “K” restriction on your CDL.
    • Excepted Intrastate: You operate exclusively within Kentucky in roles exempted from some or all state driver qualification requirements. A “K” restriction will also be printed on your CDL for this category. However, it is important to note that according to the form, no applicant should select this option as all must be medically certified.
  3. Why is it important to correctly select a category on this form?

    Correctly selecting your operation category is crucial as it directly affects your medical certification requirements. It ensures compliance with both state and federal regulations regarding commercial driving operations. Failing to accurately self-certify can result in the loss of commercial driving privileges until the proper certification is provided.

  4. What happens if I operate in both excepted and non-excepted interstate commerce?

    If you drive in both excepted and non-excepted interstate commerce, you must choose the non-excepted interstate commerce category. This selection qualifies you to operate in both types of commerce, provided you meet the medical certification requirements applicable to non-excepted interstate drivers.

  5. How does self-certification affect drivers who only operate within Kentucky?

    Drivers who operate exclusively within Kentucky are still required to self-certify and, depending on their operation category, may need to meet Kentucky's specific medical certification requirements. For non-excepted intrastate commerce drivers, this includes obtaining a medical examiner's certificate. Excepted intrastate commerce drivers typically have exemptions from some of the state's driver qualification requirements, but according to Kentucky state regulations and the self-certification form notes, all CDL holders must be medically certified regardless of their operation category.

Common mistakes

Filling out the Kentucky CDL (Commercial Driver License) Self-Certification form accurately is crucial for commercial drivers. However, mistakes can occur. Here are eight common mistakes to avoid:

  1. Not reading instructions carefully: Drivers often skip reading the detailed instructions provided, leading to incorrect category selection based on the type of driving they perform or expect to perform.

  2. Selecting multiple categories: The form requires selecting only one category that best describes the driver’s type of commerce. Choosing more than one creates confusion and may require resubmission.

  3. Incorrect category selection: Some drivers choose the wrong category because they do not understand the differences between excepted and non-excepted, or interstate and intrastate commerce. This mistake could lead to legal issues or the invalidity of the certification.

  4. Omitting personal information: Missing details such as the driver's full name, SSN, DLN, DOB, phone number, or email address can lead to processing delays or the rejection of the form.

  5. Choosing the "Excepted Intrastate" category: As the form notes, no Kentucky CDL holder/applicant should select this option since all need to be medically certified, regardless of their operation category.

  6. Forgetting to sign and date the form: An unsigned or undated form is considered incomplete and will not be processed until corrected and resubmitted.

  7. Not providing updated medical certification: Kentucky requires all CDL holders to be medically certified, regardless of the category selected. Failing to attach or update medical certification leads to certification issues.

  8. Lack of clarity on operating in multiple types of commerce: Drivers who operate in both excepted interstate commerce and non-excepted interstate commerce must choose non-excepted interstate commerce to qualify for both. This distinction is often misunderstood or overlooked.

In conclusion, paying close attention to the details, understanding the categories properly, and ensuring all personal information is accurately filled out are key steps to successfully completing the Kentucky CDL Self-Certification form. Avoiding these common mistakes can prevent processing delays and ensure compliance with Kentucky regulations.

Documents used along the form

When drivers in Kentucky embark on the process of self-certifying for a Commercial Driver License (CDL), there is a need to complement the Kentucky CDL Self-Certification Form with several other crucial documents. These forms are vital for ensuring compliance with state and federal regulations, highlighting the driver's eligibility, and ensuring the safety and security of commercial driving operations.

  • Medical Examiner's Certificate (Form MCSA-5876): This document is essential as it provides evidence that a driver has met the physical qualification standards required to operate a commercial motor vehicle. The certificate is issued following a thorough examination by a certified medical examiner.
  • Commercial Driver's License Application: Before obtaining a CDL, a driver must fill out and submit an application form. This document collects basic personal information, driving history, and the type of commercial vehicle the applicant intends to operate.
  • Proof of Identity and Residency: Applicants must provide documentation verifying their identity and Kentucky residency. This could include a social security card, birth certificate, and utility bills or lease agreements showing a Kentucky address.
  • CDL Skills Test Results: After successfully completing the required skills tests for their specific CDL class, drivers must submit their test results. These results confirm a driver's practical competence in operating a commercial vehicle safely.
  • Record of Duty Status (RODS): For certain CDL holders, especially those in non-excepted interstate commerce, maintaining and presenting a record of duty status is mandatory. This helps affirm that the driver adheres to Hours of Service regulations, ensuring they are not overworked.
  • Drug and Alcohol Testing Records: CDL applicants might be required to provide proof of passing drug and alcohol screening tests. This is part of the federal requirements aimed at maintaining road safety and public health.

Each document plays a significant role in the self-certification process, offering a comprehensive view of a driver's qualifications, health status, and legal compliance. For anyone setting out on a commercial driving career in Kentucky, preparing and submitting these documents alongside the Kentucky CDL Self-Certification form is a vital step towards securing their license and embarking on a safe and lawful driving career.

Similar forms

  • The Medical Examination Report Form for commercial driver's license (CDL) holders is quite similar to the Kentucky CDL Self Certification form. Both documents ensure the driver meets health and safety standards necessary for operating commercial vehicles. The key similarity lies in their purpose to align with safety regulations — while the Self Certification specifies the type of commerce a driver is involved in and asserts the need for medical certification, the Medical Examination Report Form provides the detailed health assessment that supports that certification.

  • The Commercial Driver's License (CDL) Application resembles the Kentucky CDL Self Certification form in that both are integral steps in the process of obtaining or renewing a CDL. They collect essential information about the driver, including personal details and specific qualifications related to the type of driving the applicant intends to perform. However, the CDL Application is broader, encompassing various aspects of qualification, while the Self Certification form zeroes in on the driver's commerce category and medical certification requirement.

  • The Driver's Qualification File Checklist shares objectives with the Kentucky CDL Self Certification form, as both contribute to ensuring that drivers meet all federal and state guidelines to operate commercial vehicles legally and safely. This checklist is a comprehensive record that includes evidence of medical certification among other essential documents, thereby incorporating the need established in the Self Certification form for drivers to declare their commerce type and confirm their medical certification status.

  • The Hazardous Materials Endorsement Application is related to the Kentucky CDL Self Certification form in terms of its role in enhancing road safety and compliance with federal regulations. Although focusing on drivers who transport hazardous materials, this application requires drivers to meet additional safety standards, including background checks and specific training. The similarity lies in their mutual goal of ensuring drivers are qualified for their specific roles, with the Self Certification form addressing medical fitness and commerce category as part of the overall certification process for CDL holders.

Dos and Don'ts

Filling out the Kentucky CDL Self Certification form is a critical step for commercial drivers in Kentucky. Here are some dos and don'ts to guide you through the process smoothly and ensure your documentation is in proper order.

Do:

  • Read the instructions carefully before you start filling out the form. Understanding what is required can save time and prevent mistakes.
  • Ensure that all personal information matches the details on your current CDL. This includes your name, Social Security Number (SSN), driver's license number (DLN), date of birth (DOB), phone number, and email address.
  • Select only one category that best describes the type of driving you perform or expect to perform. It's crucial to choose the correct category as it affects your medical certification requirement.
  • Sign and date the form. Your signature verifies that the information provided is accurate and true to the best of your knowledge.
  • Consult with the Kentucky Transportation Cabinet or a legal professional if you have any doubts or questions about the categories or any other part of the form.
  • Keep a copy of the completed form for your records before submitting it to the Kentucky Transportation Cabinet, Division of Driver Licensing.

Don't:

  • Select the "Excepted Intrastate" category as Kentucky CDL holders/applicants are not exempt from medical certification. This option should never be marked.
  • Fill out the form in a rush. Take your time to ensure all information is correct and complete.
  • Forget to check if you need to update your medical certification based on the category you select. All Kentucky CDL holders must be medically certified.
  • Overlook the need to update this form if your driving status changes. Any change in the type of driving you perform requires completing a new form.
  • Use incorrect or outdated personal information. Any discrepancy can lead to delays or problems with your CDL status.
  • Assume you only need to complete this form once. Periodic updates may be necessary, especially if your type of driving changes or new regulations are implemented.

Misconceptions

There are several misconceptions about the Kentucky CDL (Commercial Driver License) Self-Certification form that need to be addressed for a clearer understanding of its purpose and requirements. Below are five of the most common misunderstandings:

  • All CDL holders are not required to self-certify.

    This is incorrect. The Federal Motor Carriers Safety Regulations mandate that all CDL holders must self-certify the type of driving they perform or expect to perform. This requirement ensures that drivers comply with the appropriate health and safety regulations.

  • Medical certification is only necessary for those driving in non-excepted, interstate operations.

    In fact, Kentucky requires all CDL holders to be medically certified regardless of the driving category they have selected. This includes drivers operating in excepted interstate, excepted intrastate, and non-excepted intrastate commerce.

  • Selecting more than one category on the form is permissible.

    Drivers are required to select only one category that best describes the type of driving they perform. This is crucial to ensure that the driver meets the specific medical and operational requirements for that category.

  • All categories allow for interstate operation.

    Incorrect. Two specific categories differentiate between interstate and intrastate operation. Non-excepted interstate and excepted interstate commerce involve operation in Kentucky and other states, while non-excepted intrastate and excepted intrastate commerce is confined to Kentucky only.

  • Intrastate excepted drivers do not require medical certification.

    Contrary to this misconception, the note on the self-certification form clearly states that all Kentucky CDL applicants and holders, including those in excepted intrastate commerce, must be medically certified. Drivers are reminded that no CDL holder or applicant should mark the excepted intrastate category, highlighting the universal need for medical certification.

Understanding the specifics of the Kentucky CDL Self-Certification form is crucial for compliance with state and federal regulations. Misinterpretations can lead to legal complications, fines, or restrictions on a driver's license. Drivers are encouraged to read the form carefully and consult with the Kentucky Transportation Cabinet or a legal advisor if they have any questions or concerns about their self-certification and medical certification requirements.

Key takeaways

Filling out the Kentucky CDL Self-Certification form is a required step for all commercial driver’s license (CDL) holders and applicants in Kentucky. Understanding this form and its significance plays a crucial role in ensuring that drivers comply with both state and federal regulations. Here are some key takeaways to help navigate this process:

  • The Federal Motor Carriers Safety Regulations (FMCSR) mandates all CDL holders to self-certify the type of driving they perform or expect to perform. This requirement aims to ensure drivers meet the appropriate medical certification standards.
  • Unlike some states, Kentucky requires all CDL holders, regardless of their category of driving, to be medically certified according to 601 KAR 1:005. This means that every driver must undergo a medical exam to maintain a valid CDL.
  • There are four categories from which to choose on the form: Non-excepted Interstate, Excepted Interstate, Non-excepted Intrastate, and Excepted Intrastate. Selecting the correct category is essential as it affects the type of medical certification required.
  • The category "Non-excepted Interstate" is for drivers who operate in Kentucky and other states (interstate commerce) and do not qualify for any exceptions. Drivers selecting this category must meet federal medical certification requirements.
  • "Excepted Interstate" commerce refers to drivers who operate interstate but are engaged in specific activities that are excepted from some or all of the federal driver qualification requirements.
  • Drivers operating only within Kentucky (intrastate commerce) will choose between "Non-excepted Intrastate" and "Excepted Intrastate", although it's important to note, that per the form, no CDL holder/applicant should select "Excepted Intrastate" as all must be medically certified.
  • For drivers who sometimes engage in both excepted interstate commerce activities and activities that require non-excepted status, they must choose "Non-excepted Interstate" to be properly qualified for all types of driving they perform.
  • The "K" restriction is noted for those in the Non-excepted or Excepted Intrastate commerce categories, indicating that the driver is restricted to operating commercial motor vehicles (CMVs) in Kentucky only.
  • Filling out this self-certification form accurately is crucial. Misrepresenting one's self-certification category can lead to serious legal and regulatory consequences, including the loss of one’s CDL.
  • Finally, the self-certification process is not a one-time event. CDL holders must update their certification status any time there is a change in their driving status or medical certification.

Understanding and accurately completing the Kentucky CDL Self-Certification form is vital for all commercial drivers in Kentucky. It ensures compliance with state and federal regulations, helps maintain the safety of the roads, and safeguards the driver's ability to work in their chosen profession.

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