Minnesota CDL Medical Self-Certification Form
This form is for all commercial driver's license (CDL) holders in Minnesota. It includes instructions for completing and submitting the self-certification form and medical examiner's certificate. It also contains a Tennessen Warning as required by state law.
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How do I fill this out?
Filling out this form ensures compliance with Minnesota's CDL requirements. Follow the instructions carefully to complete each section. Submit the form as specified to avoid any delays.
How to fill out the Minnesota CDL Medical Self-Certification Form?
1
Print the form.
2
Complete the driver information section.
3
Choose the applicable self-certification category.
4
Answer the medical certificate and waiver questions.
5
Sign and date the form.
Who needs the Minnesota CDL Medical Self-Certification Form?
1
All Minnesota CDL holders for initial certification.
2
CDL holders who are renewing their license.
3
CDL holders changing their license class.
4
CDL holders with a school bus endorsement.
5
CDL holders with a change in medical or interstate/intrastate status.
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What are the instructions for submitting this form?
Complete and submit the self-certification form along with your medical examiner's certificate. Mail to: Driver and Vehicle Services Division, 445 Minnesota Street, Suite 175, St. Paul, MN 55101-5175. Fax to (651) 297-4447. Submit in person at any driver exam station or driver license office that accepts applications. It is advisable to check the Driver and Vehicle Services Website for a list of locations and detailed instructions. Ensure all fields are properly filled out and signed before submission to avoid processing delays.
What are the important dates for this form in 2024 and 2025?
CDL holders must ensure they complete and submit their self-certification form by their license renewal date or any changes in status in 2024 and 2025.
What is the purpose of this form?
The purpose of this form is to ensure all commercial driver's license (CDL) holders in Minnesota are in compliance with state and federal medical requirements. By completing this form, drivers self-certify their operating status and, if applicable, submit a medical examiner's certificate. This helps the Department of Public Safety verify that CDL holders meet the necessary medical standards for safe driving.
Tell me about this form and its components and fields line-by-line.
- 1. Print Name: Enter the driver's full name (First, Middle, Last).
- 2. Date of Birth: Enter the driver's date of birth in mm/dd/yyyy format.
- 3. Minnesota Driver's License Number: Enter the driver's Minnesota Driver's License Number.
- 4. Self-Certification Category: Check only one category that applies to the driver.
- 5. Medical Certificate Submission: Indicate if submitting a medical examiner's certificate.
- 6. Medical Waiver Submission: Indicate if submitting a medical waiver.
- 7. Driver's Signature: The driver must sign the form.
- 8. Date: Enter the date the form is signed.
What happens if I fail to submit this form?
Failure to submit this form may result in the suspension or revocation of your commercial driving privileges.
- Driving Privileges: Non-compliance can lead to suspension or revocation of your CDL.
- Legal Consequences: You may face legal actions due to non-compliance with state and federal laws.
How do I know when to use this form?
- 1. Initial Certification: When applying for a CDL for the first time.
- 2. License Renewal: When renewing an existing CDL.
- 3. Change in License Class: When upgrading or changing the class of your CDL.
- 4. Change in Medical Status: When there are changes in your health condition.
- 5. Change in Interstate/Intrastate Status: When your operating status changes from interstate to intrastate or vice versa.
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Can I edit the Tennessen Warning section?
No, the Tennessen Warning section is for informational purposes and should not be edited.
Do I need to submit additional documents with this form?
Depending on your certification category, you may need to submit a medical examiner's certificate or a medical waiver.
Where can I find more information about this form?
Check the Minnesota Department of Public Safety's website for additional details and updates.
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