Fill in Your Kentucky Cdl Self Certification Form

Fill in Your Kentucky Cdl Self Certification Form

The Kentucky CDL Self Certification form, mandated by the Federal Motor Carriers Safety Regulations and localized Kentucky requirements, serves as an essential document for commercial driver's license (CDL) holders. It ensures that all CDL holders in Kentucky must self-certify the type of driving they perform and are medically certified regardless of the driving category they select. Knowing which category to choose and ensuring accuracy on this form is crucial for compliance and maintaining valid driving privileges. Ready to complete your Kentucky CDL Self Certification? Click the button below to get started.

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In navigating the complexities of compliance within the commercial driving sector, the Kentucky CDL Self Certification form emerges as a crucial document, underscoring the interplay between federal mandates and state-specific regulations. Crafted by the Kentucky Transportation Cabinet's Division of Driver Licensing, this form is designed to align with the Federal Motor Carriers Safety Regulations, which dictate that all holders of a Commercial Driver's License (CDL) must self-certify the nature of their driving activities. Importantly, while the Federal Motor Carrier Safety Administration (FMCSA) mandates medical certification exclusively for drivers engaged in non-excepted, interstate operations, Kentucky extends this requirement to all its CDL holders, encapsulating a broader spectrum of driving categories. This comprehensive approach, detailed within the form, encompasses four distinct categories—non-excepted interstate, excepted interstate, non-excepted intrastate, and excepted intrastate—each with specific operational definitions and implications for medical certification and licensure restrictions. Furthermore, the form explicitly outlines the conditions under which drivers operate in either excepted or non-excepted capacities, whether crossing state lines or confining their operations within Kentucky, thus providing a structured pathway for drivers to ascertain their compliance obligations and ensure uninterrupted professional pursuits in the commercial driving realm.

Kentucky Cdl Self Certification Example

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
Purpose of Form TC 94-169 This form is used by CDL holders in Kentucky to self-certify the type of commercial driving they perform, as mandated by the Federal Motor Carriers Safety Regulations.
Medical Certification Requirement All CDL holders in Kentucky must be medically certified (601 KAR 1:005) regardless of their selected commercial driving category, distinguishing Kentucky's requirement from federal only requirements.
Categories of Operation The form identifies four categories of operation for self-certification: Non-excepted interstate, Excepted interstate, Non-excepted intrastate, and Excepted intrastate, each with specific operational definitions.
Interstate vs. Intrastate Commerce CDL holders must self-identify whether they operate in interstate (between states) or intrastate (within Kentucky only) commerce, impacting the type of medical certification and restrictions on their license.
"K" Restriction Certain categories of intrastate operation require a "K" restriction to be printed on the CDL/permit, indicating state-specific driver qualification requirements that must be met.

How to Fill Out Kentucky Cdl Self Certification

After receiving the Kentucky CDL Self-Certification form, it's important to understand that you're engaging in a requirement that helps categorize the type of commercial driving you perform. This categorization impacts your medical certification requirements. Kentucky mandates that all CDL holders, regardless of their interstate or intrastate classification, maintain medical certification. This step is essential for ensuring that all drivers meet the health standards necessary for the safety of themselves and others on the road. Following, you'll find a clear breakdown of the steps needed to correctly fill out this form.

  1. Locate the section labeled NAME (last) (first) (MI), and enter your legal name as it appears on your driver's license.
  2. In the fields marked SSN (Social Security Number), DLN (Driver's License Number), and DOB (Date of Birth), fill in your information accurately.
  3. Provide a current PHONE number and EMAIL address where you can be reached for any follow-up or clarification.
  4. Read through the four categories of driving type provided on the form. These categories are crucial as they define the nature of your driving operations and the corresponding regulatory expectations.
  5. Select only one category that accurately describes the type of driving you are engaged in or expect to engage in. Mark the corresponding box for one of the following options:
    • Non-Excepted Interstate
    • Excepted Interstate
    • Non-Excepted Intrastate
    • Excepted Intrastate
    Note: As indicated on the form, no CDL holder or applicant should choose the option Excepted Intrastate due to state-specific medical certification requirements.
  6. Understand that by selecting "Non-Excepted Interstate" or "Non-Excepted Intrastate," you are indicating a need to meet the Federal Motor Carrier Safety Administration (FMCSA) medical certification requirements or state-specific requirements, respectively.
  7. At the bottom of the first page, there is a space provided for you to Print Name. Print your name again as confirmation of the information provided.
  8. Sign your name in the designated Signature field to certify that the information you have provided is accurate and true to the best of your knowledge.
  9. Enter the Date on which you are filling out this form to document when you self-certified.

After completing the Kentucky CDL Self-Certification form, you should review it for accuracy. Ensure that all the information you provided is correct and that you have chosen the category that best fits your driving activities. The accurate completion of this form is crucial as it directly impacts your licensing and your ability to operate a commercial vehicle legally within or across the state of Kentucky. Once the form is filled out, follow the Kentucky Transportation Cabinet's instructions for submission, which may involve returning it to a specific office or submitting it online, if available. This process is integral to maintaining your CDL status and ensuring that you comply with both state and federal regulations for commercial drivers.

Crucial Queries on This Form

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

    The Kentucky CDL Self-Certification form is a document required by the Kentucky Transportation Cabinet and the Federal Motor Carriers Safety Regulations (FMCSA). It mandates all CDL holders to self-certify the type of driving they perform or expect to perform. The form helps distinguish between drivers who operate in interstate or intrastate commerce and whether they participate in excepted or non-excepted transportation activities, according to specific categories defined by federal and state regulations.

  2. Why do I need to complete the Kentucky CDL Self-Certification form?

    Completion of the Kentucky CDL Self-Certification form is necessary for all CDL holders in Kentucky. This requirement ensures that drivers meet the medical certification standards set by Kentucky law (601 KAR 1:005), regardless of the type of commercial driving they engage in. It is a legal requirement for maintaining a valid Commercial Driver's License in the state of Kentucky.

  3. What are the categories of driving I can certify to on the form?

    • Non-excepted interstate: For those operating or expecting to operate across state lines and are subject to federal qualification requirements.
    • Excepted interstate: For those operating across state lines but engaged in operations that are excepted from certain federal qualifications.
    • Non-excepted intrastate: For those operating solely within Kentucky and subject to state medical certification requirements.
    • Excepted intrastate: Not applicable as all Kentucky CDL applicants/holders must be medically certified and cannot mark this category.
  4. What happens if I do not select the correct category or fail to self-certify?

    Failure to accurately self-certify or not self-certifying at all can result in the suspension of your Commercial Driver’s License. It is critical to select the correct category that truly reflects the type of commercial driving you are or will be performing. The accuracy of this information ensures that you are in compliance with both federal and state regulations regarding medical certification and licensing requirements.

  5. Can I change my self-certification category if my type of driving changes?

    Yes, if your type of driving changes, you should update your self-certification category accordingly. This can be done by completing a new Kentucky CDL Self-Certification form with the updated information and submitting it to the Kentucky Transportation Cabinet. It is important to keep your self-certification status current to reflect your actual driving activities accurately.

  6. What documents are needed in addition to the self-certification form for medical certification?

    In addition to the self-certification form, CDL holders required to meet non-excepted medical standards must also provide a current medical examiner’s certificate. The medical certification must demonstrate that the driver meets the physical qualifications in accordance with FMCSA standards or Kentucky state requirements, depending on their self-certified driving category.

  7. How do I submit my Kentucky CDL Self-Certification form and any required medical documents?

    The completed Kentucky CDL Self-Certification form along with any necessary medical documents can be submitted to the Kentucky Transportation Cabinet via mail, fax, or in person at a Driver Licensing Regional Office. Ensure that all provided information is accurate and that the documents are complete to avoid delays in the processing of your certification.

Common mistakes

Filling out the Kentucky CDL Self-Certification form requires careful attention to detail and an understanding of the categories. However, people often make mistakes that can lead to incorrect certification or even delay their licensing process. Here are five common errors to avoid:

  1. Choosing the Wrong Category: One common mistake is selecting the wrong certification category. The form outlines four different categories based on the type of commerce (interstate or intrastate) and whether the operation is excepted or non-expected from certain federal or state regulations. It's crucial to understand these distinctions to ensure you're correctly certified for the type of driving you plan to do.

  2. Not Providing Complete Personal Information: Skipping fields or not providing complete personal information can cause processing delays. Every field from your name, social security number, driver's license number, date of birth, phone number, and email is essential for the Kentucky Transportation Cabinet to process your certification accurately.

  3. Overlooking the Medical Certification Requirement: With Kentucky requiring medical certification for all CDL holders, regardless of the selected category, a significant mistake is failing to understand this requirement. Applicants sometimes assume that selecting an "excepted" category exempts them from needing a medical certificate, which is not the case, leading to incomplete applications.

  4. Marking the Excepted Intrastate Category: An explicit note on the form indicates that no CDL holder or applicant should select the "excepted intrastate" category. Despite this clear instruction, some applicants mistakenly choose this category, which can invalidate their self-certification process.

  5. Forgetting to Sign and Date the Form: Finally, a surprisingly common oversight is failing to sign and date the form at the bottom. This simple misstep can render the form invalid, as it's necessary for legal acknowledgment of the self-certification.

To ensure a smooth certification process, applicants are encouraged to:

  • Review the descriptions of each category carefully to select the correct one.
  • Fill out all personal information fields completely and accurately.
  • Understand and comply with the medical certification requirement, regardless of the category chosen.
  • Avoid selecting the "excepted intrastate" category, as it is not applicable to Kentucky CDL holders or applicants.
  • Remember to sign and date the form before submitting.

By avoiding these common mistakes, Kentucky CDL applicants can ensure their self-certification is completed correctly, helping to avoid any unnecessary delays or complications in their licensing process.

Documents used along the form

When a commercial driver in Kentucky completes the CDL Self Certification form, it's often just one step in a series of necessary actions to ensure legal compliance and operational readiness for the road. Alongside this crucial form, there are several other documents and forms that drivers might need to complete or have on hand, depending on their specific type of commercial driving activity.

  • Medical Examiner’s Certificate (DOT Physical Form): As part of the self-certification process, all commercial drivers must undergo a medical examination by a certified medical examiner. The Medical Examiner’s Certificate proves that the driver is physically qualified to operate a commercial motor vehicle.
  • Commercial Driver’s License (CDD License Application Form): Any individual seeking to obtain, renew, or upgrade a commercial driver’s license in Kentucky needs to complete the license application form, which is a prerequisite for legal commercial operation.
  • Vehicle Registration Forms: These forms are necessary for registering the commercial vehicle(s) a driver will operate. Different types of vehicles may require different registration forms.
  • Drug and Alcohol Testing Consent Form: Commercial drivers might be required to sign a consent form agreeing to drug and alcohol testing in accordance with state and federal regulations.
  • Record of Duty Status (RODS): Also known as a logbook, this document is essential for drivers to record their hours of service (HOS), proving compliance with HOS regulations.
  • Road Test Certificate: Before obtaining a CDL, drivers must pass a road test specific to the class and type of commercial vehicle they will operate. The certificate validates the successful completion of this test.
  • Entry-Level Driver Training (ELDT) Certificate: New drivers undergoing CDL training after February 7, 2022, are required to complete the ELDT and provide certification of this training as part of their CDL application process.
  • Hazardous Materials Endorsement (HME) Application: Drivers who transport hazardous materials may need to complete additional forms to apply for or renew their HME, including undergoing a background check by the Transportation Security Administration (TSA).
  • Annual Vehicle Inspection Report: Commercial vehicles are required to undergo an annual safety inspection. The report from this inspection must be carried in the vehicle to prove compliance with safety standards.

Understanding and managing the paperwork is crucial for compliance and safety in commercial driving. Whether a driver is renewing their CDL, certifying their medical fitness, or ensuring their vehicle is properly registered and inspected, each form plays a significant role in the commercial driving landscape. Staying abreast of the requirements and maintaining organized records helps facilitate a smoother operation and minimizes the risk of non-compliance.

Similar forms

The Medical Examination Report Form (MER) for Commercial Driver License (CDL) holders is a document that, like the Kentucky CDL Self Certification form, is integral to ensuring the safety of commercial driving operations. Both documents require information about the driver’s medical fitness to operate commercial motor vehicles (CMVs) safely. However, while the self-certification form allows drivers to indicate the type of commercial driving they perform, the MER requires a detailed examination by a medical examiner to determine the driver's physical qualification to drive a CMV based on federal regulations.

The Commercial Driver’s License Application is another document similar to the Kentucky CDL Self Certification form. Both are necessary steps in the process of obtaining or renewing a CDL, and each requires the driver to provide personal information and details about their driving category. However, the application form is broader, encompassing various legal and personal qualification questions, while the self-certification specifically addresses the driver’s medical status and the nature of their intended commercial driving operations.

The Driver’s Consent for Release of Medical Information form shares similarities with the Kentucky document, as it also plays a role in the medical certification process for CDL holders. This consent form allows medical practitioners to share the driver’s health information with licensing authorities, ensuring compliance with safety regulations. Unlike self-certification, which is filled out by the driver, this form facilitates the sharing of medical examination results conducted by a healthcare professional.

The Department of Transportation (DOT) Physical Examination Form is closely related to the Kentucky CDL Self Certification form in its purpose to ensure that drivers are medically able to operate CMVs. While the Self Certification offers a declaration of the driving category, the DOT Physical is an in-depth health assessment performed by a certified medical examiner. It evaluates the physical and mental fitness of a driver, which affects their certification status.

The Hazardous Materials Endorsement (HME) Application is also connected to the Kentucky Self Certification due to its role in the certification process for CDL holders who transport hazardous materials. While the Self Certification form helps determine the nature of a driver’s commercial operations in general terms, the HME Application is specific to drivers needing endorsement to haul hazardous materials. Both are critical for assessing the qualification and eligibility of drivers under federal and state regulations.

The Vehicle Inspection Report, although not a driver-centric document, is similar to the Kentucky CDL Self Certification form in its focus on safety compliance. While the Self Certification form assesses the driver's medical fitness and type of driving, the Vehicle Inspection Report evaluates the condition of the commercial vehicle itself. Both forms are essential for maintaining high safety standards within the commercial driving industry.

Lastly, the Motor Carrier Identification Report (Form MCS-150) resembles the Kentucky CDL Self Certification in that it involves regulatory compliance for commercial driving operations. The MCS-150 provides the Federal Motor Carrier Safety Administration (FMCSA) with information about a carrier’s operations, whereas the Self Certification form provides information about an individual driver’s medical certification and type of commercial driving. Both are integral to the oversight of commercial transportation safety.

Dos and Don'ts

When filling out the Kentucky CDL Self-Certification form, it's important to pay close attention to the details to ensure that your submission is accurate and compliant with state regulations. Below are some essential dos and don'ts to guide you through the process.

Dos:

  1. Make sure to read the instructions carefully before you begin filling out the form. Understanding the different categories and their requirements is crucial for accurate self-certification.
  2. Double-check your personal information, including your name, SSN, DLN, DOB, phone, and email, for accuracy. Errors in this information can lead to unnecessary delays or issues with your certification.
  3. Select only one category that best describes the type of driving you perform or expect to perform. Given that Kentucky requires medical certification for all CDL holders, choose the category that matches your situation closely.
  4. Remember to sign and date the form. An unsigned form is considered incomplete and will not be processed.
  5. Keep a copy of the completed form for your records. Should any questions arise later on, you'll have the necessary documentation for clarification or verification.

Don'ts:

  1. Do not leave any section of the form blank. If a section does not apply to you, indicate this appropriately as instructed on the form.
  2. Do not guess or make assumptions about the categories without fully understanding their definitions and implications. Incorrect categorization can affect your driving privileges and legal compliance.
  3. Do not select the "Excepted Intrastate" category, as the note clearly states that no CDL holder/applicant in Kentucky should mark this category due to the universal medical certification requirement.
  4. Do not forget to check whether you need a "K" restriction printed on your CDL/permit based on the category you select. This is essential for ensuring your license accurately reflects your certification status.
  5. Do not neglect to update your self-certification status and medical examiner’s certificate, if applicable, with the Kentucky Transportation Cabinet as required. Failing to maintain current records can lead to penalties and suspension of your CDL.

Misconceptions

When it comes to the Kentucky CDL Self Certification form, misunderstandings can easily arise. Let's clear up four common misconceptions:

  • Medical Certification Is Not Required for All CDL Holders: Contrary to what some might believe, the form clarifies that every CDL holder or applicant in Kentucky must be medically certified, regardless of the type of commercial driving they do. This requirement is in place to ensure the safety of the driver and those around them on the road.
  • Selection of Multiple Categories Is Allowed: Some may think it's possible to choose more than one category when certifying the type of driving they perform. However, the form specifies that individuals must select only one category that best describes their driving activity. Making the correct selection is crucial for compliance with state and federal regulations.
  • Excepted Intrastate Category Is an Option: It's a common mistake to believe that drivers can select the "excepted intrastate" category. The form explicitly states that no CDL holder or applicant in Kentucky should ever mark this category, as all need to be medically certified and thus do not fall under the exceptions that may apply in other contexts.
  • The "K" Restriction Is Automatically Applied: There seems to be some confusion around how the "K" restriction, indicating that the driver is limited to intrastate commerce, is applied. It's important to understand that this restriction is only added to the CDL or permit if the driver certifies that they will operate in non-excepted or excepted intrastate commerce. It is not an automatic designation for all CDL holders.

By understanding these key points, commercial drivers in Kentucky can better navigate the self-certification process. Knowing the requirements ensures compliance with the Kentucky Transportation Cabinet and contributes to safer roadways for everyone.

Key takeaways

Filling out the Kentucky CDL Self-Certification form is a crucial step for drivers to comply with both federal and state regulations. Here are ten key takeaways to ensure you complete this process correctly:

  • Self-certification is mandatory under the Federal Motor Carriers Safety Regulations for all CDL holders to declare their type of driving — highlighting the importance of accurately reporting the nature of your driving to comply with regulations.
  • Kentucky mandates medical certification for all CDL holders, regardless of the category they select, reinforcing the state's commitment to road safety through ensuring drivers meet health standards.
  • There are four categories to choose from when self-certifying: Non-Excepted Interstate, Excepted Interstate, Non-Excepted Intrastate, and Excepted Intrastate. Choosing the correct category is essential for legal compliance and for the validity of your CDL in Kentucky.
  • The designation of a "K" restriction is required for those who certify in either Non-Excepted Intrastate or Excepted Intrastate commerce, indicating a limitation to intrastate driving.
  • Applicants must provide personal information including name, Social Security Number (SSN), Driver's License Number (DLN), Date of Birth (DOB), phone number, and email address, underscoring the need for accuracy and current information.
  • Understanding the distinction between interstate commerce (operating in Kentucky and other states) and intrastate commerce (operating in Kentucky only) is crucial for correctly selecting your certification category.
  • If you drive in both excepted interstate commerce and non-excepted interstate commerce, you must select non-excepted interstate commerce to be qualified to operate in both types, emphasizing the necessity of careful consideration in your selection process.
  • Drivers operating under excepted interstate commerce are engaged in specific activities delineated by federal regulations, such as transporting school children, government work, or responding to emergencies among others. It is important for drivers in these roles to properly identify their exemption category.
  • All Kentucky CDL applicants/holders must sign and date their self-certification forms, which serves as an acknowledgment of their understanding and compliance with the certification requirements.
  • The note on the form stating that no CDL holder/applicant should mark excepted intrastate category emphasizes the criticality of understanding and selecting the appropriate category that reflects your driving activity accurately.

Ultimately, the Kentucky CDL Self-Certification form is a vital document that ensures drivers operate within legal parameters. By accurately completing this form, drivers affirm their commitment to adhering to safety and health standards essential for maintaining the integrity of Kentucky's roadways.

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