Medical examiner certification testing. The Agency adds a new paragraph
(b) (and changes the designation of the subsequent paragraphs as
appropriate),

to require additional security and privacy procedures for those testing
organizations who intend to administer the test on-line as an
alternative or additional option to in-person testing. FMCSA also
eliminates the reference to Appendix A of this part. The NPRM had
proposed an Appendix A, but FMCSA did not adopt it in the final rule. A
provision is added to make it clear that the test to be administered is
the currently authorized test developed and furnished by FMCSA.
    Section 390.109. FMCSA adopts Sec.  390.109 Issuance of the FMCSA
medical examiner certification credential, as proposed, except to
specify compliance with the requirements of Sec.  390.103(a) or (b)
rather than compliance with the requirements of Sec. Sec.  390.103-
390.107.
    Section 390.111. Although proposed paragraph (a)(5)(ii) would have
required a certified ME to retake the initial training in alternating
6-year periods, this requirement was not adopted. Instead, the ME will
be required to complete periodic training as specified by FMCSA every 5
years. The ME will still be required to take the certification test
every 10 years in order to retain the certification.
    Section 390.113. The final rule adds a general statement of the
grounds for removal of an ME, based on 49 U.S.C. 31149.
    Section 390.115. In the NPRM, this section described procedures for
removal from the National Registry. Proposed paragraph (d) addressed
requests for administrative review after an ME has been removed from
the National Registry, but did not describe what would happen if the
administrative review found that the removal of the ME was not valid.
To correct this oversight, FMCSA adds text to paragraph (d)(2), which
requires FMCSA to reinstate the ME and reissue a certification
credential. The reinstated ME essentially must follow the requirements
of Sec.  390.111(a), which describes what the ME must do to continue to
be listed on the National Registry. Similarly, FMCSA adds the same text
to paragraph (f), which describes applying for reinstatement on the
National Registry after voluntary or involuntary removal. In addition
to requiring a person who was involuntarily removed to complete
corrective actions described in the notice of proposed removal, the
rule requires reinstated MEs to follow the requirements of Sec.
390.111(a).
    Proposed paragraph (g) would have required that if a person is
removed from the National Registry under paragraph (c) or (e), or a
removal is affirmed under paragraph (d), then that person's listing is
removed and the certification credential is no longer valid. FMCSA
deletes the phrase ``or a removal is affirmed under paragraph (d),''
because a person who requests administrative review under paragraph (d)
has already been removed from the National Registry under paragraph (c)
or (e). That person's listing has been removed and his or her
certification credential is no longer valid.
    Finally, Director of Medical Programs is updated to Director,
Office of Carrier, Driver and Vehicle Safety Standards throughout to
reflect a change in FMCSA's organizational structure.
    Appendix A. FMCSA does not adopt proposed Appendix A to part 390,
Medical Examiner Application Data Elements. Instead of adopting
proposed Appendix A, FMCSA will make available on its Web site the
current minimum data elements that must be included in the application
for medical examiner certification.

Part 391

    Section 391.23. Amendments to paragraphs (m)(1) and (m)(2)(i)(B) of
this section require the motor carrier to verify that a driver was
certified by an ME on the National Registry beginning 2 years after the
effective date of the rule.
    Section 391.42. The NPRM contained a phase-in schedule for
implementation. In the final rule, beginning 2 years after the
effective date of the final rule, this section now requires that every
medical examination under subpart E of part 391 must be conducted by an
ME listed on the National Registry. For the reasons explained above in
Section IV.E.1, FMCSA does not believe a phase-in period is necessary.
    Section 391.43. The NPRM contained several proposed amendments to
Sec.  391.43, including an addition to the information required on a
medical examiner's certificate. FMCSA adopts paragraph (a) as proposed
to specify that, in accordance with the compliance schedule established
in Sec.  391.42, the medical examination must be performed by an ME
listed on the National Registry under subpart D of part 390 of this
chapter.
    Proposed paragraph (g) would have required the ME to complete a
medical examiner's certificate for drivers found to be physically
qualified to drive a CMV. In the final rule, the paragraph is modified
slightly to reflect the wording of the current paragraph, which was
revised on December 1, 2008 (73 FR 73096) to include providing a copy
of the medical examiner's certificate to the driver's employer. FMCSA
adopts the proposed new requirement in paragraph (g)(3) that, once
every calendar month, the ME must electronically transmit certain
information to the FMCSA Director, Office of Carrier, Driver and
Vehicle Safety Standards. (Director of Medical Programs is updated to
Director, Office of Carrier, Driver and Vehicle Safety Standards to
reflect a change in FMCSA's organizational structure.) The final rule
specifies that the information must be provided on Form MCSA-5850 and
transmitted via a secure FMCSA-designated Web site.
    FMCSA adopts proposed paragraph (h) to revise the medical
examiner's certificate by adding a field for the ME to enter his or her
unique National Registry Number. Under the proposed paragraph, MEs
would have been allowed to use printed certificates they have on hand
until 4 years after the effective date of the final rule. Because the
MEs do not need to be listed on the National Registry until 2 years
after the effective date of the rule, FMCSA believes additional time
for using up old certificates is unnecessary and the final rule does
not provide for the use of obsolete printed certificates.
    FMCSA adopts proposed paragraph (i) to specify that the ME must
retain the original (paper or electronic) completed Medical Examination
Report and a copy or electronic version of the medical examiner's
certificate, and make them available, along with related medical
documentation, to an authorized representative of FMCSA or an
authorized Federal, State, or local enforcement agency representative,
within 48 hours of the request. The proposed paragraph would have
required the records to be retained for 3 years, but the final rule
retains the Med. Cert./CDL language, which specifies ``at least 3 years
from the date of the examination.'' Nothing in our 3-year retention
requirement precludes longer retention which, in fact, may be required
by States. In the case of an ME whose practice has closed, State law
will govern the retention of medical records. Some States may require
the ME's successor to retain drivers' medical records, or in the case
of a deceased ME, the ME's estate may be responsible for retaining the
records. Additionally, FMSCA has modified the medical examiner's
certificate to include additional information.
    Section 391.51. FMCSA amends this section to require the motor
carrier to place a note in the driver qualification file relating to
verification of ME listing on the National Registry beginning 2 years
after the effective date of the final rule.

VI. Regulatory Analyses and Notices

Executive Order 12866 (Regulatory Planning and Review) and DOT
Regulatory Policies and Procedures as Supplemented by Executive Order
13563

    The FMCSA has determined that this rulemaking action is a
significant regulatory action under Executive Order 12866, Regulatory
Planning and Review, as supplemented by Executive Order 13563 (76 FR
3821, January 18, 2011), and that it is significant under DOT
regulatory policies and procedures.
    This rule establishes a training, testing, and registration program
that would certify medical professionals as qualified to conduct
medical certification examinations of commercial drivers. Current
regulations require all interstate commercial drivers (with certain
limited exceptions) to be medically examined by a licensed health care
provider to determine whether these drivers meet the FMCSA physical
qualification requirements. All drivers must carry a medical examiner's
certificate as proof that they have passed this physical qualification
examination. The MEs who conduct said physical examinations must retain
copies of the Medical Examination Reports of all drivers they examine.
The Medical Examination Report lists the specific results of the
various medical tests used to determine whether a driver meets the
physical qualification standards set forth in subpart E of part 391 of
the FMCSRs.
    Before the adoption of this rule, there was no required training
program for the medical professionals who conduct driver physical
examinations, although the FMCSRs required MEs to be knowledgeable
about the regulations (49 CFR 391.43(c)(1)). The former rules required
that any medical professional licensed by his or her State to conduct
physical examinations could conduct driver medical certification exams.
No specific knowledge of the Agency's physical qualification standards
was required or verified by testing. As a result, some of the medical
professionals who conduct these examinations may be unfamiliar with
FMCSA physical qualification standards and how to apply them. These
professionals may also be unaware of the mental and physical rigors
that accompany the occupation of CMV driver, and how various medical
conditions (and the therapies used to treat them) can affect the
ability of drivers to safely operate CMVs.
    This rule establishes the National Registry to ensure that all MEs
who conduct driver medical certifications have been trained in FMCSA
qualification standards and guidelines. In order to be listed on the
National Registry, MEs are required to attend an accredited training
program and pass a certification test to assess their knowledge of the
Agency's physical qualification standards and guidelines and how to
apply them to drivers. Upon passing this certification test, and
meeting the other administrative requirements associated with the
Program, MEs will be listed on the National Registry. Once this rule is
fully implemented, only medical certificates issued to drivers by MEs
on the National Registry will be considered valid by the Agency as
proof of medical certification.

Alternatives

    The regulatory evaluation that accompanied the NPRM for this rule
considered three alternatives for implementing this Program. One
alternative, referred to as the Public-Private Partnership Model,
involved a partnership between the Agency and various private-sector
training and testing organizations that currently exist to provide
continuing professional education and credentialing to medical
professionals. This Public-Private Partnership Model was the Agency's
preferred alternative. The majority of public comments to the docket
during the notice and comment period for the NPRM supported the Public-
Private Partnership Model over the other alternatives considered. This
final rule implements the Public-Private Partnership Model. Under this
partnership, the Agency will develop and provide guidance for the core
curriculum specifications and the certification test and protocols. Any
interested organization that can meet FMCSA requirements will be
eligible to deliver training or testing. Training would therefore be
delivered by private-sector professional associations, health care
organizations, and other for-profit and non-profit training groups.
Testing will be delivered by private-sector professional testing
organizations. After completing one of these accredited training
programs, passing the certification test, and agreeing to comply with
FMCSA administrative requirements, MEs will be listed on the National
Registry, and authorized to conduct CMV driver physical examinations.
Once the National Registry is fully implemented, only physical
examinations conducted by MEs on the National Registry will be
recognized by FMCSA and enforcement personnel as proof of driver
physical qualification.
    The second alternative considered by the Agency at the NPRM stage
was based on the Federal Aviation Administration's Aviation Medical
Examiner program, referred to here as the Government Model. This
alternative required the Agency to establish its own centralized
training and testing program. As described in the regulatory evaluation
accompanying the NPRM, this program would have required MEs to attend
this Agency-run program and pass a test administered by the Agency.
Upon completion of the test, an ME would be eligible for listing on the
National Registry. This program's components are essentially the same
as the Public-Private Partnership Model, but all training and testing
would have been conducted by the Agency rather than private-sector
training and testing programs. This alternative would also have
required all MEs to travel to the FMCSA facility or other regional
training sites to receive the FMCSA training. This would have involved
greater travel expenses for MEs when compared to the Public-Private
Partnership Model, which has training programs distributed throughout
the country as well as some vendors who would offer on-line training
modules. However, this option would have given FMCSA optimal control
over the training of MEs.
    The third alternative, referred to as the MRO Model, was based on
the current MRO program requirements set forth in 49 CFR part 40,
subpart G. The DOT MRO training program grew out of the DOT drug and
alcohol program, which monitors use of controlled substances and
alcohol. MROs are trained and certified by accredited training programs
operated by professional associations in cooperation with DOT. Only
licensed MDs or DOs are eligible to be MROs. MROs review drug and
alcohol test results for other safety-sensitive occupations such as
airline mechanics, train operators, and ship's pilots.
    The existing program specifies that MROs who oversee drug and
alcohol testing for commercial drivers must attend a training and
certification program that meets DOT standards. Each of these programs
maintains its own registry of graduates rather than contributing names
to a single Federal database. DOT does not administer the training
curriculum or testing protocols for these programs. Thus, the Agency
would exert less control over a program based on the MRO model than
under the other options discussed at the NPRM stage. In addition, MRO
programs charge more for testing than would likely be charged for
testing in the

National Registry program. Long distance travel for the initial
training and testing would also have been required under this
alternative.
    As noted, the Agency has chosen to adopt the Public-Private
Partnership Model at the final rule stage. This alternative was
estimated to have the lowest cost of the three alternatives considered,
and would afford the greatest degree of flexibility, convenience, and
training opportunity to MEs. Moreover, it was supported by the majority
of comments that mentioned the various alternative models proposed in
the NPRM. We summarize the estimated costs and benefits of the three
models below. To a large extent, costs have not changed. However, the
Agency has decided to drop the phase-in described in the NPRM in which
drivers who work for carriers who employ 50 or more drivers would be
required to comply with the rule one year earlier than drivers who work
for smaller carriers or are owner-operators. The Agency concurs with
comments received that the phase-in schedule would pose some issues,
such as limiting the number of MEs in the first year. Additionally,
FMCSA does not believe the phase-in would reflect the reality of the
industry's distribution of drivers. Under this final rule, all drivers,
regardless of the size carrier they work for, are required to obtain
medical certification from a National Registry-certified ME within 2
years of the full implementation of the Program. This change has
advanced the date at which all drivers must be certified by an ME on
the National Registry, and as a result, a portion of the impacts that
would be felt by drivers and the industry will be felt earlier than
would have been the case with the phase-in. Related cost adjustments
are described below in detail.

Summary of Costs and Benefits

    The costs and benefits for all three alternatives are analyzed in
this regulatory evaluation. It is anticipated that approximately 40,000
MEs will be needed for the NRCME to accommodate the demand for an
estimated 2.6 million medical examinations per year, and to provide
adequate access, both in terms of geographic coverage and relatively
short appointment waiting times. All alternatives involve an initial
training phase in which the 40,000 MEs receive training. This phase is
expected to last 2 years. At the beginning of the third year the Agency
requires drivers to be examined by MEs listed on the NRCME once their
current medical certification expires. Under Alternative 1, the
alternative adopted by this Final Rule, MEs are required to attend a
training conducted by a private-sector organization. It is anticipated
that this will result in training and testing fees that would have to
be paid by MEs. Under Alternative 2, no training or testing fees would
have been incurred by MEs, but the Agency would have borne the costs of
providing the training and testing services. MEs would have borne the
cost of long distance travel to the FMCSA training center under
Alternative 2. Long distance travel to a designated training program
was also anticipated under Alternative 3. Under Alternative 1 it is
anticipated that training programs will be available throughout the
country, and that some programs will offer online training courses,
which will minimize the need for long distance travel.
    It is also anticipated that by screening out physically unqualified
drivers, this rule may require some drivers, who cannot meet the
physical qualification standards, and would no longer be able to evade
detection, to leave the industry and seek an alternative occupation.
Carriers to would bear the cost of hiring replacement drivers.
Recruiting new drivers is an activity that consumes carrier resources,
and there is therefore a cost associated with that activity. We
therefore provide an estimate of the number of drivers who may be
forced to retire from the occupation, and estimate the costs associated
with recruiting an equal number of replacement drivers.
    The 10-year total cost of the Public-Private Partnership Model is
estimated at $232 million, when discounted at a 7 percent discount
rate. Undiscounted annual costs vary between $14 million and $59
million, with ME certification costs (training and testing costs plus
lost time and travel costs) being the largest portion of the cost at
approximately $31.5 million in the highest-cost year. Alternative 2 has
a total discounted 10-year cost of $383 million, with undiscounted
annual costs ranging between $17 million and $88 million. Alternative 3
has a total 10-year discounted cost of $337 million, with undiscounted
annual costs ranging between $16 million and $92 million. In all
alternatives, the value of ME time spent in training is the largest
portion of cost. The costs of the training/testing, including lost time
and travel costs for MEs, is estimated to vary between $63 million and
$131 million during the initial training phase, depending on the
alternative, with Alternative 1 having the lowest cost. The lower cost
associated with Alternative 1 is due to its minimization of travel and
associated costs, both in expenses and lost time, to MEs.
    Because all three alternatives are expected to improve the
performance of MEs by equivalent amounts, total benefits are expected
to be equivalent for all programs. These benefits are based on the
reduction in CMV crashes that is likely to result from improved medical
screening of drivers. It is estimated that physically impaired
interstate drivers are responsible for approximately 9,687 of the
roughly 440,000 commercial motor vehicle crashes that occur annually.
Although it is not anticipated that this program would completely
eliminate these crashes, it is expected to prevent a portion of them.
We estimate that this program may prevent up to one-fifth of these
crashes annually, which would result in approximately 1,219 fewer
crashes per year. The estimated annual benefit associated with avoiding
these crashes is $189 million per year, undiscounted. These full
benefits are not realized until the program is fully phased in, which
is several years after the establishment of the program. Nevertheless,
at a 7 percent discount rate, the 10-year net benefits of this rule are
estimated at approximately $633.2 million to $784.1 million over 10
years depending on the alternative. The Agency's chosen alternative has
the highest net benefits at $784.1 million.

Regulatory Flexibility Act

    The Regulatory Flexibility Act of 1980 (5 U.S.C. 601-612) requires
Federal agencies to consider the effects of the regulatory action on
small business and other small entities and to minimize any significant
economic impact. The term ``small entities'' comprises small businesses
and not-for-profit organizations that are independently owned and
operated and are not dominant in their fields, and governmental
jurisdictions with populations of less than 50,000. Accordingly, DOT
policy requires an analysis of the impact of all regulations on small
entities, and mandates that agencies strive to lessen any adverse
effects on these businesses. The Agency conducted an initial Regulatory
Flexibility Analysis for the NPRM and found that the rule would not
have a significant economic impact on a substantial number of small
entities. No comments were received on that analysis from the public. I
certify that this rule would not have a significant economic impact on
a substantial number of small entities.

Unfunded Mandates Reform Act of 1995

    This rulemaking will not impose an unfunded Federal mandate, as
defined by the Unfunded Mandates Reform Act

of 1995 (2 U.S.C. 1532, et seq.), that would result in the expenditure
by State, local, and tribal governments, in the aggregate, or by the
private sector, of $143.1 million or more in any 1 year. The $143.1
million figure was derived by inflation adjusting the $100 million cap
in the original Act from 1995 to 2010 dollars using the Consumer Price
Index.

Executive Order 12988 (Civil Justice Reform)

    This action meets applicable standards in sections 3(a) and 3(b)(2)
of Executive Order 12988, Civil Justice Reform, to minimize litigation,
eliminate ambiguity, and reduce burden.

Executive Order 13045 (Protection of Children)

    FMCSA analyzed this action under Executive Order 13045, Protection
of Children from Environmental Health Risks and Safety Risks. We
determined that this rulemaking does not concern an environmental risk
to health or safety that may disproportionately affect children.

Executive Order 12630 (Taking of Private Property)

    This final rule does not effect a taking of private property or
otherwise have taking implications under Executive Order 12630,
Governmental Actions and Interference with Constitutionally Protected
Property Rights.

Executive Order 13132 (Federalism)

    FMCSA analyzed this rule in accordance with the principles and
criteria contained in Executive Order 13132. FMCSA has determined that
this rulemaking will have no significant cost or other effect on or for
States. States will have policy-making discretion. Nothing in this
document will preempt any State law or regulation. Therefore, this rule
does not have sufficient federalism implications to warrant the
preparation of a federalism assessment.

Executive Order 12372 (Intergovernmental Review)

    The regulations implementing Executive Order 12372 regarding
intergovernmental consultation on Federal programs and activities do
not apply to this program.

Privacy Impact Assessment

    FMCSA conducted a privacy impact assessment of this rule as
required by section 522(a)(5) of division H of the Fiscal Year 2005
Omnibus Appropriations Act, Public Law 108-447, 118 Stat. 3268
(December 8, 2004) (set out as a note to 5 U.S.C. 552a). The assessment
considers any impacts of the rule on the privacy of information in an
identifiable form and related matters. FMCSA determined that this
initiative will create impacts on privacy of information associated
with implementation of this rule.
    FMCSA only collects PII necessary for official purposes as stated
in the National Registry final rule. In addition, FMCSA only obtains
such PII by lawful and fair means and, to the greatest extent possible,
with the knowledge or consent of the individual. The FMCSA Office of
Information Technology adheres to the Fair Information Practice
Principles (FIPPs) to assist the Agency in protecting the
confidentiality and privacy of PII associated with the implementation
of the National Registry final rule. These best practices incorporate
standards and practices equivalent to those required under the Privacy
Act of 1974 (5 U.S.C. 552a) and other Federal laws that are consistent
with the FIPPs. These practices include management, operational, and
technical safeguards that are appropriate for the protection of PII.
The entire privacy impact assessment is available for review in the
docket.

Paperwork Reduction Act

    This rule contains the following new information collection
requirements. As required by the Paperwork Reduction Act of 1995 (PRA)
(44 U.S.C. 3507(d)), FMCSA submitted the information requirements
associated with the proposal to the Office of Management and Budget for
its review.
    Title: National Registry of Certified Medical Examiners (National
Registry).
    Summary: Under SAFETEA-LU, the Secretary of Transportation is
required to establish and maintain a current national registry of
medical examiners who are qualified to perform examinations and issue
medical certificates that verify whether a CMV driver's health meets
FMCSA standards. In addition, section 4116(b) of SAFETEA-LU requires
that the medical examinations of CMV operators be performed by MEs who
have received training in physical and medical examination standards,
and, after the National Registry is established, are listed on the
National Registry. SAFETEA-LU also requires MEs to electronically
transmit the name of the applicant and FMCSA numerical identifier for
any completed Medical Examination Report required under Sec.  391.43 to
the Chief Medical Examiner on a monthly basis.
    Once the National Registry Program is implemented, FMCSA will
accept medical examinations performed only by certified MEs listed on
the National Registry, as required by law. The National Registry
Program would require MEs to complete training developed from
standardized curriculum specifications and pass a national
certification test. The procedures used to develop and maintain the
quality of the Program are expected to be in accordance with national
accreditation standards for certification programs established by the
NCCA, the accreditation arm of the National Organization for Competency
Assurance.
    Requirements imposed on intrastate drivers and employers for this
information collection are being considered since State laws are
generally in substantial conformity with the Federal regulations for
medical qualifications of commercial drivers. Consequently, the
estimate of the number of CMV drivers (respondents) covered by this
information collection reflects both interstate drivers subject to the
FMCSRs and intrastate drivers subject to compatible State regulations.
Although Federal regulations do not require States to comply with the
medical requirements in the FMCSRs, most States do mirror the Federal
requirements; therefore, we are including intrastate drivers, which is
consistent with other FMCSA information collections, to accurately
reflect the burden of this information collection.
    Close tracking and monitoring of certification activities and
medical outcomes are crucial, and the rule addresses the information
collection aspects of National Registry implementation. To this end,
the rule requires MEs to submit four types of data:
    (1) Medical Examiner Application and Test Results Data: To be
listed on the National Registry, MEs must first pass a certification
test to ensure they demonstrate an established level of competency.
FMCSA and private-sector testing organizations will collect data from
MEs as the medical professionals apply to take this certification test.
Data elements required of MEs at the time of application will include
professional contact and identifying information such as job title,
address, and training and State licenses obtained. These data will be
collected each time the ME applies to sit for the certification test
and information will be updated with FMCSA as needed. Test results data
will include total test score and responses for each test item.
Private-sector testing organizations will regularly transmit medical
examiner data and test results

electronically to FMCSA for inclusion in a centralized, confidential
database.
    (2) CMV Driver Medical Examination Results Data: Once every
calendar month, each ME listed on the National Registry is required to
complete and transmit to FMCSA Form MCSA-5850, CMV Driver Medical
Examination Results, with the following information about each CMV
driver examined during the previous month: Name, date of birth,
driver's license number and State, date of examination, an indication
of the examination outcome (for example, medically qualified), whether
intrastate driver only, and date of driver medical certification
expiration. Data will be submitted electronically via a secure FMCSA-
designated Web site. In order to continue to be listed on and to
continue participation in the National Registry, MEs need to comply
with this requirement on a monthly basis. MEs who examine drivers who
operate only in intrastate commerce may report those driver examination
results on the form and check the checkbox for ``Intrastate Only''.
Data on intrastate only driver examinations will be used to provide
information to State and local enforcement officials on medical
examiner performance and driver physical qualifications.
    (3) Medical Examination Reports and Medical Examiner's
Certificates: The National Registry Final Rule requires medical
examiners to provide copies of Medical Examination Reports and medical
examiner's certificates to authorized representatives, special agents,
or investigators of the FMCSA or authorized State or local enforcement
agency representatives. These documents contain the driver's social
security number, date of birth, driver license number, and health and
medical information.
    It is necessary for medical examiners to provide Medical
Examination Reports and medical examiner's certificates to an
authorized representative, special agent, or investigator of FMCSA or
an authorized State or local enforcement agency representative in order
to determine ME compliance with FMCSA medical standards and guidelines
in performing CMV driver medical examinations. Failure to comply with
FMCSA medical standards and guidelines may result in removal from the
National Registry. Medical examiner's certificates provide additional
documentation to determine compliance with FMCSA medical standards and
guidelines by linking the ME to both the medical examination and the
driver medical certification decision. They also determine compliance
by ensuring the certification decision matches the information in the
medical examination and that the certificate is completed correctly.
    (4) Verification of National Registry Number by Motor Carriers:
Motor carriers will be required to verify the National Registry Number
of the medical examiner for each driver required to be examined by a
medical examiner on the National Registry and place a note relating to
verification in the driver qualification file, as required by
provisions in 49 CFR 391.23 and 391.51. This data collection
requirement will also provide proof that the motor carrier has met its
obligation to require drivers to comply with the regulations that apply
to the driver (49 U.S.C. 31135(a) and 49 CFR 390.11).
    Respondents (Including the Number of): The likely respondents to
this proposed information requirement are 40,000 MEs from medical
professions who are believed to conduct the majority of current CMV
driver medical examinations (APNs, DCs, DOs, MDs, and PAs) and one or
more national private-sector testing organizations that deliver the
certification test. We are unable to estimate the number of private-
sector organizations that might wish to perform testing.
    Frequency: FMCSA estimates each of the respondents would provide ME
test application data every 6 years and updated information as needed.
FMCSA further estimates that each respondent would provide CMV driver
examination data a maximum of 12 times per year. It is estimated that
an average of approximately 20,000 MEs will apply to take the
certification test annually for the first 2 years of National Registry
implementation. It is estimated that one or more testing organizations
will deliver the FMCSA medical examiner certification test to 20,000
MEs annually for the first 2 years following implementation of the
National Registry Program. It is projected that MEs would file
4,623,000 medical examiner's certificates per year and that authorized
representatives of FMCSA or authorized State or local enforcement
agency representatives would request MEs to provide copies of the
Medical Report Form and the medical examiner's certificate 2,100 times
a year.
    Annual Burden Estimate: This proposal would result in an annual
recordkeeping and reporting burden as follows:
    FMCSA estimates each of the respondents will provide medical
examiner certification test results and application data every 6 years
and updated information to FMCSA as needed. It is estimated that 20,000
medical examiner candidates will apply to take the certification test
annually for the first 2 years of National Registry implementation, or
an average of 13,333 applicants per year for the first 3 years of the
program. FMCSA estimates that the total annual burden hours for the
collection of the medical examiner application data is 1,111 hours
[13,333 applicants x 5 minutes/60 minutes per response = 1,111 hours].
This annual burden includes medical examiner candidate time for
submitting the application data to the private-sector testing
organizations.
    It is estimated that it will take private-sector testing
organization personnel 5 minutes per ME to collect and upload to FMCSA
application data and test results. FMCSA estimates that the total
annual burden hours for private-sector testing organizations to collect
medical examiner application data and send ME application and test
results data to FMCSA is 1,111 hours (13,333 applicants x 5 minutes/60
minutes per medical examiner = 1,111 hours).
    FMCSA estimates that respondents would provide CMV driver
examination data a maximum of 12 times per year and would file
4,623,000 medical examiner's certificates per year. It is projected
that 40,000 certified MEs will be needed to perform the 4,623,000 CMV
driver medical examinations required annually. The transmission of CMV
driver examination data will require approximately 46,525 hours of
medical examiner administrative personnel time on a yearly basis
[40,000 registered medical examiners x 1 minute/60 minutes to file a
report x 12 reports per year + 4,623,000 reports x 30 seconds/3600
seconds to enter each driver's examination data elements = 46,525
hours]. It is estimated that it will take medical examiner
administrative personnel 30 seconds to file the medical examiner's
certificate. This will require approximately 38,525 hours of
administrative personnel time on a yearly basis [4,623,000 examinations
x 30 seconds/3600 seconds per certificate = 38,525]. In addition, FMCSA
estimates that half of motor carriers will request a copy of the
medical examiner's certificate and that it will take administrative
personnel 1 minute to provide a copy of the medical examiner's
certificate to a motor carrier. The annual time burden to the
administrative personnel for providing motor carriers with a copy of
the medical examiner's certificate is approximately 38,525 hours
[4,623,000 examinations x .5 (50%) x 1 minute/60 minutes = 38,525
hours]. The annual time burden to medical examiner administrative
personnel for transmitting CMV driver examination

data to the FMCSA, filing medical examiner's certificates, and
providing copies of the medical examiner's certificates to motor
carriers is approximately 123,575 hours [46,525 hours to enter driver
examination data elements and 38,525 hours for filing the medical
examiner's certificate and 38,525 hours for providing medical
examiner's certificates to motor carriers = 123,575 hours].
    FMCSA estimates that authorized representatives, special agents, or
investigators of FMCSA or authorized State or local enforcement agency
representatives will request MEs to provide copies of the Medical
Examination Report and the medical examiner's certificate 2,100 times a
year.
    It is estimated that it will take ME administrative personnel 5
minutes to provide both the Medical Examination Report and the medical
examiner's certificate to FMCSA or an authorized State or local
enforcement agency representative upon request, so this will require
approximately 175 hours of administrative personnel time on a yearly
basis [2,100 requests x 5 minutes/60 minutes per response = 175 hours].
    FMCSA estimates that motor carriers will verify the National
Registry Number for 4,623,000 drivers per year who are medically
certified. It is estimated that it will take motor carrier
administrative personnel 4 minutes to verify the National Registry
Number, write a note regarding the verification, and file the note in
the Driver Qualification file, so this will require approximately
308,200 hours of administrative personnel time on a yearly basis
[4,623,000 verifications x 4 minutes/60 minutes per verification =
308,200 hours].
    The total estimated annual time burden to respondents for the
National Registry components is approximately 434,172 hours \7\ [2,222
hours for provision of medical examiner application and test results
data (1,111 hours for medical examiners and 1,111 hours for testing
organizations) + 123,575 hours for CMV driver examinations (46,525
hours to enter driver examination data elements + 38,525 hours for
filing the medical examiner's certificate + 38,525 hours for providing
medical examiner's certificates to motor carriers) + 175 hours for
provision of Medical Examination Reports and medical examiner's
certificates + 308,200 hours for verification of National Registry
Number].
---------------------------------------------------------------------------

    \7\ The accompanying supporting statement also reflects the
correction of a minor mathematical error.
---------------------------------------------------------------------------

National Environmental Policy Act and Clean Air Act

    The Agency analyzed this final rule for the purpose of the National
Environmental Policy Act of 1969 (42 U.S.C. 4321 et seq.) and
determined under our environmental procedures Order 5610.1, published
March 1, 2004, in the Federal Register (69 FR 9680), that this action
required an Environmental Assessment (EA) to determine if a more
extensive Environmental Impact Statement was required. FMCSA prepared
an EA and placed it in the docket for this rulemaking. The EA found
that there are no significant negative impacts expected from the
actions. Although congestion and air emission impacts are discussed in
the EA, the impacts are minimal and are not expected to alter the
Nation's highway congestion or air emissions from surface or air
transportation vehicles. In addition, while not quantified in this
analysis, minor benefits to the environment from reducing CMV crashes
are expected.
    We have also analyzed this rule under the Clean Air Act, as amended
(CAA), section 176(c) (42 U.S.C. 7401 et seq.), and implementing
regulations promulgated by the Environmental Protection Agency.
Approval of this action is exempt from the CAA's general conformity
requirement since it involves rulemaking and policy development and
issuance.

Executive Order 13211 (Energy Effects)

    We analyzed this action under Executive Order 13211, Actions
Concerning Regulations That Significantly Affect Energy Supply,
Distribution, or Use. We determined that it is not a ``significant
energy action'' under that Executive Order because it will not be
likely to have a significant adverse effect on the supply,
distribution, or use of energy.

Executive Order 12898 (Environmental Justice)

    FMCSA evaluated the environmental effects of this final rule in
accordance with Executive Order 12898 and determined that there are no
environmental justice issues associated with its provisions and no
collective environmental impact resulting from its promulgation.

Executive Order 13175 (Tribal Consultation)

    FMCSA analyzed this action under Executive Order 13175, dated
November 6, 2000, and believes that it will not have substantial direct
effects on one or more Indian tribes; will not impose substantial
compliance costs on Indian tribal governments; and will not preempt
tribal law. Therefore, a tribal summary impact statement is not
required.

List of Subjects

49 CFR Part 350

    Grant programs--transportation, Highway safety, Motor carriers,
Motor vehicle safety, Reporting and recordkeeping requirements.

49 CFR Part 383

    Administrative practice and procedure, Alcohol abuse, Drug abuse,
Highway safety, Motor carriers

49 CFR Part 390

    Highway safety, Intermodal transportation, Motor carriers, Motor
vehicle safety, Reporting and recordkeeping requirements.

49 CFR Part 391

    Alcohol abuse, Drug abuse, Drug testing, Highway safety, Motor
carriers, Reporting and recordkeeping requirements, Safety,
Transportation.

    In consideration of the foregoing, FMCSA amends title 49, Code of
Federal Regulations, parts 350, 383, 390, and 391, as follows:

PART 350--COMMERCIAL MOTOR CARRIER SAFETY ASSISTANCE PROVISION

0
1. The authority citation for part 350 continues to read as follows:

    Authority: 49 U.S.C. 13902, 31101-31104, 31108, 31136, 31140-
31141, 31161, 31310-31311, 31502; and 49 CFR 1.73.

0
2. In Sec.  350.341, add paragraph (h)(3) to to read as follows:

Sec.  350.341  What specific variances from the FMCSRs are allowed for
State laws and regulations governing motor carriers, CMV drivers, and
CMVs engaged in intrastate commerce and not subject to Federal
jurisdiction?

* * * * *
    (h) * * *
    (3) The State may decide not to adopt laws and regulations that
implement a registry of medical examiners trained and qualified to
apply physical qualification standards or variances continued in effect
or adopted by the State under this paragraph that apply to drivers of
CMVs in intrastate commerce.

PART 383--COMMERCIAL DRIVER'S LICENSE STANDARDS; REQUIREMENTS AND
PENALTIES

0
3. The authority citation for part 383 continues to read as follows:

    Authority: 49 U.S.C. 521, 31136, 31301 et seq., and 31502; secs.
214 and 215, Pub. L. 106-159, 113 Stat. 1748, 1766, 1767; sec. 4140,
Pub. L. 109-59, 119 Stat. 1144, 1746; and 49 CFR 1.73.

0
4. Amend Sec.  383.73 to by revising paragraph (o)(1)(iii)(E)to read as
follows:

Sec.  383.73  State procedures.

* * * * *
    (o) * * *
    (1) * * *
    (iii) * * *
    (E) Medical examiner's National Registry Number issued in
accordance with Sec.  390.109;
* * * * *

PART 390--FEDERAL MOTOR CARRIER SAFETY REGULATIONS; GENERAL

0
5. Revise the authority citation for part 390 to read as follows:

    Authority: 49 U.S.C. 504, 508, 31132, 31133, 31136, 31144,
31151, and 31502; sec. 114, Pub. L. 103-311, 108 Stat. 1673, 1677-
1678; secs. 212 and 217, Pub. L. 106-159, 113 Stat. 1748, 1766,
1767; sec. 229, Pub. L. 106-159 (as transferred by sec. 4115 and
amended by secs. 4130-4132, Pub. L. 109-59, 119 Stat. 1144, 1726,
1743-1744); sec. 4136, Pub. L. 109-59, 119 Stat. 1144, 1745; and 49
CFR 1.73.

0
6. Amend Sec.  390.5 by revising the definition of ``medical examiner''
to read as follows:

Sec.  390.5  Definitions.

* * * * *
    Medical examiner means the following:
    (1) For medical examinations conducted before May 21, 2014, a
person who is licensed, certified, and/or registered, in accordance
with applicable State laws and regulations, to perform physical
examinations. The term includes but is not limited to, doctors of
medicine, doctors of osteopathy, physician assistants, advanced
practice nurses, and doctors of chiropractic.
    (2) For medical examinations conducted on and after May 21, 2014,
an individual certified by FMCSA and listed on the National Registry of
Certified Medical Examiners in accordance with subpart D of this part.
* * * * *

0
7. Add subpart D, consisting of Sec. Sec.  390.101 through 390.115, to
read as follows:
Subpart D--National Registry of Certified Medical Examiners
Sec.
390.101 Scope.
390.103 Eligibility requirements for medical examiner certification.
390.105 Medical examiner training programs.
390.107 Medical examiner certification testing.
390.109 Issuance of the FMCSA medical examiner certification
credential.
390.111 Requirements for continued listing on the National Registry
of Certified Medical Examiners.
390.113 Reasons for removal from the National Registry of Certified
Medical Examiners.
390.115 Procedure for removal from the National Registry of
Certified Medical Examiners.

Subpart D--National Registry of Certified Medical Examiners

Sec.  390.101  Scope.

    The rules in this subpart establish the minimum qualifications for
FMCSA certification of a medical examiner and for listing the examiner
on FMCSA's National Registry of Certified Medical Examiners. The
National Registry of Certified Medical Examiners Program is designed to
improve highway safety and operator health by requiring that medical
examiners be trained and certified to determine effectively whether an
operator meets FMCSA physical qualification standards under part 391 of
this chapter. One component of the National Registry Program is the
registry itself, which is a national database of names and contact
information for medical examiners who are certified by FMCSA to perform
medical examinations of operators.

Sec.  390.103  Eligibility requirements for medical examiner
certification.

    (a) To receive medical examiner certification from FMCSA a person
must:
    (1) Be licensed, certified, or registered in accordance with
applicable State laws and regulations to perform physical examinations.
The applicant must be an advanced practice nurse, doctor of
chiropractic, doctor of medicine, doctor of osteopathy, physician
assistant, or other medical professional authorized by applicable State
laws and regulations to perform physical examinations.
    (2) Complete a training program that meets the requirements of
Sec.  390.105.
    (3) Pass the medical examiner certification test provided by FMCSA
and administered by a testing organization that meets the requirements
of Sec.  390.107 and that has electronically forwarded to FMCSA the
applicant's completed test and application information no more than
three years after completion of the training program required by
paragraph (a)(2) of this section. An applicant must not take the test
more than once every 30 days.
    (b) If a person has medical examiner certification from FMCSA, then
to renew such certification the medical examiner must remain qualified
under paragraph (a)(1) of this section and complete additional testing
and training as required by Sec.  390.111(a)(5).

Sec.  390.105  Medical examiner training programs.

    An applicant for medical examiner certification must complete a
training program that:
    (a) Is conducted by a training provider that:
    (1) Is accredited by a nationally recognized medical profession
accrediting organization to provide continuing education units; and
    (2) Meets the following administrative requirements:
    (i) Provides training participants with proof of participation.
    (ii) Provides FMCSA point of contact information to training
participants.
    (b) Provides training to medical examiners on the following topics:
    (1) Background, rationale, mission, and goals of the FMCSA medical
examiner's role in reducing crashes, injuries, and fatalities involving
commercial motor vehicles.
    (2) Familiarization with the responsibilities and work environment
of commercial motor vehicle operation.
    (3) Identification of the operator and obtaining, reviewing, and
documenting operator medical history, including prescription and over-
the-counter medications.
    (4) Performing, reviewing, and documenting the operator's medical
examination.
    (5) Performing, obtaining, and documenting additional diagnostic
tests or medical opinion from a medical specialist or treating
physician.
    (6) Informing and educating the operator about medications and non-
disqualifying medical conditions that require remedial care.
    (7) Determining operator certification outcome and period for which
certification should be valid.
    (8) FMCSA reporting and documentation requirements.
    Guidance on the core curriculum specifications for use by training
providers is available from FMCSA.

Sec.  390.107  Medical examiner certification testing.

    An applicant for medical examiner certification or recertification
must apply, in, accordance with the minimum specifications for
application elements established by FMCSA, to a testing organization
that meets the following criteria:
    (a) The testing organization has documented policies and procedures
that:
    (1) Use secure protocols to access, process, store, and transmit
all test items, test forms, test data, and candidate information and
ensure access by authorized personnel only.
    (2) Ensure testing environments are reasonably comfortable and have
minimal distractions.
    (3) Prevent to the greatest extent practicable the opportunity for
a test taker to attain a passing score by fraudulent means.
    (4) Ensure that test center staff who interact with and proctor
examinees or provide technical support have completed formal training,
demonstrate competency, and are monitored periodically for quality
assurance in testing procedures.
    (5) Accommodate testing of individuals with disabilities or
impairments to minimize the effect of the disabilities or impairments
while maintaining the security of the test and data.
    (b) Testing organizations that offer testing of examinees not at
locations that are operated and staffed by the organizations but by
means of remote, computer-based systems must, in addition to the
requirements of paragraph (a) of this section, ensure that such
systems:
    (1) Provide a means to authenticate the identity of the person
taking the test.
    (2) Provide a means for the testing organization to monitor the
activity of the person taking the test.
    (3) Do not allow the person taking the test to reproduce or record
the contents of the test by any means.
    (c) The testing organization has submitted its documented policies
and procedures as defined in paragraph (a) of this section and, if
applicable, paragraph (b) of this section to FMCSA and agreed to future
reviews by FMCSA to ensure compliance with the criteria listed in this
section.
    (d) The testing organization administers only the currently
authorized version of the medical examiner certification test developed
and furnished by FMCSA.

Sec.  390.109  Issuance of the FMCSA medical examiner certification
credential.

    Upon compliance with the requirements of Sec.  390.103(a) or (b),
FMCSA will issue to a medical examiner applicant an FMCSA medical
examiner certification credential with a unique National Registry
Number and will add the medical examiner's name to the National
Registry of Certified Medical Examiners. The certification credential
will expire 10 years after the date of its issuance.

Sec.  390.111  Requirements for continued listing on the National
Registry of Certified Medical Examiners.

    (a) To continue to be listed on the National Registry of Certified
Medical Examiners, each medical examiner must:
    (1) Continue to meet the requirements of this subpart and the
applicable requirements of part 391 of this chapter.
    (2) Report to FMCSA any changes in the application information
submitted under Sec.  390.103(a)(3) within 30 days of the change.
    (3) Continue to be licensed, certified, or registered, and
authorized to perform physical examinations, in accordance with the
applicable laws and regulations of each State in which the medical
examiner performs examinations.
    (4) Maintain documentation of State licensure, registration, or
certification to perform physical examinations for each State in which
the examiner performs examinations and maintain documentation of and
completion of all training required by this section and Sec.  390.105.
The medical examiner must make this documentation available to an
authorized representative of FMCSA or an authorized representative of
Federal, State, or local government. The medical examiner must provide
this documentation within 48 hours of the request for investigations
and within 10 days of the request for regular audits of eligibility.
    (5) Maintain medical examiner certification by completing training
and testing according to the following schedule:
    (i) No sooner than 4 years and no later than 5 years after the date
of issuance of the medical examiner certification credential, complete
periodic training as specified by FMCSA.
    (ii) No sooner than 9 years and no later than 10 years after the
date of issuance of the medical examiner certification credential:
    (A) Complete periodic training as specified by FMCSA; and
    (B) Pass the test required by Sec.  390.103(a)(3).
    (b) FMCSA will issue a new medical examiner certification
credential valid for 10 years to a medical examiner who complies with
paragraphs (a)(1) through (4) of this section and who successfully
completes the training and testing as required by paragraphs (a)(5)(i)
and (ii) of this section.

Sec.  390.113  Reasons for removal from the National Registry of
Certified Medical Examiners.

    FMCSA may remove a medical examiner from the National Registry of
Certified Medical Examiners when a medical examiner fails to meet or
maintain the qualifications established by this subpart, the
requirements of other regulations applicable to the medical examiner,
or otherwise does not meet the requirements of 49 U.S.C. 31149. The
reasons for removal may include, but are not limited to:
    (a) The medical examiner fails to comply with the requirements for
continued listing on the National Registry of Certified Medical
Examiners, as described in Sec.  390.111.
    (b) FMCSA finds that there are errors, omissions, or other
indications of improper certification by the medical examiner of an
operator in either the completed Medical Examination Reports or the
medical examiner's certificates.
    (c) The FMCSA determines the medical examiner issued a medical
examiner's certificate to an operator of a commercial motor vehicle who
failed to meet the applicable standards at the time of the examination.
    (d) The medical examiner fails to comply with the examination
requirements in Sec.  391.43 of this chapter.
    (e) The medical examiner falsely claims to have completed training
in physical and medical examination standards as required by this
subpart.

Sec.  390.115  Procedure for removal from the National Registry of
Certified Medical Examiners.

    (a) Voluntary removal. To be voluntarily removed from the National
Registry of Certified Medical Examiners, a medical examiner must submit
a request to the FMCSA Director, Office of Carrier, Driver and Vehicle
Safety Standards. Except as provided in paragraph (b) of this section,
the Director, Office of Carrier, Driver and Vehicle Safety Standards
will accept the request and the removal will become effective
immediately. On and after the date of issuance of a notice of proposed
removal from the National Registry of Certified Medical Examiners, as
described in paragraph (b) of this section, however, the Director,
Office of Carrier, Driver and Vehicle Safety Standards will not approve
the medical

examiner's request for voluntary removal from the National Registry of
Certified Medical Examiners.
    (b) Notice of proposed removal. Except as provided by paragraphs
(a) and (e) of this section, FMCSA initiates the process for removal of
a medical examiner from the National Registry of Certified Medical
Examiners by issuing a written notice of proposed removal to the
medical examiner, stating the reasons that removal is proposed under
Sec.  390.113 and any corrective actions necessary for the medical
examiner to remain listed on the National Registry of Certified Medical
Examiners.
    (c) Response to notice of proposed removal and corrective action. A
medical examiner who has received a notice of proposed removal from the
National Registry of Certified Medical Examiners must submit any
written response to the Director, Office of Carrier, Driver and Vehicle
Safety Standards no later than 30 days after the date of issuance of
the notice of proposed removal. The response must indicate either that
the medical examiner believes FMCSA has relied on erroneous reasons, in
whole or in part, in proposing removal from the National Registry of
Certified Medical Examiners, as described in paragraph (c)(1) of this
section, or that the medical examiner will comply and take any
corrective action specified in the notice of proposed removal, as
described in paragraph (c)(2) of this section.
    (1) Opposing a notice of proposed removal. If the medical examiner
believes FMCSA has relied on an erroneous reason, in whole or in part,
in proposing removal from the National Registry of Certified Medical
Examiners, the medical examiner must explain the basis for his or her
belief that FMCSA relied on an erroneous reason in proposing the
removal. The Director, Office of Carrier, Driver and Vehicle Safety
Standards will review the explanation.
    (i) If the Director, Office of Carrier, Driver and Vehicle Safety
Standards finds FMCSA has wholly relied on an erroneous reason for
proposing removal from the National Registry of Certified Medical
Examiners, the Director, Office of Carrier, Driver and Vehicle Safety
Standards will withdraw the notice of proposed removal and notify the
medical examiner in writing of the determination. If the Director,
Office of Carrier, Driver and Vehicle Safety Standards finds FMCSA has
partly relied on an erroneous reason for proposing removal from the
National Registry of Certified Medical Examiners, the Director, Office
of Carrier, Driver and Vehicle Safety Standards will modify the notice
of proposed removal and notify the medical examiner in writing of the
determination. No later than 60 days after the date the Director,
Office of Carrier, Driver and Vehicle Safety Standards modifies a
notice of proposed removal, the medical examiner must comply with this
subpart and correct any deficiencies identified in the modified notice
of proposed removal as described in paragraph (c)(2) of this section.
    (ii) If the Director, Office of Carrier, Driver and Vehicle Safety
Standards finds FMCSA has not relied on an erroneous reason in
proposing removal, the Director, Office of Carrier, Driver and Vehicle
Safety Standards will affirm the notice of proposed removal and notify
the medical examiner in writing of the determination. No later than 60
days after the date the Director, Office of Carrier, Driver and Vehicle
Safety Standards affirms the notice of proposed removal, the medical
examiner must comply with this subpart and correct the deficiencies
identified in the notice of proposed removal as described in paragraph
(c)(2) of this section.
    (iii) If the medical examiner does not submit a written response
within 30 days of the date of issuance of a notice of proposed removal,
the removal becomes effective and the medical examiner is immediately
removed from the National Registry of Certified Medical Examiners.
    (2) Compliance and corrective action. (i) The medical examiner must
comply with this subpart and complete the corrective actions specified
in the notice of proposed removal no later than 60 days after either
the date of issuance of the notice of proposed removal or the date the
Director, Office of Carrier, Driver and Vehicle Safety Standards
affirms or modifies the notice of proposed removal, whichever is later.
The medical examiner must provide documentation of compliance and
completion of the corrective actions to the Director, Office of
Carrier, Driver and Vehicle Safety Standards. The Director, Office of
Carrier, Driver and Vehicle Safety Standards may conduct any
investigations and request any documentation necessary to verify that
the medical examiner has complied with this subpart and completed the
required corrective action(s). The Director, Office of Carrier, Driver
and Vehicle Safety Standards will notify the medical examiner in
writing whether he or she has met the requirements to continue to be
listed on the National Registry of Certified Medical Examiners.
    (ii) If the medical examiner fails to complete the proposed
corrective action(s) within the 60-day period, the removal becomes
effective and the medical examiner is immediately removed from the
National Registry of Certified Medical Examiners. The Director, Office
of Carrier, Driver and Vehicle Safety Standards will notify the person
in writing that he or she has been removed from the National Registry
of Certified Medical Examiners.
    (3) At any time before a notice of proposed removal from the
National Registry of Certified Medical Examiners becomes final, the
recipient of the notice of proposed removal and the Director, Office of
Carrier, Driver and Vehicle Safety Standards may resolve the matter by
mutual agreement.
    (d) Request for administrative review. If a person has been removed
from the National Registry of Certified Medical Examiners under
paragraph (c)(1)(iii), (c)(2)(ii), or (e) of this section, that person
may request an administrative review no later than 30 days after the
date the removal becomes effective. The request must be submitted in
writing to the FMCSA Associate Administrator for Policy and Program
Development. The request must explain the error(s) committed in
removing the medical examiner from the National Registry of Certified
Medical Examiners, and include a list of all factual, legal, and
procedural issues in dispute, and any supporting information or
documents.
    (1) Additional procedures for administrative review. The Associate
Administrator may ask the person to submit additional data or attend a
conference to discuss the removal. If the person does not provide the
information requested, or does not attend the scheduled conference, the
Associate Administrator may dismiss the request for administrative
review.
    (2) Decision on administrative review. The Associate Administrator
will complete the administrative review and notify the person in
writing of the decision. The decision constitutes final Agency action.
If the Associate Administrator decides the removal was not valid, FMCSA
will reinstate the person and reissue a certification credential to
expire on the expiration date of the certificate that was invalidated
under paragraph (g) of this section. The reinstated medical examiner
must:
    (i) Continue to meet the requirements of this subpart and the
applicable requirements of part 391 of this chapter.
    (ii) Report to FMCSA any changes in the application information
submitted under Sec.  390.103(a)(3) within 30 days of the
reinstatement.
    (iii) Be licensed, certified, or registered in accordance with
applicable

State laws and regulations to perform physical examinations.
    (iv) Maintain documentation of State licensure, registration, or
certification to perform physical examinations for each State in which
the examiner performs examinations maintain documentation of completion
of all training required by Sec.  390.105 and Sec.  390.111. The
medical examiner must also make this documentation available to an
authorized representative of FMCSA or an authorized representative of
Federal, State, or local government. The medical examiner must provide
this documentation within 48 hours of the request for investigations
and within 10 days of the request for regular audits of eligibility.
    (v) Complete periodic training as required by the Director, Office
of Carrier, Driver and Vehicle Safety Standards.
    (e) Emergency removal. In cases of either willfulness or in which
public health, interest, or safety requires, the provisions of
paragraph (b) of this section are not applicable and the Director,
Office of Carrier, Driver and Vehicle Safety Standards may immediately
remove a medical examiner from the National Registry of Certified
Medical Examiners and invalidate the certification credential issued
under Sec.  390.109. A person who has been removed under the provisions
of this paragraph may request an administrative review of that decision
as described under paragraph (d) of this section.
    (f) Reinstatement on the National Registry of Certified Medical
Examiners. No sooner than 30 days after the date of removal from the
National Registry of Certified Medical Examiners, a person who has been
voluntarily or involuntarily removed may apply to the Director, Office
of Carrier, Driver and Vehicle Safety Standards to be reinstated. The
person must:
    (1) Continue to meet the requirements of this subpart and the
applicable requirements of part 391 of this chapter.
    (2) Report to FMCSA any changes in the application information
submitted under Sec.  390.103(a)(3).
    (3) Be licensed, certified, or registered in accordance with
applicable State laws and regulations to perform physical examinations.
    (4) Maintain documentation of State licensure, registration, or
certification to perform physical examinations for each State in which
the person performs examinations and maintains documentation of
completion of all training required by Sec. Sec.  390.105 and 390.111.
The medical examiner must also make this documentation available to an
authorized representative of FMCSA or an authorized representative of
Federal, State, or local government. The person must provide this
documentation within 48 hours of the request for investigations and
within 10 days of the request for regular audits of eligibility.
    (5) Complete training and testing as required by the Director,
Office of Carrier, Driver and Vehicle Safety Standards.
    (6) In the case of a person who has been involuntarily removed,
provide documentation showing completion of any corrective actions
required in the notice of proposed removal.
    (g) Effect of final decision by FMCSA. If a person is removed from
the National Registry of Certified Medical Examiners under paragraph
(c) or (e) of this section, the certification credential issued under
Sec.  390.109 is no longer valid. However, the removed person's
information remains publicly available for 3 years, with an indication
that the person is no longer listed on the National Registry of
Certified Medical Examiners as of the date of removal.

PART 391--QUALIFICATIONS OF DRIVERS AND LONGER COMBINATION VEHICLE
(LCV) DRIVER INSTRUCTORS

0
8. Revise the authority citation for part 391 to read as follows:

    Authority: 49 U.S.C. 504, 508, 31133, 31136, and 31502; sec.
4007(b), Pub. L. 102-240, 105 Stat, 1914, 2152; sec. 114, Pub. L.
103-311, 108 Stat. 1673, 1677; sec. 215, Pub. L. 106-159, 113 Stat.
1748, 1767; and 49 CFR 1.73.

0
9. Amend Sec.  391.23 by:
0
a. Revising paragraph (m)(1);
0
b. Removing ``, and'' at the end of paragraph (m)(2)(i)(A) and adding
in its place a period;
0
c. Redesignating paragraph (m)(2)(i)(B) as (m)(2)(i)(C) and adding a
new paragraph (m)(2)(i)(B).
    The revision and addition read as follows:

Sec.  391.23  Investigation and inquiries.

* * * * *
    (m) * * *
    (1) The motor carrier must obtain an original or copy of the
medical examiner's certificate issued in accordance with Sec.  391.43,
and any medical variance on which the certification is based, and,
beginning on or after May 21, 2014, verify the driver was certified by
a medical examiner listed on the National Registry of Certified Medical
Examiners as of the date of issuance of the medical examiner's
certificate, and place the records in the driver qualification file,
before allowing the driver to operate a CMV.
    (2) * * *
    (i) * * *
    (B) Beginning on or after May 21, 2014, that the driver was
certified by a medical examiner listed on the National Registry of
Certified Medical Examiners as of the date of medical examiner's
certificate issuance.
* * * * *

0
10. Add Sec.  391.42 to read as follows:

Sec.  391.42  Schedule for use of medical examiners listed on the
National Registry of Certified Medical Examiners.

    On and after May 21, 2014, each medical examination required under
this subpart must be conducted by a medical examiner who is listed on
the National Registry of Certified Medical Examiners.

0
11. Amend Sec.  391.43 by revising paragraphs (a), (g), and (h), and
adding paragraph (i) to read as follows:

Sec.  391.43  Medical examination; certificate of physical examination.

    (a) Except as provided by paragraph (b) of this section and as
provided by Sec.  391.42, the medical examination must be performed by
a medical examiner listed on the National Registry of Certified Medical
Examiners under subpart D of part 390 of this chapter.
* * * * *
    (g) Upon completion of the medical examination required by this
subpart:
    (1) The medical examiner must date and sign the Medical Examination
Report and provide his or her full name, office address, and telephone
number on the Report.
    (2) If the medical examiner finds that the person examined is
physically qualified to operate a commercial motor vehicle in
accordance with Sec.  391.41(b), he or she must complete a certificate
in the form prescribed in paragraph (h) of this section and furnish the
original to the person who was examined. The examiner must provide a
copy to a prospective or current employing motor carrier who requests
it.
    (3) Once every calendar month, beginning May 21, 2014, the medical
examiner must electronically transmit to the Director, Office of
Carrier, Driver and Vehicle Safety Standards, via a secure FMCSA-
designated Web site, a completed Form MCSA-5850, Medical Examiner
Submission of CMV Driver Medical Examination Results. The Form must
include all information specified for each medical examination
conducted during the previous month for any driver who is required to
be

examined by a medical examiner listed on the National Registry of
Certified Medical Examiners.
    (h) The medical examiner's certificate shall be substantially in
accordance with the following form.
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[GRAPHIC] [TIFF OMITTED] TR20AP12.000

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    (i) Each original (paper or electronic) completed Medical
Examination Report and a copy or electronic version of each medical
examiner's certificate must be retained on file at the office of the
medical examiner for at least 3 years from the date of examination. The
medical examiner must make all records and information in these files
available to an authorized representative of FMCSA or an authorized
Federal, State, or local enforcement agency representative, within 48
hours after the request is made.

0
12. Amend Sec.  391.51 by:
0
a. Removing ``and'' at the end of paragraph (b)(7)(iii);
0
b. Removing the period at the end of paragraph (b)(8) and adding in its
place ``; and'';
0
c. Removing ``and'' at the end of paragraph (d)(4);
0
d. Removing the period at the end of paragraph (d)(5) and adding in its
place ``; and''; and
0
e. Adding paragraphs (b)(9) and (d)(6).
    The additions read as follows:

Sec.  391.51  General requirements for driver qualification files.

* * * * *
    (b) * * *
    (9) A note relating to verification of medical examiner listing on
the National Registry of Certified Medical Examiners required by Sec.
391.23(m).
* * * * *
    (d) * * *
    (6) The note relating to verification of medical examiner listing
on the National Registry of Certified Medical Examiners required by
Sec.  391.23(m).

    Issued on: April 10, 2012.
Anne S. Ferro,
Administrator.

Appendix A

Guidance for the Core Curriculum Specifications

    The guidance for the core curriculum specifications is intended
to assist training organizations in developing programs that would
be used to fulfill the proposed requirements in the Federal Motor
Carrier Safety Administration's (FMCSA) final rule for the National
Registry of Certified Medical Examiners (National Registry). The
final rule states that a medical examiner must complete a training
program. FMCSA explained in the preamble to the final rule that
training providers and organizations must follow the core curriculum
specifications in developing training programs for medical examiners
who apply for listing on the Agency's National Registry. This
training prepares medical examiners to:
     Apply knowledge of FMCSA's driver physical
qualifications standards and advisory criteria to findings gathered
during the driver's medical examination; and
     Make sound determinations of the driver's medical and
physical qualifications for safely operating a commercial motor
vehicle (CMV) in interstate commerce.
    The rule, 49 CFR 390.105(b), lists eight topics which must be
covered in the core curriculum specifications. The core curriculum
specifications are arranged below by numbered topic, followed by
guidance to assist training providers in developing programs based
on the core curriculum specifications.

Guidance for Each of the Core Curriculum Specifications

    (1) Background, rationale, mission and goals of the FMCSA
medical examiner's role in reducing crashes, injuries and fatalities
involving commercial motor vehicles.

Mission and Goals of Federal Motor Carrier Safety Administration
(FMCSA)

     Discuss the history of FMCSA and its position within
the Department of Transportation including its establishment by the
Motor Carrier Safety Improvement Act of 1999 and emphasize FMCSA's
Mission to reduce crashes, injuries and fatalities involving large
trucks and buses.

Role of the Medical Examiner

     Explain the role of the medical examiner as described
in 49 CFR 391.43.
    (2) Familiarization with the responsibilities and work
environment of commercial motor vehicle (CMV) operations.

The Job of CMV Driving

     Describe the responsibilities, work schedules, physical
and emotional demands and lifestyle among CMV drivers and how these
vary by the type of driving.
     Discuss factors and job tasks that may be involved in a
driver's performance, such as:
    [cir] Loading and unloading trailers;
    [cir] Inspecting the operating condition of the CMV; and
    [cir] Work schedules:
    [dec221] irregular work, rest, and eating patterns/dietary
choices.
    (3) Identification of the driver and obtaining, reviewing, and
documenting driver medical history, including prescription and over-
the-counter medications.

Driver Identification and Medical History:

    Discuss the importance of driver identification and review of
the following elements of the driver's medical history as related to
the tasks of driving a CMV in interstate commerce.
     Inspect a State-issued identification document with the
driver's photo to verify the identity of the individual being
examined; identify the commercial driver's license or other types of
driver's license.
     Identify, query and note issues in a driver's medical
record and/or health history as available, which may include:
    [cir] specific information regarding any affirmative responses
in the history;
    [cir] any illness, surgery, or injury in the last five years;
    [cir] any other hospitalizations or surgeries;
    [cir] any recent changes in health status;
    [cir] whether he/she has any medical conditions or current
complaints;
    [cir] any incidents of disability/physical limitations;
    [cir] current medications and supplements, and potential side
effects, which may be potentially disqualifying;
    [cir] his/her use of recreational/addictive substances (e.g.,
nicotine, alcohol, inhalants, narcotics or other habit-forming
drugs);
    [cir] disorders of the eyes (e.g., retinopathy, cataracts,
aphakia, glaucoma, macular degeneration, monocular vision);
    [cir] disorders of the ears (e.g., hearing loss, hearing aids,
vertigo, tinnitus, implants);
    [cir] cardiac symptoms and disease (e.g., syncope, dyspnea,
chest pain, palpitations, hypertension, congestive heart failure,
myocardial infarction, coronary insufficiency, or thrombosis);
    [cir] pulmonary symptoms and disease (e.g., dyspnea, orthopnea,
chronic cough, asthma, chronic lung disorders, tuberculosis,
previous pulmonary embolus, pneumothorax);
    [cir] sleep disorders (e.g., obstructive sleep apnea, daytime
sleepiness, loud snoring, other);
    [cir] gastrointestinal disorders (e.g., liver disease, digestive
problems, hernias);
    [cir] genitourinary disorders (e.g., kidney stones and other
renal conditions, renal failure, hernias);
    [cir] diabetes mellitus:
    [dec221] current medications (type, potential side effects,
duration on current medication);
    [dec221] complications from diabetes; and
    [dec221] presence and frequency of hypoglycemic/hyperglycemic
episodes/reactions;
    [cir] other endocrine disorders (e.g., thyroid disorders,
interventions/treatment);
    [cir] musculoskeletal disorders (e.g., amputations, arthritis,
spinal surgery);
    [cir] neurologic disorders (e.g., loss of consciousness,
seizures, stroke/transient ischemic attack, headaches/migraines,
numbness/weakness); or
    [cir] psychiatric disorders (e.g., schizophrenia, severe
depression, anxiety, bipolar disorder, or other conditions) that
could impair a driver's ability to safely function.
    (4) Performing, reviewing and documenting the driver's medical
examination.

Physical Examination (Qualification/Disqualification Standards (Sec.
391.41 and 391.43))

     Explain the FMCSA physical examination requirements and
advisory criteria in relationship to conducting the driver's
physical examination of the following:
    [cir] Eyes (Sec.  391.41(b)(10))
    [dec221] equal reaction of both pupils to light;
    [dec221] evidence of nystagmus and exophthalmos;
    [dec221] evaluation of extra-ocular movements.
    [cir] Ears (Sec.  391.41(b)(11))
    [dec221] abnormalities of the ear canal and tympanic membrane;
    [dec221] presence of a hearing aid.
    [cir] Mouth and throat (Sec.  391.41(b)(5))
    [dec221] conditions contributing to difficulty swallowing,
speaking or breathing;
    [cir] Neck (Sec.  391.41(b)(7))
    [dec221] range of motion;

    [dec221] soft tissue palpation/examination (e.g., lymph nodes,
thyroid gland).
    [cir] Heart (Sec.  391.41(b)(4) and (b)(6))
    [dec221] chest inspection (e.g., surgical scars, pacemaker/
implantable automatic defibrillator);
    [dec221] auscultation for thrills, murmurs, extra sounds, and
enlargement;
    [dec221] blood pressure and pulse (rate and rhythm);
    [dec221] additional signs of disease (e.g., edema, bruits,
diaphoresis, distended neck veins.
    [cir] Lungs, chest, and thorax (Sec.  391.41(b)(5))
    [dec221] respiratory rate and pattern;
    [dec221] auscultation for abnormal breath sounds;
    [dec221] abnormal chest wall configuration/palpation.
    [cir] Abdomen (Sec.  391.41(a)(3)(i) and 391.43(f))
    [dec221] surgical scars;
    [dec221] palpation for enlarged liver or spleen, abnormal masses
or bruits/pulsation, abdominal tenderness, hernias (e.g., inguinal,
umbilical, ventral, femoral or other abnormalities).
    [cir] Spine (Sec.  391.41(b)(7))
    [dec221] surgical scars and deformities;
    [dec221] tenderness and muscle spasm;
    [dec221] loss in range of motion and painful motion;
    [dec221] spinal deformities.
    [cir] Extremities and trunk (Sec.  391.41(b)(1), (b)(4) and
(b)(7))
    [dec221] gait, mobility, and posture while bearing his/her
weight; limping or signs of pain;
    [dec221] loss, impairment, or use of orthosis;
    [dec221] deformities, atrophy, weakness, paralysis, or surgical
scars;
    [dec221] elbow and shoulder strength, function, and mobility;
    [dec221] handgrip and prehension relative to requirements for
controlling a steering wheel and gear shift;
    [dec221] varicosities, skin abnormalities, and cyanosis,
clubbing, or edema;
    [dec221] leg length discrepancy; lower extremity strength,
motion, and function
    [dec221] other abnormalities of the trunk.
    [cir] Neurologic status (Sec.  391.41(b)(7), (b)(8) and(b)(9))
    [dec221] impaired equilibrium, coordination or speech pattern
(e.g., ataxia);
    [dec221] sensory or positional abnormalities;
    [dec221] tremor;
    [dec221] radicular signs;
    [dec221] reflexes (e.g., asymmetric deep-tendon, normal/abnormal
patellar and Babinski).
    [cir] Mental status (Sec.  391.41(b)(9))
    [dec221] comprehension and interaction;
    [dec221] cognitive impairment;
    [dec221] signs of depression, paranoia, antagonism, or
aggressiveness that may require follow-up with a mental health
professional.
    (5) Performing, obtaining and documenting diagnostic tests and
obtaining additional testing or medical opinion from a medical
specialist or treating physician.

Diagnostic Testing and Further Evaluation

     Describe the FMCSA diagnostic testing requirements and
the medical examiner's ability to request further testing and
evaluation by a specialist.
    [cir] Urine test for specific gravity, protein, blood and
glucose (Sec.  391.41(a)(3)(i));
    [cir] Whisper or audiometric testing (Sec.  391.41(b)(11));
    [cir] Vision testing for color vision, distant acuity,
horizontal field of vision and presence of monocular vision (Sec.
391.41(b)(10));
    [cir] Other testing as indicated to determine the driver's
medical and physical qualifications for safely operating a CMV.
    [cir] Refer to a specialist a driver who exhibits evidence of
any of the following disorders (Sec.  391.43(e) and (f)):
    [dec221] vision (e.g., retinopathy, macular degeneration);
    [dec221] cardiac (e.g., myocardial infarction, coronary
insufficiency, blood pressure control);
    [dec221] pulmonary (e.g., emphysema, fibrosis);
    [dec221] endocrine (e.g., diabetes);
    [dec221] musculoskeletal (e.g., arthritis, neuromuscular
disease);
    [dec221] neurologic (e.g., seizures);
    [dec221] sleep (e.g., obstructive sleep apnea);
    [dec221] mental/emotional health (e.g., depression,
schizophrenia); or
    [dec221] other medical condition(s) that may interfere with
ability to safely operate a CMV.
    (6) Informing and educating the driver about medications and
non-disqualifying medical conditions that require remedial care.

Health Counseling

     Inform course participants of the importance of
counseling the driver about:
    [cir] possible consequences of non-compliance with a care plan
for conditions that have been advised for periodic monitoring with
primary healthcare provider;
    [cir] possible side effects and interactions of medications
(e.g., narcotics, anticoagulants, psychotropics) including products
acquired over-the-counter (e.g., antihistamines, cold and cough
medications or dietary supplements) that could negatively affect
his/her driving;
    [cir] the effect of fatigue, lack of sleep, poor diet, emotional
conditions, stress, and other illnesses that can affect safe
driving;
    [cir] if he/she is a contact lens user, the importance of
carrying a pair of glasses while driving;
    [cir] if he/she uses a hearing aid, the importance of carrying a
spare power source for the device while driving;
    [cir] if he/she has a history of deep vein thrombosis, the risk
associated with inactivity while driving and interventions that
could prevent another thrombotic event;
    [cir] if he/she has a diabetes exemption, that he/she should:
    [dec221] carry a rapidly absorbable form of glucose while
driving;
    [dec221] self-monitor blood glucose one hour before driving and
at least once every four hours while driving;
    [dec221] comply with each condition of his/her exemption;
    [dec221] plan to submit glucose monitoring logs for each annual
recertification;
    [cir] corrective or therapeutic steps needed for conditions
which may progress and adversely impact safe driving ability (e.g.,
seek follow-up from primary care physician);
    [cir] steps needed for reconsideration of medical certification
if driver is certified with a limited interval, e.g., the return
date and documentation required for extending the certification time
period.
    (7) Determining driver certification outcome and period for
which certification should be valid.

Assessing the Driver's Qualifications and Disposition

     Explain how to assess the driver's medical and physical
qualification to operate a CMV safely in interstate commerce using
the medical examination findings weighed against the physical and
mental demands associated with operating a CMV by:
    [cir] Considering a driver's ability to
    [dec221] move his/her body through space while climbing ladders;
bend, stoop, and crouch; enter and exit the cab;
    [dec221] manipulate steering wheel;
    [dec221] perform precision prehension and power grasping;
    [dec221] use arms, feet, and legs during CMV operation;
    [dec221] inspect the operating condition of a tractor and/or
trailer;
    [dec221] monitor and adjust to a complex driving situation; and
    [dec221] consider the adverse health effects of fatigue
associated with extended work hours without breaks;
    [cir] Considering identified disease or condition(s) progression
rate, stability, and likelihood of gradual or sudden incapacitation
for documented conditions (e.g., cardiovascular, neurologic,
respiratory, musculoskeletal and other).

Medical Certificate Qualification/Disqualification Decision and
Examination Intervals

     Discuss the medical examiner's obligation to consider
potential risk to public safety and the driver's medical and
physical qualifications to drive safely when issuing a Medical
Examiner's Certificate, when to qualify/disqualify the driver and
how to determine the expiration date of the certificate by:
    [cir] using the requirements stated in the FMCSRs, with
nondiscretionary certification standards to disqualify a driver
    [dec221] with a history of epilepsy;
    [dec221] with diabetes requiring insulin control (unless
accompanied by an exemption);
    [dec221] when vision parameters (e.g., acuity, horizontal field
of vision, color) fall below minimum standards unless accompanied by
an exemption;
    [dec221] when hearing measurements with or without a hearing aid
fall below minimum standards;
    [dec221] currently taking methadone;
    [dec221] with a current clinical diagnosis of alcoholism; or
    [dec221] who uses a controlled substance including a narcotic,
an amphetamine, or another habit-forming drug without a prescription
from the treating physician;
    [cir] using clinical expertise, disqualify a driver when
evidence shows a driver has a medical condition that in your opinion
will likely interfere with the safe operation of a CMV;
    [cir] certifying a driver for an appropriate duration of
certification interval;

    [cir] if he/she has a condition for which the medical examiner
is deferring the driver's medical certification or disqualifying the
driver, informing the driver of the reasons which may include:
    [dec221] a vision deficiency (e.g., retinopathy, macular
degeneration);
    [dec221] the immediate post-operative period;
    [dec221] a cardiac event (e.g., myocardial infarction, coronary
insufficiency);
    [dec221] a chronic pulmonary exacerbation (e.g., emphysema,
fibrosis);
    [dec221] uncontrolled hypertension;
    [dec221] endocrine dysfunctions (e.g., insulin-dependent
diabetes);
    [dec221] musculoskeletal challenges (e.g., arthritis,
neuromuscular disease);
    [dec221] a neurologic event (e.g., seizures, stroke, TIA);
    [dec221] a sleep disorder (e.g., obstructive sleep apnea); or
    [dec221] mental health dysfunctions (e.g., depression, bipolar
disorder).
    (8) FMCSA reporting and documentation requirements.

Documentation of Medical Examination Findings

    Demonstrate the required FMCSA medical examination report forms,
appropriate methods for recording the medical examination findings
and the rationale for certification decisions including:
     Medical Examination Report Form
    [cir] identification of the driver;
    [cir] use of appropriate Medical Examination Report form;
    [cir] assurance that driver completes and signs driver's portion
of the Medical Examination Report form;
    [cir] specifics regarding any affirmative response on the
driver's medical history;
    [cir] height/weight, blood pressure, pulse;
    [cir] results of the medical examination, including details of
abnormal findings;
    [cir] audiometric and vision testing results;
    [cir] presence of a hearing aid and whether it is required to
meet the standard;
    [cir] if obtained, funduscopic examination results;
    [cir] the need for corrective lenses for driving;
    [cir] presence or absence of monocular vision and need for a
vision exemption;
    [cir] if driver has diabetes mellitus and is insulin dependent,
the need for a diabetes exemption;
    [cir] other laboratory, pulmonary, cardiac testing performed;
and
    [cir] the reason(s) for the disqualification and/or referral.
     Other supporting documentation
    [cir] if driver has current vision exemption, include the
ophthalmologist's or optometrist's report;
    [cir] if a driver has a diabetes exemption, include the
endocrinologist's and ophthalmologist's/optometrist's report;
    [cir] treating physician's work release;
    [cir] if obtained, specialist's evaluation report;
    [cir] if the driver has a current Skill Performance Evaluation
Certificate, include it; and
    [cir] results of Substance Abuse Professional evaluations for
alcohol and drug use and/or abuse for a driver with
    [dec221] alcoholism who completed counseling and treatment to
the point of full recovery.
     Medical Examiner's Certificate
    [cir] certification status, which may require:
    [dec221] waiver/exemption;
    [dec221] wearing corrective lenses;
    [dec221] wearing a hearing aid; or
    [dec221] a Skill Performance Evaluation Certificate;
    [cir] complete and accurate documentation on medical
certification card including:
    [dec221] the examiner's name, examination date, office address,
and telephone number and Medical Examiner signature; and
    [dec221] the driver's signature.

[FR Doc. 2012-9034 Filed 4-19-12; 8:45 am]
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