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In the intricate landscape of commercial driving regulations, the Kentucky CDL Self Certification form emerges as a crucial document for drivers in the state. As mandated by the Federal Motor Carriers Safety Regulations, all holders of Commercial Driver's Licenses (CDL) must declare the type of driving they perform or intend to perform, a process simplified through the use of this form. Unlike the federal requirement, which necessitates medical certification only for those engaged in non-excepted, interstate operations, Kentucky’s legislation extends this requirement to all CDL holders, emphasizing the importance of safety and compliance across all driving categories. With four specific categories for drivers to select from, the form enables clear communication regarding the nature of a driver’s work, whether it involves crossing state lines or operating exclusively within the boundaries of Kentucky. This detailed self-certification assists in ensuring that only medically certified and appropriately qualified drivers are behind the wheel, thereby sustaining the safety of roads and transport operations. Additionally, the form lays out specific exceptions for a variety of drivers and stipulates the conditions under which they operate, highlighting Kentucky's comprehensive approach to managing commercial driving operations within its jurisdiction.

Kentucky Cdl Self Certification Sample

Kentucky Transportation Cabinet

TC 94169

Division of Driver Licensing

05/2017

COMMERCIAL DRIVER LICENSE SELF‐CERTIFICATION

Page 1 of 2

 

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

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

NAME (last)

(first)

(MI)

 

 

 

SSN

DLN

DOB

 

 

 

PHONE

EMAIL

 

 

 

 

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

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

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

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

CDL/permit.)

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

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

______________________________

Print Name

______________________________

Signature

______________________________

Date

Kentucky Transportation Cabinet

TC 94169

Division of Driver Licensing

05/2017

COMMERCIAL DRIVER LICENSE SELF‐CERTIFICATION

Page 2 of 2

 

INTERSTATE COMMERCE:

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

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

As Federal, State or local government employees;

To transport human corpses or sick or injured persons;

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

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

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

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

Beekeeper in the seasonal transportation of bees;

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

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

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

To transport migrant workers.

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

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

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

operate in both types of interstate commerce.

INTRASTATE COMMERCE:

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

Form Features

Fact Number Description
1 The Kentucky Commercial Driver License Self-Certification Form is governed by the Kentucky Transportation Cabinet TC 94-169 Division of Driver licensing as of May 2017.
2 All CDL holders in Kentucky must self-certify the type of driving they perform or expect to perform, in compliance with Federal Motor Carriers Safety Regulations.
3 Unlike the FMCSA's requirement, which only requires medical certification for drivers operating in non-excepted, interstate operations, Kentucky mandates medical certification for all CDL holders regardless of their chosen category, as per 601 KAR 1:005.
4 There are four categories from which CDL holders in Kentucky can choose for self-certification: Non-excepted interstate, Excepted interstate, Non-excepted intrastate, and Excepted intrastate.
5 The form includes a notice that no CDL holder or applicant in Kentucky should select the "Excepted intrastate" category since all are required to be medically certified.
6 Choosing "Non-excepted intrastate" for your driving type requires a "K" restriction to be printed on the CDL or permit, indicating the driver operates only within Kentucky (intrastate).
7 Interstate Commerce definitions are included to help drivers determine if they operate in excepted or non-excepted interstate commerce based on the specific nature of their driving jobs.

Detailed Steps for Using Kentucky Cdl Self Certification

Completing the Kentucky CDL Self-Certification form is a crucial step for commercial drivers in Kentucky. This process involves providing personal details and certifying the type of commercial driving one performs or expects to perform. It is important for all CDL holders or applicants in Kentucky to understand that no matter the driving category they select, they need to be medically certified as per state regulations. The following guide will walk you through the steps of filling out this form accurately.

  1. Start by writing your full name in the space provided, following the format: last name, first name, and middle initial (MI).
  2. Enter your Social Security Number (SSN) in the designated space.
  3. Provide your Driver's License Number (DLN).
  4. Write down your Date of Birth (DOB) in the format provided on the form.
  5. Include a contact phone number where you can be reached.
  6. Add your email address in the space provided to receive any communications regarding your CDL self-certification.
  7. From the four categories listed, select only one that accurately represents the type of driving you perform or expect to perform. Choices are between non-excepted interstate, excepted interstate, non-excepted intrastate, and excepted intrastate commerce. Note that Kentucky CDL holders/applicants should not mark the "excepted intrastate" category as all are required to be medically certified regardless of the category selected.
  8. After reading the descriptions carefully and selecting the appropriate category, it's time to print your name again in the designated area as a confirmation of your selection.
  9. Sign your name in the signature space provided to certify that the information provided is accurate and true to the best of your knowledge.
  10. Lastly, record the date of signing the form to complete your self-certification process.

Once you have completed these steps, review the form to ensure all information is accurately entered and legible. This document serves as a critical part of maintaining your CDL in Kentucky, so it is important to fill it out with care and attention to detail. Submit the form as directed by the Kentucky Transportation Cabinet or the Division of Driver Licensing to finalize your self-certification process. Remember, maintaining accurate and up-to-date information with the Division of Driver Licensing is essential for every commercial driver. It ensures compliance with both state and federal regulations, safeguarding your ability to work within the commercial driving industry.

Obtain Clarifications on Kentucky Cdl Self Certification

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

    The Kentucky CDL Self-Certification Form serves as a mandatory declaration by commercial driver's license (CDL) holders, indicating the type of commercial motor vehicle (CMV) operations they are engaged in or plan to engage in. This includes specifying whether their driving falls under interstate or intrastate commerce, and whether they are involved in excepted or non-excepted activities as defined by Federal Motor Carrier Safety Regulations (FMCSR) and Kentucky law. This self-certification is required for ensuring compliance with medical certification regulations pertinent to the driver’s specific category of operation.

  2. What are the different categories on the form, and what do they mean?

    There are four categories from which CDL holders can select, each reflecting a type of driving operation:

    • Non-Excepted Interstate: Designates drivers operating or expecting to operate across state lines (interstate commerce) who must meet federal medical certification standards.
    • Excepted Interstate: For drivers in interstate commerce who are involved exclusively in types of transportation or operations exempt from some or all federal medical certification requirements under specific CFR provisions.
    • Non-Excepted Intrastate: Applies to drivers operating only within Kentucky (intrastate commerce) and are subject to state medical certification requirements. This selection will add a "K" restriction to the CDL or permit.
    • Excepted Intrastate: Reserved for those operating intrastate but engaged in activities exempt from some state driver qualification requirements. However, it is noted that for Kentucky CDL holders/applicants, this category is not applicable and should not be selected.
  3. Who must fill out the Kentucky CDL Self-Certification Form?

    All individuals holding or applying for a CDL in Kentucky are required to complete the Self-Certification Form. This requirement is in place to ensure that all CDL operators are properly categorized according to their operating status and are compliant with the relevant medical certification requirements.

  4. Is medical certification necessary for all CDL holders in Kentucky?

    Yes, according to Kentucky Regulation 601 KAR 1:005, all CDL holders, regardless of the category they have selected, must undergo medical certification. This underscores the state’s commitment to ensuring that all commercial drivers meet the necessary health standards to operate safely on the road.

  5. How do you choose the correct category for your driving operation?

    To accurately choose your category, carefully review the types of driving operations described for each category on the self-certification form and assess which one aligns with your current or expected commercial driving activities. Important determinants include whether your driving is within Kentucky only (intrastate) or crosses state lines (interstate), and if your operations are subject to any exemptions under federal or state regulations. If you engage in both excepted and non-excepted interstate commerce, you must choose the non-excepted interstate commerce category to be qualified for both types of driving.

  6. What happens if you select the wrong category on the form?

    Selecting the wrong category can lead to non-compliance with federal and state regulations, potentially resulting in legal and licensing consequences. It’s important to assess your driving type accurately and consult with legal or regulatory advisors if you're uncertain which category fits your operations. Corrections should be made promptly by submitting a new self-certification form with the accurate information.

  7. Where and how do you submit the Kentucky CDL Self-Certification Form?

    The completed form must be submitted to the Kentucky Transportation Cabinet, Division of Driver Licensing. Submission can typically be done via mail, in person at a local office, or possibly through other means offered by the state, such as online services. For the most current submission methods and addresses, it is recommended to check with the Kentucky Transportation Cabinet or its website.

Common mistakes

When filling out the Kentucky Commercial Driver License Self-Certification form, individuals frequently make several common mistakes that can lead to delays or issues with their certification. Understanding these mistakes can help ensure a smoother process.

One common error is misunderstanding the categories of certification. The form divides driving types into four categories: non-excepted interstate, excepted interstate, non-excepted intrastate, and excepted intrastate. Applicants often select the wrong category because they don’t fully understand the definitions or differences between interstate and intrastate, or excepted and non-excepted operations. Especially noteworthy is that Kentucky does not allow CDL holders/applicants to select the excepted intrastate category, as it mandates medical certification for all CDL holders regardless of category.

Another mistake involves incomplete or inaccurate personal information. The form requires detailed information such as name, social security number (SSN), driver license number (DLN), date of birth (DOB), phone number, and email address. Failing to provide complete and accurate information in these fields can cause unnecessary delays.

Mistakes in the acknowledgment section, particularly forgetting to sign and date the form, are also common. This oversight can invalidate the entire submission, as a signature and date confirm the accuracy of the information provided and the applicant's agreement to the certification type selected.

  1. Not carefully selecting the correct driving category: This is crucial for compliance with both federal and state regulations.
  2. Submitting incomplete or inaccurate personal information: This can delay processing and affect certification status.
  3. Omitting the signature and date: Both are necessary for the form to be considered valid.
  4. Failing to understand the “K” restriction: This applies to non-excepted intrastate commerce and must be acknowledged.
  5. Incorrectly identifying as an excepted intrastate driver: Kentucky requires all CDL holders to be medically certified, making this category inapplicable.
  6. Unfamiliarity with exempt activities for interstate commerce: This can lead to incorrect category selection.
  7. Overlooking the need for medical certification: All Kentucky CDL holders/applicants must be medically certified, regardless of the category chosen.
  8. Assuming prior certification rollovers: All CDL holders must recertify with the Kentucky Transportation Cabinet, as prior certifications from other states or entities may not transfer.

In summary, applicants must provide accurate personal information and understand the specifics of the certification categories, including the "K" restriction for non-excepted intrastate commerce and the requirement for medical certification for all drivers. Additionally, never assume that certifications from other states will automatically transfer to Kentucky. Being aware of these common mistakes can help applicants complete the Kentucky CDL Self-Certification form correctly.

Documents used along the form

Completing the Kentucky CDL Self Certification is a significant step for commercial drivers within the state, requiring thorough attention and accuracy. This process is crucial for aligning with federal and state regulations, ensuring that drivers meet the necessary requirements for the type of driving they perform. In addition to the self-certification form, several other documents and forms are often used together with it to ensure full compliance and readiness for commercial driving in Kentucky. Knowing these documents can help streamline the application process and maintain regulatory compliance.

  • Medical Examiner's Certificate (DOT Physical Card): This document certifies that a commercial driver has met the minimum physical requirements to operate a commercial motor vehicle. It is a result of a DOT physical examination conducted by a certified medical examiner.
  • Commercial Driver's License (CDL) Application: The primary application form for individuals seeking to obtain a CDL, detailing personal information, type of license sought, and endorsements required.
  • Proof of Identity and Residency Documents: Drivers must provide documents verifying their identity, such as a birth certificate or passport, and residency within Kentucky, like a utility bill or rental agreement.
  • CDL Skills Test Score Sheet: After completing the required skills test for obtaining a CDL, this sheet records the applicant's performance. It is necessary for finalizing the issuance of the CDL.
  • Record of Duty Status (RODS): For those operating under certain categories, maintaining a log of duty status might be required to demonstrate compliance with hours of service regulations.
  • CDL Holder’s Medical Waiver: If applicable, a driver might need a waiver for certain medical conditions that would typically disqualify them from holding a CDL. This document grants permission to operate a commercial vehicle despite those conditions.
  • Vehicle Registration and Proof of Insurance: Essential documents proving the commercial vehicle is registered and insured according to Kentucky law. These must be kept current and available for inspection.
  • Hazardous Materials Endorsement (HME) Application: For drivers transporting hazardous materials, an additional endorsement on their CDL is required, necessitating its own application process including a background check.
  • Entry-Level Driver Training (ELDT) Certification: New drivers and those upgrading their CDL, or adding endorsements for school buses, passengers, or hazardous materials, must complete ELDT and provide certification of completion.

Each document plays a vital role in the comprehensive process of becoming a fully compliant commercial driver in Kentucky. Together, they ensure that the driver is properly licensed, medically fit, and possesses the necessary knowledge and skills to safely operate commercial vehicles. It's important for applicants to closely follow the requirements set forth by the Kentucky Transportation Cabinet and the Federal Motor Carrier Safety Administration to navigate the process effectively and efficiently.

Similar forms

The Medical Examination Report Form for Commercial Driver's License (CDL) holders is quite similar to the Kentucky CDL Self-Certification form. Both documents are essential in ensuring that drivers are medically fit and meet the required health standards for operating commercial vehicles. The Medical Examination Report Form requires a healthcare professional to confirm a driver’s health status, while the Self-Certification form requires the driver to declare their type of commerce activity and affirm their medical certification status.

The Driver’s Application for Employment is another document similar to the Kentucky CDL Self-Certification form. This application typically requires the driver to provide personal information, employment history, and, importantly, any driving qualifications including their CDL status. Similar to self-certification, this form may require the driver to disclose their medical certification status if their job would involve commercial driving, thus ensuring compliance with safety regulations.

The Commercial Motor Vehicle (CMV) Driver’s Medical Examination Waiver is also related to the Kentucky CDL Self-Certification form. This waiver allows drivers with certain medical conditions to operate a CMV, provided they've been granted an exemption. Just like the Self-Certification form, it deals with the driver's medical capability to drive safely. However, whereas self-certification requires all drivers to affirm their medical status, the waiver is specifically for those seeking exemption from standard medical qualifications.

The Hazardous Materials Endorsement Application bears similarity to the Kentucky CDL Self-Certification form by requiring drivers to meet specific standards and certifications. While the Self-Certification form addresses the driver’s medical capability and type of driving, the Hazardous Materials Endorsement Application ensures the driver meets safety and security standards for transporting hazardous materials. Both forms are critical for maintaining public safety and drivers’ compliance with federal regulations.

The Motor Carrier Identification Report (Form MCS-150) shares a common goal with the Kentucky CDL Self-Certification form in terms of compliance and safety regulation. While the MCS-150 is more focused on the carrier or company, collecting information to obtain a USDOT number, it similarly requires accurate reporting of operational status, just as drivers self-certify their medical status and type of operation (e.g., interstate commerce).

The Vehicle Inspection Report, required in many states, parallels the Kentucky CDL Self-Certification form by ensuring vehicles are safe for operation. Similarly, the self-certification form ensures the driver is medically fit for operating the vehicle. Both forms are preventative measures, aiming to reduce accidents and improve road safety through regular checks - one on the vehicle’s condition and the other on the driver’s health.

Last but not least, the Consent to Release Information Form, often used by employers to verify a potential or current employee's driving and medical certification records, complements the Self-Certification form's purpose. By allowing employers to check these qualifications, it ensures the continued compliance of commercial drivers with the health and safety standards that self-certification initially declares, thereby promoting a safe driving environment.

Dos and Don'ts

When filling out the Kentucky CDL Self Certification form, the precision of information and adherence to instructions directly impact your driving privileges and compliance with both state and federal regulations. Paying attention to certain dos and don’ts can guide you through the process smoothly:

  • Do carefully read the descriptions for each certification category to make certain that the one you select accurately reflects the type of driving you perform or expect to perform.
  • Do understand the distinction between interstate and intrastate commerce as it significantly influences which category you should select.
  • Do note that all CDL holders in Kentucky must be medically certified regardless of the certification category chosen, demonstrating the state's commitment to road safety.
  • Do provide your personal information accurately, including your name, Social Security number (SSN), driver's license number (DLN), date of birth (DOB), phone number, and email address, to ensure your certification is properly recorded.
  • Don't overlook the instruction that holders and applicants for a Kentucky CDL are not eligible for the "Excepted Intrastate" category, as this could lead to incorrectly completing the form.
  • Don't select more than one category; it's crucial to choose the one that best corresponds to your situation. Selecting multiple categories can cause confusion and potentially delay your certification.
  • Don't forget to sign and date the form. An unsigned form is considered incomplete and will not be processed, delaying your certification or recertification.
  • Don't hesitate to contact the Kentucky Transportation Cabinet or consult with a professional if you are uncertain about which category to choose or have questions about the certification process.

Following these guidelines will help ensure that your Kentucky CDL Self Certification is filled out correctly and efficiently, thereby facilitating compliance with the legal requirements for commercial drivers in the state. Keeping up to date with regulatory requirements and maintaining valid certification are key responsibilities of all commercial drivers.

Misconceptions

When it comes to understanding the Kentucky Commercial Driver License (CDL) Self-Certification form, there are several common misconceptions that can lead to confusion and errors in completing the form. Clarifying these misunderstandings can help ensure that CDL holders in Kentucky remain compliant with state and federal regulations. Here are five such misconceptions:

  • Misconception 1: Medical certification is not required for all CDL holders in Kentucky. Contrary to this belief, Kentucky requires all CDL holders to be medically certified, regardless of the category they select on the self-certification form. This includes even those engaged in excepted intrastate or interstate commerce who might not require medical certification under federal regulations.
  • Misconception 2: You can select multiple categories on the self-certification form. The form asks you to choose only one category that best describes the type of driving you perform or expect to perform. Choosing more than one category can lead to unnecessary complications and delays in processing the form.
  • Misconception 3: You only need to fill out this form once. This is incorrect. Changes in your work situation, such as switching from intrastate to interstate commerce or changing your type of cargo, necessitate updating your self-certification status. Regular updates ensure that your medical certification is in alignment with the type of commerce you are currently engaged in.
  • Misconception 4: The “excepted intrastate” category is a valid option for Kentucky CDL holders/applicants. Even though the option is listed on the form, the instructions clearly state that no CDL holder or applicant in Kentucky should mark this category, as all are required to be medically certified.
  • Misconception 5: If you work in excepted activities, you do not need to meet Kentucky’s medical certification requirements. This misunderstanding could lead to noncompliance with state regulations. Regardless of working in an excepted activity (such as transporting school children or working in emergency response), Kentucky law mandates that all CDL holders meet medical certification requirements without exception.

Understanding and adhering to the guidelines provided in the Kentucky CDL Self-Certification and its requirements is crucial for all commercial drivers in the state. Clearing up these misconceptions is vital for ensuring compliance and avoiding penalties that can arise from mistakenly completed documentation.

Key takeaways

Anyone holding or applying for a Commercial Driver's License (CDL) in Kentucky must understand the importance of accurately completing the Kentucky CDL Self-Certification form. This form is crucial because it complies with Federal Motor Carriers Safety Regulations and Kentucky's specific requirements. Here are seven key takeaways regarding filling out and using this form:

  • Self-certification Requirement: All CDL holders must self-certify to indicate the type of commercial driving they perform or plan to perform. This is a federal requirement aimed at ensuring drivers meet necessary medical standards.
  • Four Categories: Drivers must select from one of four categories that best describes their operating status—these range from non-excepted interstate to excepted intrastate, each with its particular implications and requirements.
  • Medical Certification: Unlike some states where only certain categories require medical certification, Kentucky mandates that all CDL holders, regardless of their operation category, must be medically certified. This highlights the importance of maintaining valid medical certification for all drivers.
  • “K” Restriction: For those operating in non-excepted intrastate or excepted intrastate commerce, a “K” restriction will be printed on the CDL or permit. This denotes specific limitations pertaining to the driver's operational permissions within the state of Kentucky.
  • Exemptions Not Allowed: It's significant to note that no CDL holder or applicant in Kentucky should select the excepted intrastate category, as all are required to be medically certified. This ensures consistency and safety across all types of commercial driving within the state.
  • Understanding Commerce Types: The form defines interstate vs. intrastate commerce, including exceptions for certain activities. Drivers must thoroughly understand these distinctions to select the correct category that aligns with their driving activities.
  • Accuracy is Crucial: The proper completion of this form is not merely a formality but a legal requirement. Providing accurate information ensures compliance with both state and federal regulations and prevents potential legal issues or disruptions in the ability to operate a CMV.

This key information highlights the critical aspects of the Kentucky CDL Self-Certification process. It underscores the necessity for drivers to accurately assess and declare their operational status and ensure their medical certification is up to date. This not only keeps the roads safer for everyone but also protects the livelihood of the commercial driver.

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