About this document

This document is the Federal hearing exemption renewal application used by individuals renewing their Federal hearing exemption. All requested information must be submitted to the Federal Motor Carrier Safety Administration (FMCSA) for consideration.

U.S. Department of Transportation
Federal Motor Carrier Safety Administration

THE FEDERAL HEARING EXEMPTION RENEWAL PROCESS

Dear Sir/Madam:

If you have been issued a Federal exemption from the hearing standard under 49 CFR 391.41(b)(11) and you would like to renew it, you must submit the following information no later than 3 MONTHS PRIOR TO THE EXPIRATION DATE listed on the current exemption. If the information is submitted past this date, there is a chance that you will have a lapse in your ability to operate a commercial motor vehicle in interstate commerce. FMCSA must have adequate time to process your renewal request.

Please submit the following information:

1. A written request to renew your hearing exemption.
2. A legible copy of your driver's license, front and back.
3. A legible copy of your driving record for the last 3 years from your state licensing authority. If you were involved in any crash or were convicted for any moving violation, provide additional official documentation (e.g., a copy of the crash report or the citation, or copies of court records).
4. Completed and signed Authorization for Release of Medical Information Form.
   1. This form is available on FMCSA’s website at https://www.fmcsa.dot.gov/medical/driver-medical-requirements/medical-release-info-12-2006
   2. A sample of a completed form is available on FMCSA’s website at https://www.fmcsa.dot.gov/medical/driver-medical-requirements/medical-release-info-hearing-sample
5. A legible copy of your Medical Examiner’s Certificate, MCSA-5876 indicating that a hearing exemption is required.
6. A legible copy of your current exemption.

Your information may be e-mailed, mailed or faxed (PLEASE DO NOT DO MORE THAN ONE).

E-mail to:
FMCSAhearingexemptions@dot.gov
1200 New Jersey Ave, SE
Washington, DC 20590

Mail to:
Department of Transportation
Federal Motor Carrier Safety Administration
Medical Programs Division, W64-224
Hearing Exemption Program
1200 New Jersey Ave., SE
Washington, DC 20590

Fax to:
(877) 764-6920 and title the document, “ATTENTION HEARING EXEMPTIONS C/O Christine A. Hydock”
If you do not wish to renew your Federal hearing exemption, please notify FMCSA in writing.

If you have any questions, please call (202) 366-4001 or e-mail FMCSAhearingexemptions@dot.gov.

Sincerely,
signed
Christine A. Hydock
Chief, FMCSA Medical Programs Division