You are here

Medical Release Form (Hearing) SAMPLE

About this document

This is a completed sample form which provides authorization to the Federal Motor Carrier Safety Administration to publish hearing exemption information in a public docket.

DOT is committed to ensuring that information is available in appropriate alternative formats to meet the requirements of persons who have a disability. If you require an alternative version of files provided on this page, please contact Christine.hydock@dot.gov
Submit Feedback >