Federal Hearing Exemption Application

About this document

This document is the Federal Hearing exemption application used by individuals newly applying to obtain a 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
1200 New Jersey Ave, SE Washington, DC 20590

Dear Applicant:

The Department of Transportation (DOT), Federal Motor Carrier Safety Administration (FMCSA) allows drivers operating commercial motor vehicles in interstate commerce to apply to the Agency for an exemption from the hearing standard at 49 CFR 391.41(b)(11) of the Federal Motor Carrier Safety Regulations. The process to determine if such an exemption should be granted includes a thorough review of documents and information that would support your request for an exemption from this regulation.

To apply for a Federal hearing exemption, FMCSA requests submission of the following information:

1. An applicant statement, indicating:
   1. Full name (Last, First, MI);
   2. Mailing Address;
   3. Date of birth;
   4. Phone number;
   5. Email address;
   6. Type of vehicle you will drive, including the gross vehicle weight; and
   7. Confirmation that you drive, or intend to drive, in interstate commerce.

2. A legible copy of your driver’s license, front and back.

3. Completed and signed Authorization for Release of Medical Information Form.
   1. This form is available on FMCSA’s website at 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 www.fmcsa.dot.gov/medical/driver-medical-requirements/medical-release-info-hearing-sample

4. 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).

5. A legible copy of your Medical Examiner’s Certificate, MCSA-5876 indicating that a hearing exemption is required.

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

E-mail to: FMCSAhearingexemptions@dot.gov

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 EXEMPTION PROGRAM C/O Christine A. Hydock”

The Exemption Process

To grant a Federal medical exemption, FMCSA must ensure that each exemption would maintain a level of safety equivalent to, or greater than, the level achieved without the exemption. In addition, the recipient must operate in interstate commerce.

To process an application, the Agency must carefully evaluate the information submitted and, as required by 49 CFR U.S.C.31315(b), publish a Federal Register notice requesting public comment on the application for each exemption. The public is provided 30-days to comment and the Agency must consider and respond to all comments received when making a final determination whether to grant or deny the exemption. Once a decision has been made, you will be notified in writing of the decision.

If you have questions, contact the Medical Programs Division at 202-366-4001.

Sincerely,

CHRISTINE HYDOCK

Christine A. Hydock
Chief, FMCSA Medical Programs Division