Homepage Blank Kentucky Cdl Self Certification Form
Outline

The Kentucky CDL Self-Certification form is a crucial document for all commercial driver’s license (CDL) holders in the state. It ensures compliance with both federal and state regulations regarding the type of driving activities performed. Each CDL holder must select one of four categories that best describes their expected driving operations: non-excepted interstate, excepted interstate, non-excepted intrastate, or excepted intrastate. While federal guidelines only mandate medical certification for non-excepted interstate drivers, Kentucky law requires all CDL holders to be medically certified, regardless of the category chosen. This form collects essential personal information, such as name, social security number, and contact details, along with a signature confirming the selected category. It is important to note that the excepted intrastate category is not applicable for Kentucky CDL holders, as all must meet medical certification requirements. The form also outlines specific activities that qualify as excepted interstate commerce, providing clarity on the distinctions between interstate and intrastate operations. Understanding these categories is vital for ensuring compliance and maintaining the validity of a CDL in Kentucky.

Sample - Kentucky Cdl Self Certification Form

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 Information

Fact Name Details
Form Title Kentucky Commercial Driver License Self-Certification
Governing Laws 601 KAR 1:005, Federal Motor Carrier Safety Regulations
Medical Certification Requirement All CDL holders in Kentucky must be medically certified, regardless of the selected category.
Categories of Operation There are four categories: Non-excepted interstate, Excepted interstate, Non-excepted intrastate, and Excepted intrastate.
Interstate Commerce Definition Involves driving a commercial motor vehicle (CMV) across state lines.
Intrastate Commerce Definition Involves driving a CMV only within Kentucky state lines.
Excepted Interstate Activities Includes transporting school children, emergency services, and certain agricultural activities.
K Restriction A "K" restriction must be printed on the CDL/permit for intrastate operations.

Detailed Guide for Filling Out Kentucky Cdl Self Certification

Filling out the Kentucky CDL Self Certification form is an important step for all commercial driver license holders. After completing the form, it will be submitted to the Kentucky Transportation Cabinet for processing. Ensure that all information is accurate and complete to avoid any delays in your application or certification.

  1. Obtain the Kentucky CDL Self Certification form (TC 94‐169) from the Kentucky Transportation Cabinet website or your local Division of Driver Licensing office.
  2. At the top of the form, fill in your name (last, first, middle initial), social security number, driver's license number, date of birth, phone number, and email address.
  3. Read through the four categories of driving operations carefully. Choose only one category that best describes your driving activities:
    • Non‐excepted interstate: For those who operate in interstate commerce.
    • Excepted interstate: For those who operate in interstate commerce but engage in specific excepted activities.
    • Non‐excepted intrastate: For those who operate only in Kentucky.
    • Excepted intrastate: For those who operate only in Kentucky but engage in specific excepted activities.
  4. Sign your name where indicated to certify that the information provided is true and accurate.
  5. Print your name beneath your signature.
  6. Write the date on which you are completing the form.
  7. Submit the completed form to the Kentucky Transportation Cabinet or your local Division of Driver Licensing office.

Obtain Answers on Kentucky Cdl Self Certification

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

    The Kentucky CDL Self-Certification form is essential for all commercial driver’s license (CDL) holders in Kentucky. It serves to ensure that drivers self-certify the type of driving they perform or expect to perform. This requirement is in line with the Federal Motor Carrier Safety Administration (FMCSA) regulations. While federal regulations only mandate medical certification for non-excepted interstate operations, Kentucky law requires all CDL holders to be medically certified, regardless of the category they select.

  2. What are the categories I can select on the form?

    There are four distinct categories from which you can choose:

    • Non-excepted interstate: You operate or expect to operate in Kentucky and other states (interstate commerce).
    • Excepted interstate: You operate or expect to operate in Kentucky and other states (interstate commerce) but engage exclusively in activities that are excepted from certain qualification requirements.
    • Non-excepted intrastate: You operate or expect to operate solely within Kentucky (intrastate commerce). This category requires a “K” restriction on your CDL/permit.
    • Excepted intrastate: You operate or expect to operate within Kentucky only, but engage in activities that are excepted from state driver qualification requirements. This category also requires a “K” restriction.

    It is important to note that all CDL applicants and holders in Kentucky must be medically certified, which means marking the excepted intrastate category is not permissible.

  3. What does it mean to operate in interstate commerce?

    Operating in interstate commerce refers to driving a commercial motor vehicle (CMV) across state lines. If you engage in activities such as transporting school children, responding to emergencies, or transporting agricultural products, you may be classified under excepted interstate commerce. If none of these activities apply, you would typically fall under non-excepted interstate commerce, which is the category most CDL holders will select.

  4. What are the medical certification requirements?

    All CDL holders in Kentucky must meet medical certification requirements, regardless of the category they choose on the self-certification form. This means that a valid medical certificate must be obtained, demonstrating that the driver is physically qualified to operate a commercial vehicle. It’s crucial to ensure that this certification is current, as it is a requirement for maintaining your CDL status.

Common mistakes

When filling out the Kentucky CDL Self-Certification form, individuals often make critical mistakes that can lead to delays or complications in obtaining their commercial driver’s license. One common error is failing to understand the categories of operation. The form presents four distinct categories: non-excepted interstate, excepted interstate, non-excepted intrastate, and excepted intrastate. Many applicants mistakenly select the excepted intrastate category, not realizing that all Kentucky CDL holders must be medically certified. This misunderstanding can result in an application being rejected or delayed.

Another frequent mistake involves not providing accurate personal information. The form requires essential details such as the applicant's name, Social Security Number, driver's license number, date of birth, phone number, and email address. Omitting any of this information or making typographical errors can cause significant issues. It is crucial to double-check all entries for accuracy to avoid unnecessary complications in processing the application.

In addition, some individuals overlook the importance of understanding the medical certification requirements. While the Federal Motor Carrier Safety Administration (FMCSA) mandates medical certification only for those operating in non-excepted interstate commerce, Kentucky law requires all CDL holders to be medically certified. Failing to provide proof of medical certification can lead to the denial of the application, regardless of the selected category. Thus, ensuring compliance with state regulations is vital.

Lastly, applicants often misinterpret the definitions of interstate and intrastate commerce. Many are unclear about what constitutes interstate commerce, leading them to select the wrong category. For example, if an applicant operates a commercial motor vehicle across state lines, they must select the non-excepted interstate category. Misclassification can have serious repercussions, including potential legal consequences and the inability to operate a commercial vehicle legally. Understanding these distinctions is essential for a successful application process.

Documents used along the form

The Kentucky CDL Self Certification form is a crucial document for commercial drivers in Kentucky. It allows drivers to self-identify the type of driving they perform or expect to perform. In addition to this form, several other documents are often required for a complete application or certification process. Below are four key forms and documents that may accompany the Kentucky CDL Self Certification form.

  • Medical Examiner's Certificate (MEC): This document verifies that a driver has passed a medical examination conducted by a certified medical examiner. It is essential for all CDL holders to ensure they meet health standards required for safe driving.
  • Commercial Driver's License Application: This application is necessary for obtaining a CDL. It collects personal information, driving history, and other relevant details needed for the licensing process.
  • Proof of Identity and Residency: Applicants must provide documentation that proves their identity and residency. This may include a birth certificate, passport, or utility bill, ensuring compliance with state identification requirements.
  • Knowledge and Skills Test Results: Successful completion of written knowledge tests and driving skills tests is required to obtain a CDL. These results must be submitted as part of the application process.

Completing the Kentucky CDL Self Certification form along with these additional documents helps ensure compliance with both state and federal regulations. Proper documentation is essential for maintaining safety standards and legal driving privileges in the state.

Similar forms

  • Commercial Driver License (CDL) Application: This document requires applicants to provide personal information and specify the type of driving they intend to do. Similar to the self-certification form, it categorizes the applicant’s intended operations, ensuring compliance with both state and federal regulations.
  • Medical Examination Report (MVR): This report is necessary for CDL holders to prove they meet health standards. Like the self-certification form, it assesses the medical qualifications of the driver, focusing on their ability to safely operate a commercial vehicle.
  • Medical Certificate: Issued after a medical examination, this document confirms a driver's medical fitness. It serves a similar purpose to the self-certification form by ensuring that all drivers are medically qualified to perform their driving duties.
  • Driver's Log Book: This record is maintained by commercial drivers to track hours of service. It shares a similar intent with the self-certification form in promoting safety and compliance with regulations regarding driving hours and conditions.
  • Hazardous Materials Endorsement Application: This application is required for drivers transporting hazardous materials. It parallels the self-certification form by requiring drivers to declare their operational scope and comply with specific safety regulations.
  • State Driver's License Renewal Application: This application is necessary for renewing a driver's license. It requires individuals to confirm their eligibility and operational categories, similar to how the self-certification form requires drivers to declare their intended driving operations.

Dos and Don'ts

When filling out the Kentucky CDL Self-Certification form, it is essential to adhere to specific guidelines to ensure accuracy and compliance. Below is a list of things to do and avoid during this process.

  • Do read the instructions carefully before starting the form.
  • Do select only one category that accurately reflects your driving operations.
  • Do provide your full name, Social Security Number, and other required personal information.
  • Do ensure that you are medically certified, as required by Kentucky regulations.
  • Do double-check all entries for accuracy before submitting the form.
  • Don't mark the "excepted intrastate" category, as it is not applicable to any CDL holder in Kentucky.
  • Don't leave any sections of the form blank; all required fields must be filled out.
  • Don't provide false information or select a category that does not represent your driving activities.
  • Don't forget to sign and date the form after completing it.

Following these guidelines will help ensure that the self-certification process is completed correctly and efficiently.

Misconceptions

Understanding the Kentucky CDL Self-Certification form is crucial for all commercial driver license (CDL) holders in the state. However, there are several misconceptions that can lead to confusion. Here are five common misunderstandings:

  • All CDL holders can choose any category. Many believe they can select any category on the self-certification form. In reality, the category must accurately reflect the type of driving they perform. Misclassification can lead to legal issues.
  • Medical certification is optional for intrastate drivers. Some think that if they only drive within Kentucky, they do not need medical certification. This is incorrect. All CDL holders in Kentucky, regardless of their driving category, must be medically certified.
  • Excepted interstate drivers do not need to meet any qualifications. There is a misconception that drivers in the excepted interstate category are exempt from all qualifications. While they may be exempt from some federal requirements, they still need to meet specific state qualifications.
  • Choosing the wrong category has no consequences. Some believe that selecting an incorrect category on the self-certification form is harmless. However, it can lead to penalties, including fines or suspension of the CDL, as it may be seen as a misrepresentation of their driving activities.
  • Once certified, drivers do not need to update their information. Many assume that once they complete the self-certification, they do not need to make any changes. In fact, if a driver’s circumstances change—such as moving from intrastate to interstate driving—they must update their certification accordingly.

By clearing up these misconceptions, CDL holders can better navigate the requirements and ensure compliance with Kentucky regulations.

Key takeaways

When filling out the Kentucky CDL Self-Certification form, it is essential to understand the requirements and implications of each section. Here are key takeaways to keep in mind:

  • Medical Certification Required: All CDL holders in Kentucky must be medically certified, regardless of the category selected on the form.
  • Four Categories Available: You must select one of the four categories: Non-excepted interstate, Excepted interstate, Non-excepted intrastate, or Excepted intrastate.
  • Non-excepted Interstate: This category applies if you operate or expect to operate in Kentucky and other states.
  • Excepted Interstate: Choose this if your operations are limited to specific exceptions under federal regulations.
  • Non-excepted Intrastate: This is for those who drive only within Kentucky and must meet state medical certification requirements.
  • Excepted Intrastate: This category is similar to Non-excepted intrastate but involves operations that are exempt from certain state qualifications.
  • Do Not Select Excepted Intrastate: All CDL applicants/holders must be medically certified, making this option invalid for Kentucky drivers.
  • Interstate Commerce Clarification: Understand the specific activities that qualify as excepted interstate commerce, such as transporting school children or responding to emergencies.
  • Intrastate Commerce Definition: Non-excepted intrastate commerce requires adherence to state medical certification rules and necessitates a “K” restriction on your CDL/permit.

Completing the form accurately ensures compliance with both state and federal regulations, which is crucial for maintaining your driving privileges.