Dl 11Cd Form PDF Details

Form DL-11CD (8-25) is the Pennsylvania Department of Transportation's Self-Certification Form. All Class A, B and C license holders and permit applicants check one driving type: NI (non-excepted interstate) or NA (non-excepted intrastate), where a Medical Examiner's Certificate is required and must reach PennDOT through the National Registry, or EI (excepted interstate) or EA (excepted intrastate), where it is not. NA and EA add a K restriction, which limits the driver to Pennsylvania. The form asks for the driver's license number, name, date of birth, phone and email, whether this is an initial self-certification or a change, and a signature in ink. A driver who stops driving commercially can keep the CDL by choosing EA or EI, and resubmits the form once a medical card is required again. The form is mailed to PennDOT's Bureau of Driver Licensing in Harrisburg.

QuestionAnswer
Form NameDl 11Cd Form
Form Length2 pages
Fillable?Yes
Fillable fields13
Avg. time to fill out2 min 15 sec
Other namespa dot medical card printable, dot physical form pa, dl 11cd form, dl 11cd form printable

How to Fill Out Form DL-11CD

Form DL-11CD at a glance

What it is: DL-11CD is the Self-Certification Form where all Class A, B, or C (CDL) License holders check one of the Self-Certification Driving Types.

Who signs: By signing, you certify under penalty of law that all commercial certifications and information contained herein are true and correct.

All Class A, B, or C (CDL) License holders and all drivers applying for a Class A, B, or C permit must check one of the Self-Certification Driving Types on the form.

A filled-in Form DL-11CD example: a driver who stays within Pennsylvania

Form DL-11CD example filled out, example: a driver who stays within Pennsylvania
Dana Q. Sample, a Pennsylvania CDL holder, fills out the DL-11CD. Dana drives only within Pennsylvania, with no Medical Examiner's Certificate required, so the EA box is checked. The picture shows page 1, and every value in it is made up. This is Dana's first certification, so Initial Self Certification is checked and Change Self Certification Previously Reported stays empty. NI, NA and EI stay empty because only one Self-Certification driving type applies. JR/ETC is left blank because Dana has no suffix.

How to fill out Form DL-11CD, box by box

Check applicable box

Check applicable box: Initial Self Certification or Change Self Certification previously reported.

Driver information

Under DRIVER INFORMATION, enter the DRIVER'S LICENSE NUMBER, LAST NAME(S) and JR/ETC.

Enter the FIRST NAME and MIDDLE NAME.

Enter the DATE OF BIRTH, the TELEPHONE NUMBER (8:00 a.m. to 4:30 p.m.) and the E-MAIL ADDRESS (if applicable).

Self-Certification driving type

Please check only one of the following Self-Certification driving types that apply to you.

NI: I drive a commercial vehicle both in and outside the boundaries of Pennsylvania, and I am required to carry a Medical Examiner's Certificate (DOT PHYSICAL CARD).

NA: I drive a commercial vehicle only within the boundaries of Pennsylvania, and I am required to carry a Medical Examiner's Certificate (DOT PHYSICAL CARD).

EI: I drive a commercial vehicle both in and outside the boundaries of Pennsylvania, and I am NOT required to carry a Medical Examiner's Certificate.

EA: I drive a commercial vehicle only within the boundaries of Pennsylvania, and I am NOT required to carry a Medical Examiner's Certificate.

If you check NA or EA, a “K” restriction will be added to your license.

If you are not currently working as a commercial driver but would like to keep your CDL, you must submit the certification. If you select either the “EA” or “EI” box, you will be able to keep your CDL without needing a current medical card. If/When you return to driving a commercial vehicle and you are required to carry a medical card, you must resubmit a DL-11CD, Self-Certification Form. NOTE: You must be at least 21 years of age or older to operate a commercial vehicle in non-excepted interstate transportation.

Sign here and date

Sign in ink at SIGN HERE and enter the DATE.

More rules for Form DL-11CD

Your medical card must be received by PennDOT through the National Registry.

FMCSA will electronically transmit examination results and restriction information for commercial learner's permit (CLP) or commercial Driver's license (CDL) holders from the national Registry directly to PennDOT.

If your situation is different

You drive in non-excepted transportation (NI or NA)

NI is Non-Excepted Interstate Transportation: Interstate drivers who are subject to the Federal Physical Qualifications and Examination regulations. NA is Non-Excepted Intrastate Transportation: Intrastate drivers who are subject to the Federal Physical Qualifications and Examination regulations. A Medical Examiner's Certificate must have been received by PennDOT.

NI: Drivers who are at least 21 years of age or older.

You drive in excepted transportation (EI or EA)

EI is Excepted Interstate Transportation: Interstate drivers who are not subject to the Federal Physical Qualifications and Examination regulations. EA is Excepted Intrastate Transportation: Intrastate drivers who are not subject to the Federal Physical Qualifications and Examination regulations. Therefore, a Medical Examiner's Certificate is not required.

EI: Drivers who operate vehicles in interstate commerce that have a Gross Vehicle Weight Rating (GVWR) of 10,001 to 26,000 lbs., do NOT transport hazardous materials that require placarding, and are NOT designed to transport 16 or more persons, including the driver. Although not tied to the commercial license, drivers of these vehicles are required to carry a Medical Examiner's Certificate.

EA: Drivers who operate vehicles in intrastate commerce that have a GVWR of 17,001 to 26,000 lbs., do NOT transport hazardous materials that require placarding, and are NOT designed to transport 16 or more persons, including the driver. Drivers of these vehicles are required to carry a Medical Examiner's Certificate, although this is not tied to the commercial license.

Common questions about Form DL-11CD

Where do I file it?

Mail the Self-Certification form to: Bureau of Driver Licensing P.O.Box 69008, Harrisburg, PA 17106-9008.

Sources

[1] Form DL-11CD (8-25), Self-Certification Form, Pennsylvania Bureau of Driver Licensing (the Official source link on this page).

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