Do not contact a vendor to install an ignition interlock device if an eligibility date is not listed.
Eligibility date: your eligibility date can be found on the right corner of the front page of your restoration requirements letter.
Vehicle information: the title #, tag #, VIN #, and make of vehicle can be found on the registration card.
Information you supply: the vendor will verify the information that you supply.
Registration and insurance: you will be required to show a valid registration and proof of motor vehicle insurance.
Violation prior to 10/1/03: you do not have to list vehicle information.
Section D: Section D must be completed by the person authorized by PennDOT to perform the verification process.
| Question | Answer |
|---|---|
| Form Name | DL-21SC |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 39 |
| Avg. time to fill out | 7 min |
| Edition | 4-18 |
| Where to send | The Vendor will complete Section D and will send the form to PennDOT |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | DL-21SC, DL21SC, DL 21SC, DL-21SC form, PennDOT DL-21SC, Pennsylvania DL-21SC, Self-Certification of Vehicle(s) to be Operated or Inoperable |
| Official source | DL-21SC (Rev 4-18), |
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