Dmv Form Ds 885 PDF Details

The DMV Form DS-885 is a Driver's Privacy Protection Act (DPPA) Registration Certification Form. The form is used to certify that the person registering under the DPPA is authorized to receive motor vehicle records for the purpose of protecting against fraud or misuse. The form must be completed and submitted by the individual who will be receiving the motor vehicle records, and must include their name, address, and signature. Registrants are also required to provide their driver's license number or state ID card number. Completing and submitting the DMV Form DS-885 is a requirement for anyone who wishes to obtain motor vehicle records under the DPPA.

QuestionAnswer
Form NameDmv Form Ds 885
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names220C, disqualification, rehired, DS-885

Form Preview Example

THE BUS DRIVER UNIT MUST RECEIVE THIS FORM WITHIN
10 DAYS OF THE EFFECTIVE DATE LISTEDABOVE.

NewYorkStateDepartmentofMotorVehicles

ARTICLE 19-ABUS DRIVERADD/DROP NOTICE

DS-885 (11/13)

CompleteCARRIERINFORMATION.

CompleteCOLUMNA(ADDS) foranybusdriverwhoisbeingrehiredorreinstatedwithyourcompany.

CompleteCOLUMNB(DROPS) foranybusdriverwhohasleftservicewithyourcompanyforanyreason,orwhoisonaleaveofabsence thatwillpreventyoufromkeepingthatdriver’s19-Arecordsup-to-date,orwhoyouhavedisqualified.

Pleasetypeorprintthefollowinginformation:

CARRIER INFORMATION

Carrier/DBAName

 

Legal Name (if different)

 

Federal ID Number

 

19-ABusiness ID Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

StreetAddress

 

 

 

 

 

City

 

 

 

State

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Carrier Representative

 

 

 

Signature of Carrier Representative

 

 

 

 

Date

 

 

 

 

 

ç

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLUMNA-ADDS

 

 

 

 

 

COLUMN B - DROPS

 

 

NOTE: Ifyouare employingabusdriverforthefirsttime,donotuse

NOTE: Ifyouare droppinga driveryoudisqualifiedbecause thedriver

 

failedthe 19-Abiennialroadtest,biennial oral/writtentest,or

thisform;use form DS-870,theArticle19-ABusDriver

 

 

medicalexamination,youmustcheckthe“YES”boxintheDRIVER

Application.

 

 

 

 

 

 

 

 

 

 

DISQUALIFIEDfield,indicatethe reasonfordisqualification,and

 

 

 

 

 

 

 

 

 

 

 

 

attachacopyofthefailedtestorfailedmedicalexamination.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S LAST NAME

FIRST

 

 

M.I.

DRIVER’S LAST NAME

 

 

FIRST

 

M.I.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLIENT ID NUMBER (from driver license)

DATE OF BIRTH

 

STATEOF

CLIENT ID NUMBER (from driver license)

DATE OF BIRTH

 

STATEOF

 

 

 

LICENSE

 

 

 

 

 

 

 

 

 

LICENSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EFFECTIVE DATE DRIVER REINSTATED

 

 

 

 

EFFECTIVE DATE OF DROP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S LAST NAME

FIRST

 

 

M.I.

DRIVER DISQUALIFIED

REASON FOR DISQUALIFICATION

 

 

 

 

 

 

 

 

oYES

 

 

 

 

 

 

 

 

CLIENT ID NUMBER (from driver license)

DATE OF BIRTH

 

STATEOF

 

oNO

 

 

 

 

 

 

 

 

 

 

 

LICENSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EFFECTIVE DATE DRIVER REINSTATED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S LAST NAME

FIRST

 

 

M.I.

DRIVER’S LAST NAME

 

 

FIRST

 

M.I.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLIENT ID NUMBER (from driver license)

DATE OF BIRTH

 

STATEOF

CLIENT ID NUMBER (from driver license)

DATE OF BIRTH

 

STATEOF

 

 

 

LICENSE

 

 

 

 

 

 

 

 

 

LICENSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EFFECTIVE DATE DRIVER REINSTATED

 

 

 

 

EFFECTIVE DATE OF DROP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S LAST NAME

FIRST

 

 

M.I.

DRIVER DISQUALIFIED

REASON FOR DISQUALIFICATION

 

 

 

 

 

 

 

 

oYES

 

 

 

 

 

 

 

 

CLIENT ID NUMBER (from driver license)

DATE OF BIRTH

 

STATEOF

 

oNO

 

 

 

 

 

 

 

 

 

 

 

LICENSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EFFECTIVE DATE DRIVER REINSTATED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S LAST NAME

FIRST

 

 

M.I.

DRIVER’S LAST NAME

 

 

FIRST

 

M.I.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLIENT ID NUMBER (from driver license)

DATE OF BIRTH

 

STATEOF

CLIENT ID NUMBER (from driver license)

DATE OF BIRTH

 

STATEOF

 

 

 

LICENSE

 

 

 

 

 

 

 

 

 

LICENSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EFFECTIVE DATE DRIVER REINSTATED

 

 

 

 

EFFECTIVE DATE OF DROP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S LAST NAME

FIRST

 

 

M.I.

DRIVER DISQUALIFIED

REASON FOR DISQUALIFICATION

 

 

 

 

 

 

 

 

oYES

 

 

 

 

 

 

 

 

CLIENT ID NUMBER (from driver license)

DATE OF BIRTH

 

STATEOF

 

oNO

 

 

 

 

 

 

 

 

 

 

 

LICENSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EFFECTIVE DATE DRIVER REINSTATED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE SUBMITTHE ORIGINALCOMPLETED COPYOF THIS FORM TO: NewYork State Department of Motor Vehicles, Bus Driver Unit, 6 Empire State Plaza, Rm 136B, Albany, New York 12228. In addition, you are required to keep a copy of completed form DS-885 in yourdrivers’19-Afiles.

www.dmv.ny.gov

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