A copy of the Certificate of Compliance form must accompany your material shipment to its next destination.
Original: after completing the Certificate of Compliance form CS-4171, maintain the original at your company's location.
Line 2 and Line 5: Private Label Companies who complete form CS-4171 must identify the true manufacturer (Line 2) and the approved material (Line 5).
Signature: enter the required information and sign the Certificate of Compliance form. Ink signatures or electronic signatures are acceptable.
Iron or steel: check box if your product contains iron or steel, and complete the additional check boxes.
| Question | Answer |
|---|---|
| Form Name | Form CS-4171 |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 222 |
| Avg. time to fill out | 37 min |
| Edition | 9-26 |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | CS-4171, CS4171, CS 4171, Form CS-4171, PennDOT CS-4171, Certificate of Compliance |
| Official source | Form CS-4171 (Rev 9-26), Pennsylvania Department of Transportation |
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