Form Dl 405A – Fill Out and Use This PDF

THIS ENTIRE FORM MUST BE COMPLETED BY THE APPLICANT

and must be completed in black or blue ink.

CURRENT LEGAL NAME (FIRST, MIDDLE, LAST, SUFFIX)

CHECK THE APPROPRIATE BOX FOR THE TYPE OF OPERATION THAT APPLIES TO YOU

See Frequently Asked Questions (FAQ) for explanations

NON-EXCEPTED INTERSTATE	(NI)	Operates in interstate commerce and meets the qualification
(Required to have a DOT medical		requirements under 49 CFR part 391
card/certificate)
EXCEPTED INTERSTATE	(EI)	Operates in interstate commerce, but engages exclusively in
(See FAQ Sheet for list)		transportation or operations excepted under 49 CFR 390.3(f),
		391.2, 391.68 or 398.3
NON-EXCEPTED INTRASTATE	(NA)	Operates only in intrastate commerce and is subject to and meets
(18-20 years of age and/or		State driver qualification requirements.
license with an “I” restriction)
EXCEPTED INTRASTATE	(EA)	Operates only in intrastate commerce, but engages exclusively in
(Not applicable in South Carolina)		transportation or operations excepted from State driver
		qualification requirements.

I certify under penalty of perjury that all statements above are true and correct.

SIGNATURE OF APPLICANT

DATE

If your CDL is current, you may submit this form along with any other documents that apply to you

(Medical Examiner’s Certificate, Federal Waiver, Skills Performance Evaluation) using one of the following options:

1)Mail this form and copies of medical documents to: SCDMV - CDL Help Desk

PO Box 1498

Blythewood, SC 29016-0028

2)Scan the documents and then email them to: CDLHelpDesk@scdmv.net

3)Fax this form and medical documents to the CDL Help Desk. Fax number is (803) 896-2676

4)Deliver this form and medical documents to your local SCDMV office. A list of office locations and hours can be found on our website www.scdmvonline.com

Please contact the CDL Help Desk at (803) 896-2673 if you have any questions regarding this form.

The following FAQs will help you in determining how to meet the new Federal medical certification requirements:

Q.What must I do to comply with the new requirements for making my medical certification part of my CDL driving record?

A.Starting on February 1, 2012, when you:

Apply for a CDL; Renew a CDL;

Apply for a higher class of CDL;

Apply for a new endorsement on a CDL; or Transfer a CDL from another State

You will be required to self-certify to a single type of commercial operation on SCDMV Form DL-405A Commercial Driver’s License Holders Medical Certification Requirements. Based on that self- certification, you may need to provide your current medical examiner’s certificate and show any

variance (Federal Waiver/Skills Performance Evaluation) you may have to obtain or keep your CDL.

Q.How do I determine which type of commercial motor vehicle (CMV) operation I should self- certify?

A.For the purpose of complying with the new requirements for medical certification, it is important to know how you are using the CMV. To help you decide, follow these steps:

Step 1: Do you, or will you, use a CDL to operate a CMV in interstate or intrastate commerce?

Interstate commerce is when you drive a CMV:

From one State to another State or a foreign country;

Between two places within a State, but during part of the trip, the CMV crosses into another State or foreign country; or

Between two places within a State, but the cargo is part of a trip that began or will end in another State or foreign country.

Intrastate commerce is when you drive a CMV within a State and you do not meet any of the descriptions above for interstate commerce.

If you operate in both intrastate commerce and interstate commerce, you must choose interstate commerce.

In the state of South Carolina, Non-excepted intrastate commerce is applicable only to individuals between 18 and 20 years of age and/or with an “I” restriction on his

license.

Step 2: Once you decide you operate or will operate in interstate commerce or intrastate commerce, you must decide whether you operate (or expect to operate) in a non-excepted or excepted status. This decision will tell you which of the four types of commerce you must self-certify.

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;

Page 1 of 2

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 air- miles of the farm;

As a private motor carrier of passengers for non-business 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 and do not need a Federal medical examiner’s certificate.

If you answered no to all of the above activities, you operate in non-excepted interstate commerce and are required to provide a current medical examiner’s certificate (49 CFR

391.45), commonly referred to as a medical certificate or DOT card. 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.

Q.Will current CDL Holders be notified of the Self-certification requirement?

A.Yes, all current South Carolina Commercial Driver License and beginner’s permit holders will receive a letter notifying them of the requirement.

Q.What if my Commercial license does not expire until after January 30, 2014?

A.Prior to January 30, 2014 you must self-certify to a single type of commercial operation.

Q.What happens after January 30, 2014 if I have not self-certified my commercial operation?

A.CDL holders who do not meet the January 30, 2014 will be in jeopardy of losing their Commercial

Driver’s License.

Q.How do I self-certify?

A.You may visit any SCDMV field office and complete a form DL-405A (Commercial Driver’s License

Holders Medical Certification Requirements). The form can also be down loaded from our website www.scdmvonline.com and mailed, faxed or email to the CDL Help desk. Depending upon the self- certification you may also need to present a valid DOT medical card.

Mailing Address: SCDMV-CDL Help Desk

PO Box 1498

Blythewood SC 29016-0028

Email Address: cdlhelpdesk@scdmv.net

Fax:	(803) 896-2676

Q.If I have additional questions, who should I contact?

A.You may contact the SCDMV CDL Help Desk at (803) 896-2673.

Page 2 of 2