Commercial Driver's License Medical Self-Certification Form (PS33203-07) at a glance
What it is: The Commercial Driver's License Medical Self-Certification Form is a Minnesota Department of Public Safety Driver and Vehicle Services form.
Who signs: Sign on the line for the Driver's signature and enter the Date.
All commercial driver's license (CDL) holders, class A, B or C, must complete and submit this self-certification form for initial, renewal or change in class application.
What to bring and attach to Commercial Driver's License Medical Self-Certification Form (PS33203-07)
Drivers who check Category 1 or Category 3 must also submit a current medical examiner's certificate from a certified medical examiner and any applicable waivers.
All CDL holders with a school bus endorsement must submit a current medical examiner's certificate from a certified medical examiner.
A filled-in Commercial Driver's License Medical Self-Certification Form (PS33203-07) example: Dana Lee Sample renews a class A CDL
How to fill out Commercial Driver's License Medical Self-Certification Form (PS33203-07), box by box
Name and Date of birth
Enter your Name (first, middle, last) and your Date of birth (mm/dd/yyyy).
Enter your Minnesota driver's license number; example: A123-456-789-123.
Self-certification category
Check only one of the self-certification categories that apply to you: you certify your commercial operating status by checking only one category box, and checking more than one category box will delay processing this form.
Category 1 - Non-exempt Interstate, subject to Code of Federal Regulations title 49, part 391; a current medical examiner's certificate from a certified medical examiner must be submitted.
Category 2 - Exempt Interstate, exempt from medical examination requirements of Code of Federal Regulations title 49, part 391.
Category 3 - Non-exempt Intrastate, subject to state medical examination requirements of Minnesota Statutes, section 221; a current medical examiner's certificate from a certified medical examiner must be submitted.
Category 4 - Exempt Intrastate, exempt from state medical examination requirements listed in Minnesota Statutes, section 221.
Medical examiner's certificate and medical waiver
Answer the two questions, first: are you submitting a copy of your medical examiner's certificate from a certified medical examiner? Yes or No.
Second: are you submitting a copy of a medical waiver? Yes or No.
Driver's signature and Date
Sign on the line for the Driver's signature and enter the Date.
More rules for Commercial Driver's License Medical Self-Certification Form (PS33203-07)
If you have questions or need additional information, contact DVS at 651-297-5029 or 651-282-6555 (TTY).
You are not legally required to provide this information to DVS.
If you refuse to provide the requested information, DVS will be unable to certify your medical status which could result in the loss of your CDL driving privilege.
If your situation is different
Your medical status or interstate/intrastate status changes
If there is a change in your medical status or interstate/intrastate status you must provide a new self-certification form. When changing from intrastate to interstate, you must apply for a duplicate license and pay the appropriate fees.
Common questions about Commercial Driver's License Medical Self-Certification Form (PS33203-07)
Where do I file it?
Submit this completed self-certification form and your medical examiner's certificate from a certified medical examiner and/or medical waiver, if applicable, online: drive.mn.gov; by mail: Driver and Vehicle Services, 445 Minnesota Street, Suite 175, Saint Paul, MN 55101-5175; or in person at any driver exam station or driver's license office that accepts CDL applications.
Sources
[1] Commercial Driver's License Medical Self-Certification Form PS33203-07 (2/2024), Minnesota Department of Public Safety, Driver and Vehicle Services (the Official source link on this page).