Mv 619 Form PDF Details

Mv 619 form, also known as the "Notice of Proposed Action," is a document used by government agencies to inform citizens of proposed actions that may impact them. The form is typically filled out by agency employees and then sent to affected citizens or their representatives. It can be a helpful tool for keeping people informed about what their government is doing, and it can also provide an opportunity for citizens to provide input on proposed actions.

Here is some data that will help you find out the time it's going to take to finalize the mv 619 form.

Form NameMv 619 Form
Form Length1 pages
Fillable fields25
Avg. time to fill out5 min 19 sec
Other namesvision test form to donwload, ny dmv eye test form, dmv ny gov vision registry locator, mv619

Form Preview Example



You may renew online, by mail, or in person at your DMV office.

Renewal online or by mail:

a.Find a provider in DMV’s Vision Registry at If one of these providers completes your required vision test, you do not need this form to renew your driver license.

b.If your provider is not enrolled in DMV’s Vision Registry, this report must be completed and used when renewing your license at or by mail.

Renewal at a DMV office:

a.For no additional charge, your vision test can be completed at a DMV office.

b.DMV staff are trained to administer the eye test.


a.This form should be used only for patients who have a minimum Snellen Test score of 20/40 with one or both eyes, with or without corrective lenses. For patients whose best corrected vision is less than 20/40 but not less than 20/70, and for patients who wear telescopic lenses, complete form MV-80L ( and mail it to the address on that form.

b.ONLY a licensed physician, physician assistant, registered nurse, nurse practitioner, optician, optometrist, ophthalmologist, or supervised staff of any of these providers can complete the MV-619.

If a client renews their license at a DMV office, DMV staff are trained to administer the eye test.

c.PRINT in ink or TYPE all information below except signature.

d.Do not mail this report. Give it to the patient.

e.To enroll in DMV’s Vision Registry, please visit It’s simple, easy and free!


Patient’s Name (exactly as it appears on the patient’s driver license)



2. Date of Birth (MM/DD/YY)


3. Sex










o M o F





























Patient’s Street Address






Apt. #










State (If in U.S.)


Zip Code


5. Date of Examination (MM/DD/YY)



















Did the patient achieve a Snellen Test score of 20/40 or better with one or both eyes? o YES

o NO

If NO, complete form MV-80L











Did the patient wear corrective lenses during the test? o YES

o NO

















Name and Title of Provider




















Provider’s Street Address












State (If in U.S.)



Zip Code










10. This report is valid for up to

12 months


6 months from the date of examination.













11. I have examined the patient described above, and have accurately reported my findings

12. Professional License No.

from that examination on this form.








Provider’s Signature









(Sign name in Full) X



















MV-619 (5/20)

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stage 1 to filling out vision test report dmv

You should provide the essential data in the DateofBirth, MM, DD, YY Last, First, Patients, Street, Address Apt, Sex, oM, oF City, State, If, in, US Country, Zip, Code Date, of, Examination, MM, DD, YY oYE, So, NO Name, and, Title, of, Provider and Providers, Street, Address field.

vision test report dmv DateofBirthMMDDYY, Last, First, PatientsStreetAddress, Apt, Sex, oMoF, City, StateIfinUS, Country, ZipCode, DateofExaminationMMDDYY, oYESoNO, NameandTitleofProvider, and ProvidersStreetAddress blanks to insert

In the City, State, If, in, US Country, Zip, Code and Professional, License, No area, describe the vital data.

vision test report dmv City, StateIfinUS, Country, ZipCode, and ProfessionalLicenseNo fields to insert

Step 3: Click the "Done" button. So now, it is possible to export your PDF document - upload it to your electronic device or deliver it by using electronic mail.

Step 4: To prevent yourself from potential forthcoming troubles, you should hold minimally two copies of each document.

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