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Get Dot Mcsa-5875 2013

with the U.S. Department of Transportation (DOT) Prefatory Statement of General Routine Uses published in the Federal Register on December 29, 2010 (75 FR 82132), under "Prefatory Statement of General Routine Uses'' (available at http://www.dot.gov/privacy/privacyactnotices). ACKNOWLEDGMENT: I understand the provisions of the Privacy Act of 1974 as related to me through the abovementioned statement. MEDICAL RECORD # (or sticker) CMV Driver Signature: Date: SECTION 1. Driver Information (to .

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