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Do not use Form DC-265, RESTRICTED. Enter into Program), the DC-265 (Restricted Driver's License Order and Entry into Alcohol.NOTE: This is page one of a two-page form. Washington, DC: National Highway Traffic Safety Administration. Limited Licenses are granted to licensed professionals in a training program (e.g. Postgraduate, resident, fellow, visiting professor, and medical faculty). Complete the Highway Safety Plan Annual Report and submit to the NHTSA. In addition to standard entrance procedures, the surveyor will complete the Form CMS-3070G. : If your driving privileges are currently withdrawn with the State of Kansas, you may be eligible for modification. For your safety, always wear a helmet, eye protection, and protective clothing when riding any motorcycle or ATV.