Form 5871-2025

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Form 5871-S is a Disclosure of Ownership and Control Statement used by applicants or providers in Texas to disclose ownership and control interests. It includes sections for providing entity information, ownership details, general disclosure questions regarding criminal history, sanctions, debts, and certifications. The form must be completed accurately to ensure compliance with Texas Department of Aging and Disability Services (DADS) requirements.

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What is the FMCSA definition of monocular vision?

For drivers who have monocular vision (defined as only one eye worse than 20/40 and/or with peripheral vision of less than 70 degrees), the qualification process for your medical exam has become a little faster.

Can you drive a commercial vehicle with monocular vision?

The FMCSA vision exemption program is for monocular vision. The waiver currently in place has been granting drivers with vision in only one eye since 1998 and is estimated that over 2,500 interstate drivers hold an FMCSA vision exemption. The vision exemption is issued for a maximum of 2 years and is renewable.

What is a declaration for federal employment form?

The information collected on this form is used to determine your acceptability for Federal and Federal contract employment and your enrollment status in the Governments Life Insurance program. You may be asked to complete this form at any time during the hiring process. Follow instructions that the agency provides.

What is monocular vision as it is defined by FMCSA?

FMCSA defines monocular vision as: For general informational purposes only, to meet FMCSAs monocular vision standard, an individual must: (1) in the better eye, distant visual acuity of at least 20/40 (with or without corrective lenses) and field of vision of at. least 70 degrees in the horizontal meridian; and.

What is the MCSA 5871 form?

About the Vision Evaluation Report, Form MCSA5871: The Medical Examiner must receive a completed Vision Evaluation Report, Form MCSA5871, that is signed and dated by an ophthalmologist or optometrist before each required physical qualification examination.

mcsa 5871 pdf

Printable form 5871 Form 5871 pdf Form 5871 instructions Form 5871 texas Form 5871 texas medicaid form mcsa-5871 Form 5870 FMCSA vision Form

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What qualifies as monocular vision?

The monocular vision definition involves seeing with one eye, while binocular vision is seeing with both eyes together. Wide-set eyes on either side of the head characterize monocular vision, which improves field of view but reduces depth perception.

What is the alternative vision standard for FMCSA?

The new alternative vision standard eliminates the need for a Federal vision exemption program and allows certified medical examiners, in consultation with an ophthalmologist or optometrist and utilizing the new Vision Evaluation Report, Form MCSA-5871, to evaluate and determine whether to grant a Medical Examiners

What is a MCSA 5875 form?

About the Medical Examination Report (MER) Form, MCSA-5875: As part of the physical, drivers are required to fill out the medical history portion of the Medical Examination Report (MER) Form, MCSA-5875.

Form 5871-2025

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What is the FMCSA definition of monocular vision?

Can you drive a commercial vehicle with monocular vision?

What is a declaration for federal employment form?

What is monocular vision as it is defined by FMCSA?

What is the MCSA 5871 form?

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What qualifies as monocular vision?

What is the alternative vision standard for FMCSA?

What is a MCSA 5875 form?

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