- Form DS-103 - Report of Passing Stopped School Bus - New York
- Form DS-879 - Article 19-A Carrier Application - New York
- Form DS-3.3 - Article 19-A Motor Carrier Annual Statistical Report - New York
- Form IRP-33 - IRB Renewal Checklist - New York
- Form IRP-5 - Schedule B Mileage Information (2013) - New York
- Form DS-875 - Article 19-A Biennial Behind the Wheel Road Test - New York
Fillable Printable Form DS-3.3 - Article 19-A Motor Carrier Annual Statistical Report - New York
Fillable Printable Form DS-3.3 - Article 19-A Motor Carrier Annual Statistical Report - New York
Form DS-3.3 - Article 19-A Motor Carrier Annual Statistical Report - New York
www.dmv.ny.gov
Section 509-d(7) of the New York State Vehicle and Traffic Law (VTL) requires that you complete this statistical
report and file it with your Article 19-A Annual Affidavit of Compliance.
Please provide answers to the following questions to the best of your knowledge and ability. You must fill in a
numerical answer to all questions. Do not leave any answers blank.
1. What is the number of miles traveled by buses operated by you during the period January 1 to December 31 of
last year? ___________________
2. What is the total number of convictions and accidents involving any driver employed by you that were reported
to you under Section 509-f of the VTL during the period January 1 to December 31 of last year?
Convictions:_________________ Accidents:_____________________
3. What are the numbers of convictions/accidents per ten thousand miles traveled?
Convictions:_________________ Accidents:_____________________
The numbers can be found using the following formulas:
• Number of convictions per 10,000 miles = total number of convictions divided by the total number of miles
traveled, and multiply that result by 10,000
• Number of accidents per 10,000 miles = total number of accidents divided by the total number of miles
traveled, and multiply that result by 10,000
This report must be filed with your Article 19-A Annual Affidavit of Compliance. Failure to fully complete and file
this form will result in the rejection and return of your Annual Affidavit of Compliance.
You are required by law to make a copy of this report available to anyone who requests it.
DS-3.3 (2/15)
__________________________________
__________________________________
__________________________________
____________________________________________
____________________________________________
____________________________________________
Carrier Name
Date
Federal ID Number
Address (Include Number and Street)
City
State Zip Code 19-A Business ID Number
BUS DRIVER UNIT
ARTICLE 19-A MOTOR CARRIER
ANNUAL STATISTICAL REPORT
6 EMPIRE STATE PLAZA, ROOM 136B
ALBANY, NY 12228
(518) 473-9455
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