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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