- Form DS-3 - Article 19-A Annual Affidavit of Compliance - New York
- Form DS-872 - Carrier's Annual Review of Employee's Driving Record - New York
- Form DS-19 - Motor Carrier Accident and Conviction Notification Program Application - New York
- Form DS-874C - Supplement to: Medical Examination of Driver Report - New York
- Form IRP-21 - IRP TEAR Request Form - New York
- Form DS-885 - Bus Driver Add/Drop Notice - New York
Fillable Printable Form DS-885 - Bus Driver Add/Drop Notice - New York
Fillable Printable Form DS-885 - Bus Driver Add/Drop Notice - New York
Form DS-885 - Bus Driver Add/Drop Notice - New York
ARTICLE 19-A BUS DRIVER ADD/DROP NOTICE
l Complete CARRIER INFORMATION.
l Complete COLUMN A (ADDS) for any bus driver who is being rehired or reinstated with your company.
l Complete COLUMN B (DROPS) for any bus driver who has left service with your company for any reason, or who is on a leave of absence
that will prevent you from keeping that driver’s 19-A records up-to-date, or who you have disqualified.
PLEASE SUBMIT THE ORIGINAL COMPLETED COPY OF THIS FORM TO: New York State Department of Motor Vehicles, Bus Driver
Unit, 6 Empire State Plaza, Rm 136B, Albany, New York 12228. In addition, you are required to keep a copy of completed form DS-885 in
your drivers’ 19-A files.
Please type or print the following information:
DS-885 (6/15)
DRIVER’S LAST NAME
EFFECTIVE DATE DRIVER REINSTATED
FIRST M.I.
DRIVER’S LAST NAME
FIRST M.I.
CLIENT ID NUMBER (from driver license)
DATE OF BIRTH
EFFECTIVE DATE OF DROP
DRIVER DISQUALIFIED
o YES
o NO
REASON FOR DISQUALIFICATION
STATE OF
LICENSE
DRIVER’S LAST NAME FIRST M.I.
CLIENT ID NUMBER (from driver license)
DATE OF BIRTH
EFFECTIVE DATE OF DROP
DRIVER DISQUALIFIED
o YES
o NO
REASON FOR DISQUALIFICATION
STATE OF
LICENSE
DRIVER’S LAST NAME FIRST M.I.
CLIENT ID NUMBER (from driver license)
DATE OF BIRTH
EFFECTIVE DATE OF DROP
DRIVER DISQUALIFIED
o YES
o NO
REASON FOR DISQUALIFICATION
STATE OF
LICENSE
www.dmv.ny.gov
COLUMN A - ADDS
NOTE: If you are employing a bus driver for the first time, do not use
this form; use form DS-870,the Article 19-A Bus Driver
Application.
COLUMN B - DROPS
NOTE: If you are dropping a driver you disqualified because the driver
failed the 19-A biennial road test, biennial oral/written test, or
medical examination, you must check the “YES” box in the DRIVER
DISQUALIFIED field, indicate the reason for disqualification, and
attach a copy of the failed test or failed medical examination.
Carrier/DBA Name Legal Name (if different)
Street Address
Name of Carrier Representative
Signature of Carrier Representative
ç
Date
City State Zip Code
Federal ID Number 19-A Business ID Number
CARRIER INFORMATION
CLIENT ID NUMBER (from driver license)
DATE OF BIRTH
STATE OF
LICENSE
DRIVER’S LAST NAME
EFFECTIVE DATE DRIVER REINSTATED
FIRST M.I.
CLIENT ID NUMBER (from driver license)
DATE OF BIRTH
STATE OF
LICENSE
DRIVER’S LAST NAME
EFFECTIVE DATE DRIVER REINSTATED
FIRST M.I.
CLIENT ID NUMBER (from driver license)
DATE OF BIRTH
STATE OF
LICENSE
DRIVER’S LAST NAME
EFFECTIVE DATE DRIVER REINSTATED
FIRST M.I.
CLIENT ID NUMBER (from driver license)
DATE OF BIRTH
STATE OF
LICENSE
DRIVER’S LAST NAME
EFFECTIVE DATE DRIVER REINSTATED
FIRST M.I.
CLIENT ID NUMBER (from driver license)
DATE OF BIRTH
STATE OF
LICENSE
DRIVER’S LAST NAME
EFFECTIVE DATE DRIVER REINSTATED
FIRST M.I.
CLIENT ID NUMBER (from driver license)
DATE OF BIRTH
STATE OF
LICENSE
THE BUS DRIVER UNIT MUST RECEIVE THIS FORM WITHIN
10 DAYS OF THE EFFECTIVE DATE LISTED ABOVE.
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