INDIVIDUAL’S REQUEST FOR NATIONAL DRIVER REGISTER (NDR) FILE CHECK

IN ACCORDENCE WITH THE FEDERAL PRIVACY ACT OF 1974 (PUBLIC LAW 93-579)
The National Driver Register (NDR) contains only a listing of names and related identification, provided by State
driver licensing officials, of those whose driver licenses have been cancelled, denied, revoked, or suspended or who
have been convicted of certain serious traffic violations. The NDR does not contain a list of any other drivers. If you
have not had a driver license cancelled, denied, revoked, or suspended or have not been convicted of serious traffic
violations, you would not be listed in the NDR. Every individual is entitled, however, to request a check of the NDR
records to determine whether they appear on the NDR file. NDR will respond to every valid NDR inquiry.
The record content for those persons who are listed in the NDR files is limited to identification of the state(s) which
have taken action to cancel, deny, revoke, or suspend or have records of conviction of serious traffic violations. Any
specific information about the driver history, or request for the entire driver history, may be obtained from the state(s)
where the detailed information is recorded. The state(s) maintaining records are the (only) contacts able to correct
records in error, and the NDR will correct its pointer records when so advised by a state indicating that a report
previously made to the NDR is in error.
If the NDR has a record on you, the full record will be copied and sent to you including any older records, which may
have contained a reason for license cancellation, denial, revocation, or suspension. In addition, if such information has
been disclosed by NDR, the recipient of the information will also be identified.
The name and address of the State driver licensing official will be provided for each State listed as having reported
information on you to the NDR.
TYPE OR PRINT PLAINLY (AVOID DELAYS. INQUIRIES THAT CANNOT BE READ WILL NOT BE PROCESSED)
Full Legal Name (First, Middle, and Last)

Other Names Used (Maiden, Prior Name, Nickname, Professional Name, Other)

Mailing Address: Number & Street with Apartment or Rural Route/Carrier & box # Home Telephone (Optional)

City, State and Zip Code Work Telephone (Optional)

Driver License Number and State Social Security # (Optional)

Month, Day, and Year of Birth Sex Color of Eyes Height Weight

Driver’s Signature (Please read information on the next page before signing) Date

NOTARIZATION
OFFICIAL USE ONLY Required only if the NDR File Check
Request is not made in person
Date Received Date Sent Internal Control Sworn and ascribed before me this Notary Public
Seal or Stamp
_____________________ day of
TYPE OF IDENTIFICATION:
___________________, ________
Birth Certificate Valid Photo Driver License
in the city/county of ____________
Valid Passport State-Issued Photo ID
____________________________
Military Discharge Papers Valid Military ID
State of _____________________
Other (Specify)

Employee Verifying Applicant Identification (Print Name) Signature

FORM NDR-PRV SEE NEXT PAGE FOR ADDITIONAL EXPLANATIONS

How to Request an NDR Record Check

Any person may ask to know whether there is an NDR record on him or her and may obtain a copy of the record if
one exits. That is the purpose of this form NDR-PRV.
Complete the first page, have your signature (or your mark as witnessed) notarized, and mail the completed form to
the National Driver Register at the address below.
The NDR response will be mailed to the mailing address shown, but incomplete or illegible inquiries will not be
processed. All inquiries will be acknowledged if a return address is readable. Forms which are not notarized will also not
be processed.

What to Expect from the NDR Record Check

NDR will respond to every valid inquiry including requests that produce no record(s) on the NDR file. When records
are located, details of the probable match results will be returned to the individual Privacy Act inquirer and will contain all
information listed in the NDR records, if any, on the individual. The reply will also indicate any disclosures (reports to
others) previously made by the NDR information and will specify who, if anyone, has received reports on the inquirer.

Location of NDR Records

Records can be made available, within a reasonable time after request, for personal inspection and copying during
regular working hours at 7:45 a.m. to 4:15 p.m. each day except Saturdays, Sundays, and Federal legal holidays. The
address for requesting record information in writing directly from the NDR or for making requests in person is:

National Driver Register