Ignition Interlock Device Program forms
The following forms and documents are related to the Ignition Interlock Device Program.
Enroll as a driver with revoked status
| Form or document | When to use |
|---|---|
| Revoked status checklist | Ensure you completed the necessary steps to enroll. |
| Ignition Interlock participation agreement (PS31201) | Apply for the Ignition Interlock Device Program. |
| Special review awareness (PS31086) | Acknowledge multiple alcohol or controlled substance offenses on your driving record. |
Enroll as a driver with canceled - inimical to public safety (IPS) status
| Form or document | When to use |
|---|---|
| Canceled IPS status checklist | Ensure you completed the necessary steps to enroll. |
| Ignition Interlock participation agreement (PS31201) | Apply for the Ignition Interlock Device Program. |
| Last use statement (PS31083) | Attest to abstinence from the consumption of alcohol and controlled substances. |
Additional documentation
These forms can be used after you're enrolled in the program.
| Form | When to use |
|---|---|
| Employment exemption for Ignition Interlock (PS31205) | Apply to exempt an employer’s vehicle from the ignition interlock requirements. |
| Reduced fee for Ignition Interlock servicing and monitoring (PS31204) | Apply for a reduced fee for ignition interlock device servicing and monitoring . |
| Voluntary withdrawal from the Ignition Interlock program (PS31208) | Request voluntary withdrawal from the Ignition Interlock Device Program. |
| Request for administrative review (PS31211) | Request an administrative review if you have received an ignition interlock program violation. |
| Complaint form (PS31210) |
Complete if you are not satisfied with your certified ignition interlock vendor or service provide and you've already tried contacting the provider. Note: Before submitting this form, contact the provider directly and request to speak to a manager or supervisor in their central office. |