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Ignition Interlock Device Program Forms

 

Revoked Status

If you are in a revoked status, you must fill out the forms below to enroll in the Ignition Interlock Device Program.
 
​PS31202 ​Ignition Interlock Participation Agreement ​​Apply for the Ignition Interlock Device Program
​​PS31201 ​​Ignition Interlock Insurance Certification ​Certify insurance coverage on the vehicle to be used for participation in the Ignition Interlock Device Program; the insurance company may supply its own form
​PS31086 ​Special Review Awareness
(Applies only to the second offense)		 ​Notice of multiple alcohol and/or controlled substance offenses on their driving record

Canceled IPS Status

If you are in a canceled-IPS status, you must fill out the forms below to enroll in the Ignition Interlock Device Program.
 
​PS31202 ​Ignition Interlock Participation Agreement Apply for the Igntion Interlock Device Program
​​PS31201 ​​Ignition Interlock Insurance Certification ​Certify insurance coverage on the vehicle to be used for participation in the Ignition Interlock Device Program; the insurance company may supply its own form
​PS31203 ​Application for Ignition Interlock Limited License
(Canceled drivers only)		 ​Apply for a limited license with the Ignition Interlock Device Program​
​PS31083 ​Last Use Statement Form
(Canceled drivers only)		 ​Attest to abstinence from the consumption of alcohol and controlled substances
 

 

Additional Ignition Interlock Device Forms

PS31204 ​
Reduced Fee for Ignition Interlock Servicing and Monitoring
Apply for a reduced fee for ignition interlock device servicing and monitoring; must be approved by the Department 
PS31205​ ​Employment Exemption for Ignition Interlock​ Apply to exempt an employer’s vehicle from the ignition interlock requirements; certain restrictions apply
​PS31208​ ​Voluntary Withdrawal from the Ignition Interlock Program ​Requesting voluntary withdrawal from the Ignition Interlock Device Program
PS31211 ​Request for Administrative Review If you have received an ignition interlock program violation, you are entitled to an administrative review of the violation.
 

Ignition Interlock Device Program Documents

​Program Guidelines
​Certified Manufacturers (Vendors) List
​Checklist – Revoked
​Checklist – Canceled
​Strengthened DWI Sanctions Fact Sheet
​Impaired DWI Consequences
​Road back to Driving
​DWI EZ Guide
​Complaint Form