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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