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Driver and Vehicle Services

A Division of the Minnesota Department of Public Safety

Ignition Interlock Device Program Forms



Please read this disclaimer carefully. Changes in Minnesota law effect the Ignition Interlock Device Program Guidelines. To ensure you understand the most recent legal requirements applicable to your participation in the program, please review changes in Minnesota Statutes, Sections 169A.55 (Second Alcohol, Drug or Refusal offense in 10 years/Third on record with one or two over 10 years required to participate in IIDP), 171.29 (removing the DWI knowledge test), 171.30 (removing the limited license), and 171.306 (Ignition Interlock Device Program) before signing the participation agreement.

Revoked Status

New  Aug. 1, 2022:  Request for Reinstatement
Seeking exemption in the ignition interlock device program. Only applies to driver's with revoked driving ​privileges.
See Frequently Asked Questions​ for more information. 

If you are in a revoked status, you must fill out the forms below to enroll in the Ignition Interlock Device Program.

PS31201 Ignition Interlock Participation Agreement(12/2021) ​Apply for the Ignition Interlock Device Program
​PS31086 Special Review Awareness(01/2021)
(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 (12/2021) Apply for the Ignition Interlock Device Program
PS31083 Last Use Statement Form (01/2021)
(Canceled drivers only)
Attest to abstinence from the consumption of alcohol and controlled substances


Additional Ignition Interlock Device Forms

Employment Exemption for Ignition Interlock (01/2021)​ Apply to exempt an employer’s vehicle from the ignition interlock requirements; certain restrictions apply
​PS31204 Reduced Fee for Ignition Interlock Servicing and Monitoring(01/2021)​ ​Apply for a reduced fee for ignition interlock device servicing and monitoring; must be approved by the Department 
Voluntary Withdrawal from the Ignition Interlock Program(01/2021)​​ ​Requesting voluntary withdrawal from the Ignition Interlock Device Program
​PS31211 Request for Administrative Review (01/2021)​ 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
Checklist – Revoked (12/2021)
Checklist – Canceled (12/2021)​
​​Complaint Form ​(11/2021)