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Driver and Vehicle Services

A Division of the Minnesota Department of Public Safety
 

Ignition Interlock Device Program Forms

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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  (01/2021)
​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 (01/2021) Apply for the Ignition Interlock Device Program
PS31203  Application for Ignition Interlock Limited License (03/2021)​

(Canceled drivers only)

Apply for a limited license with 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


PS31205
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 
PS31208
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
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