Form Ds-2 - Universal Notice Of Re-Entry

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UNIVERSAL NOTICE OF RE-ENTRY
IMPAIRED DRIVER PROGRAM
dmv.ny.gov
Clients who have previously enrolled in the New York State Impaired Driver Program (NYS IDP) and who have
been dropped from the program for cause, may be permitted to re-enter with permission from the IDP Director.
The Director must complete this form and advise the client to bring it to a DMV issuing office in order to be re-
entered in the program and/or to be re-issued a conditional license, if eligible.
TO: DMV Representative
The following client was dropped from the NYS IDP:
Client Name:
NYS Client Identification Number:
(driver license, permit, or non-driver ID number)
/
/
Date dropped from NYS IDP:
I HAVE AGREED TO ALLOW THE CLIENT TO RE-ENTER THE PROGRAM AS FOLLOWS:
(
IDP Director must check the appropriate box for the type of re-entry requested)
CLASSROOM RE-ENTRY
The client needs to attend all seven sessions and be re-enrolled in the Impaired Driver Classroom
application. DMV, please allow the client to choose from one of our scheduled courses.
The client needs to resume attending class sessions and be re-enrolled in the Impaired Driver Classroom
application. DMV, please re-enter the client with IDP course code ___________ for the class that began
on
.
/
/
I agree to allow the client to re-enter with a different IDP program.
(Check this box only if the client is given permission to re-enter with a different program)
PROGRAM ONLY RE-ENTRY
The client needs to resume participation in required assessment/treatment activities, does not
require enrollment in the Impaired Driver Classroom, and is appearing to restore driving
privileges (if appropriate). I have done a program-only re-entry to re-open the enrollment which
began on
/
/
.
IMPAIRED DRIVER PROGRAM INFORMATION
IDP Name
Program Number
IDP Contact
Email
Telephone Number
Signature of IDP Director
Date
ç
DS-2 (12/15)
reset/clear

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