New York State Basic Life Support Vehicle Registration Submission Portal

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List All Vehicles For Agency Recertification or Only The New Vehicle(s) To Be Added
License Plate # Radio or Agency ID Motor Vehicle ID # (VIN) Make Year Color Vehicle Type
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Front (Must Include Inspection Sticker) Rear (Must Include License Plate) Side View
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Affirmation and Acknowledgement

By completing and signing this affirmation, I certify that the vehicles listed are in compliance with all requirements of the State EMS Code, Part 800 for BLS First Response Unit in accordance with Policy 06-04 and Part 800.26 .

The records and documentation of the agency have also been reviewed for compliance with all applicable requirements.

The vehicles listed are registered with the NYS Department of Motor vehicle (DMV) (If applicable) and the appropriate DMV inspection has been conducted. Those vehicles which are not ambulances have appropriate DMV registration, DMV inspection, and/or any safety inspection as required by the NYS Department of Transportation, The United States Coast Guard, or the Federal Aviation Administration.

I understand that under the authority of the Public Health law any deficiencies that result in violations being issued are subject to the penalties of the Public Health Law, including fines, suspension, revocation or annulment of the operating certificate or CME and vehicle registration with the Department.