DPR-104 Impaired Driver Program Service Agreement – Fillable PDF

The DPR-104 is the official Impaired Driver Program (IDP) Service Agreement required by the New York State Department of Motor Vehicles (NY DMV). This form confirms that an instructor or driving school meets all IDP eligibility rules before a student with a documented impairment can begin training.

What Is the DPR-104 Form?

DPR-104 documents the relationship between the IDP and the driving instructor. It verifies that the instructor’s out‑of‑state license is valid, not suspended, and that the school complies with NY DMV’s safety standards.

Who Must Complete DPR-104?

• Driving schools or private instructors enrolled in the NY Impaired Driver Program.
• Any instructor whose license was issued outside of New York but who wishes to teach IDP students.
• Schools applying for a new classroom site or a change to an existing site.

How to Fill Out DPR-104 Online

Instead of downloading the PDF and editing it manually, simply click the "Fill out this form" button below. The Formize PDF Filler app will load the fillable version directly in your browser:

1. Click the blue Fill out this form button.
2. Wait a few seconds while the Formize filler loads.
3. Enter the required information into each field. All fields are interactive and saved automatically.
4. When you’re finished, choose Download Completed PDF or Submit Directly to NY DMV (if your agency supports it).

Common Mistakes to Avoid

• Using an expired out‑of‑state license. The form requires a license that has been valid for the past five years.
• Leaving conditional or restricted status unchecked. Any restriction must be disclosed.
• Misspelling the instructor’s name or school address. Errors can delay approval.
• Forgetting the signature. The form is not valid without a handwritten or digital signature.

Where to Submit the Completed Form

After you’ve filled and saved DPR‑104, mail or fax the printed copy to the NY DMV IDP Office, or upload it through the NY DMV online portal if you have an account. Keep a copy for your records.

Download the original DPR‑104 PDF