Form: 

FM-11

Statement of Premiums for Assessment
FM-11

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Summary

The New York State Department of Motor Vehicles Driver Responsibility Assessment (DRA) tool is an online application that allows motorists to calculate the total cost of assessments resulting from specific traffic violations or point accumulations. The tool determines financial obligations for three categories of offenses: alcohol-related violations, drug-related violations, and refusal to submit to a chemical test. Users must provide the date of the violation and the specific offense type to receive a breakdown of the annual and total assessment amounts.

The assessment system operates independently of court-imposed fines and is typically billed in three annual installments. For a single chemical test refusal or alcohol/drug-related conviction, the standard assessment is $750, billed at $250 per year for three years. The tool also accounts for increased penalties for subsequent offenses within a five-year period. Failure to pay these assessments within the required timeframe results in the automatic suspension of the individual's driver license, learner permit, or driving privileges.

Pro Tip: To ensure accurate assessment billing, insurance carriers should double-check that the premium values entered on the FM-11 form exactly match those on the New York Supplemental Insurance Exhibit. Avoid common errors by reporting all relevant gross direct premiums and bodily injury risks correctly, and promptly submit an amended statement if any discrepancies are found between your reported data and Department of Financial Services records.

⚠️ Disclaimer
The form summaries, instructions, and "Pro Tips" provided on this website are for informational purposes only. While we strive to keep this information accurate, up-to-date, and easy to understand, official motor vehicle policies, form requirements, and state regulations change frequently. This content does not constitute formal legal or regulatory advice. For absolute accuracy, official guidelines, or further clarification regarding any New York State form or requirement, please consult the official New York State Department of Motor Vehicles (NYS DMV) directly.

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