Volunteer driver application for medical ride programs: license, auto insurance, and driving record

Who this application is for

Use this application for a volunteer who drives a personal car for a nonprofit or public ride program. The Department of Labor says employees cannot volunteer their services to a private employer run for profit, so a company that wants occasional drivers should use the paid driver application instead. The rules for who may run a program, how mileage payments are taxed, and how the insurance layers work are in the volunteer driver programs guide, and this page does not repeat them.

Kentucky’s regulation defines volunteer transportation as a ride given as a charitable act, with no expectation of a benefit or payment (603 KAR 7:080). Georgia’s Medicaid manual describes it as service from people or agencies who get nothing beyond their expenses. If your program bills Medicaid for volunteer mileage with A0080, expect the state’s driver rules to reach your volunteers. The two examples below show what they can look like.

The application asks no conviction question. The screening step covers that, once the volunteer has signed the consents in Part 7, and the order in which a state lets you ask is explained in the paid-driver application.

The application

Part 1: About you

Set the age line to the strictest program you serve. Kentucky’s regulation sets 18 for its drivers and escorts, and Virginia’s fee-for-service rules set 18 plus two years of driving experience for volunteers.

Part 2: License and driving record

The program will confirm these answers against your driving record. Georgia accepts a license from a bordering state as well as its own, so say in the instructions which states your program accepts.

Part 3: Your vehicle

Part 4: Your auto insurance

Attach a copy of the declarations page of the policy. It is the summary page your insurer issues with the policy.

For the program’s use: [liability coverage the program carries in excess of the volunteer’s own policy, such as hired and non-owned auto, and its limit].

Part 5: Mileage and expenses

The program reimburses [$__ per mile / tolls and parking / nothing] for trips I drive. I understand that federal law sets the charitable mileage rate at 14 cents a mile, that reimbursement above that rate may be taxable income to me, and that I should keep a written record of each trip’s miles. I will send my mileage record to [name] by [the first of each month].

Part 6: Availability and rides you can take

Part 7: Screening and confidentiality

The program checks each item below before your first ride. Each consent is a separate page.

• I have signed the stand-alone notice and authorization for a background check.
• I have signed the consent for the program to request my driving record.
• I have signed the statement that I will keep every rider’s information private.

If Medicaid pays for the trips, the program will also check the federal and state exclusion lists. Training the program requires, such as first aid, passenger assistance, or a safety and sensitivity course, will be scheduled after approval if you do not already hold it.

Part 8: Certification

By signing, I confirm that what I have written here is accurate and complete as far as I know. I understand that the program may check my answers, and may decline my application or end my service if I gave false information.

What Medicaid programs ask of volunteers

Two state documents show how a program turns the parts of this form into rules. They are examples, so check what your own broker or state requires.

• Georgia. The Department of Community Health’s NEMT manual (version dated October 1, 2026) makes the broker responsible for checking volunteers, and its list maps closely onto this application.
  • Driver. A Georgia license, or one from a bordering state. Current certification in first aid, in a passenger assistance orientation, and in a safety and sensitivity program.
  • Record. No earlier convictions for sexual or violent crimes. No driving-under-the-influence conviction, whether alcohol, narcotics or other drugs, in the five years before starting. A felony within the past five years sends the volunteer to a review by the broker and the state before any rider is carried.
  • Vehicle. State operating and registration requirements met, a child safety seat when one is appropriate, and a passed inspection. The broker also runs an annual inspection process.
  • Pay. Limited to expenses, on a basis the state approves.
• Kentucky. Under 603 KAR 7:080 a volunteer transportation provider needs a valid driver’s license, proof of insurance and registration, and a vehicle that meets the recipient’s safety needs. The same regulation says the contract must include signed statements of confidentiality under the federal privacy rules for subcontractor or volunteer employees, which is what the third box in Part 7 collects. The confidentiality agreement template has a ready statement.

Under both sits the federal floor in section 1902(a)(87) of the Social Security Act for every driver a state plan pays, which the volunteer driver programs guide walks through.

Screening a volunteer

The consents in Part 7 start the screening. A report from a screening company falls under the FCRA’s notice and authorization rules, and FTC staff read “employment purposes” widely enough to include a nonprofit staffed by volunteers. Give the volunteer the stand-alone notice and authorization, keep it apart from this application, and use the driving record consent page from that same form when you order the record from the state yourself.

What each search covers is in the background check guide. A program that bills Medicaid should also run the exclusion search before the first ride and repeat it on the schedule its payers set, as it would for a paid driver.

Why Parts 4 and 5 ask what they ask

Part 4 asks for the policy because the usual protection stops short of a volunteer driver. The Volunteer Protection Act shields volunteers from liability for many acts, but its text excludes harm caused by operating a vehicle that the state requires the operator to be licensed for or the owner to insure (42 U.S.C. 14503(a)(4)). The volunteer’s own policy and the program’s coverage therefore answer for a crash, and the form collects what each one says. How the layers fit together is in the volunteer driver programs guide.

Part 5 prints the program’s rate where the volunteer will see it before the first ride. The 14-cent figure comes from 26 U.S.C. 170(i), and IRS Publication 526 tells volunteers to keep reliable written records of their car expenses, which is why the form asks for a monthly mileage record. How a rate above 14 cents is taxed is in the same guide.

After approval

Once a volunteer is approved, add them to HealthRide as a driver in the fleet records and enter the license expiration and the insurance policy end date from Parts 2 and 4 as credentials. A reminder goes out before each date passes, and the board warns the dispatcher if a volunteer with a lapsed credential is picked for a trip.