There is a growing need for training and tools to identify and manage medically and cognitively impaired drivers. To address this need, the Driver Orientation Screen for Cognitive Impairment (DOSCI) was developed. To aid licensing agency assessments, the DOSCI was administered to clients at the Iowa Department of Transportation, Motor Vehicle Division (MVD) as part of their routine visits. The purpose of the current study is to investigate the association between DOSCI performance and driver licensing outcome through analysis of data collected between October 1, 2014 and August 1, 2015. The results are expected to provide insight on the feasibility and usefulness of the DOSCI tool which will contribute to the development of procedures that will better identify drivers with potential disorientation from cognitive impairment that could affect roadway safety. This study primarily focuses on the relationship between the pass/fail outcome of the DOSCI and whether a driver’s license was issued or not issued. This study addresses the following research question: Is DOSCI pass/fail outcome associated with driver licensing outcome? It is hypothesized that passing or failing the DOSCI assessment will be significantly associated with driver licensing outcome. Results showed that DOSCI performance is associated with driver licensing outcome, depending on reason for assessment. The results of the multivariate logistic regression showed a significant interaction between DOSCI pass/fail outcome and reason for assessment in their effect on driver licensing outcome after controlling for age, gender, and number of prior licensing examinations. For clients that visited a MVD office for “other” reasons, those that failed the DOSCI assessment were 5.32 times (95% CI 3.02-9.36) more likely not to receive a driver’s license than clients that passed. “Other” reasons may include vision tests, law enforcement requests, or claims of apparent confusion. The primary limitation of the study was the prevalence of missing data for the independent variable driver license outcome. Future research may investigate the impact of specific DOSCI questions on licensing outcome or conduct a linear regression analysis using DOSCI numeric score.