This report presents an overview of present routines and regulations concerning driving licensing and vehicle adaptation for people with physical impairments. The aim of the report is twofold: firstly, to present deficiencies in the current routines and secondly, compare Swedish conditions with those in other countries in order to provide a basis for improving the situation in Sweden. Thus, both national and international conditions are described in the report. In an earlier report, VTI Report 426, it was concluded that the present routines used to ensure that drivers with physical impairments are provided with the right adaptation are not satisfactory e.g. some form of adaptation evaluation is lacking. The report begins with a short description of the background and a description of how some central concepts such as impairment, disability, and handicap are used in the report. This is followed by a somewhat simplified and idealised description of what is called the mediating process i.e. from the initial assessment of fitness to drive to adaptation of the car and driving licensing. After this follows a presentation of how this process is implemented and works in Sweden of today. The following sections are devoted to the conditions in the other Nordic countries. This is followed by sections dealing with some European countries and what the EU member states have in common. The next sections are devoted to some countries outside Europe. Standards and competence centres have been considered so important in this context that these subjects are dealt with in separate sections. The report ends with some conclusions and recommendations concerning test/assessment of fitness to drive, driving test and vehicle inspection, adaptation evaluation, standards and directives, and competence centres. The authors' intention is that the report will be used as a bank of ideas for future work involving improvements of the mediating process in Sweden, in particular with respect to adaptation evaluation.