MSPA Driver's Doctor's Certificate

Application for a Farm Labor Contractor or Farm Labor Contractor Employee Certificate of Registration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0016 can be found here:

Documents and Forms

Document Name Document Type
Form WH-515 MSPA Driver's Doctor's Certificate Form and Instruction
WH-515 Doctor's Certificate WH-515 Doctors Certificate.docx www.dol.gov/whd/forms/wh515.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	MSPA Driver's Doctor's Certificate	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 500.105

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-515	Doctor's Certificate	WH-515 Doctors Certificate.docx	http://www.dol.gov/whd/forms/wh515.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,259	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Farms, Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,259	1,149	2,110
Annual IC Time Burden (Hours)	1,412	498	914
Annual IC Cost Burden (Dollars)	224,871	79,281	145,590

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.