List of Form Revisions

Revisions to MSPA Forms WH-530, WH-514, WH-514a, and WH-515

Changes to Form WH-530

Overall changes:

• Created more space for responses by rearranging boxes and lines

• Revised capitalization and punctuation for consistency across the form

• Moved the OMB number and expiration date to the bottom of the page

• Reorganized requested information within the boxes for increased readability

Page 1

• Box 1

  • Added following lines: “Is Form FD-258 Fingerprint Card attached? (See instructions)” with space for “yes” and “no” responses

• Box 2

• Added “country” to permanent address line

• Moved previous box four (mailing address) to box 2, with request to provide the mailing address if it is different from the permanent place of residence

• Added “country” to mailing address line

• Added “primary” before “telephone number”

• Added “alternate telephone number”

• Deleted “last six (6) digits of” before “social security number”

• Box 3

  • Moved lines requesting date of birth, citizenship status, visa number, and visa expiration date to box four

  • Rearranged order of requested information

• Box 4

  • Moved original requested information (mailing address) to box two.

  • Removed “(a)” and deleted the note in (a) that says “(if No, go to (b))”

  • Deleted the entire section (b) on the alien registration number

  • Removed “(c)”

  • Added lines requesting date of birth, citizenship status, visa number, and visa expiration date

• Box 5

  • Bolded the line “(Attach copy of license to application)”

  • Bolded the line that starts with “A valid Doctor’s Certificate…”

• Box 6

  • Bolded “attach a copy of the final judgment”

  • Corrected the spelling of judgment

Page 2

• Box 7

  • Deleted line “if a corporation, give legal name (and doing business as/dba), address, telephone number, date, and state of incorporation”

  • Added line “If the applicant has submitted any other applications under a different name(s), provide the names here”

  • Deleted “if none, enter none” under lines for date of incorporation, IRS employer identification number, state of incorporation, and state unemployment insurance reporting number

• Box 9

  • Changed the line that says “Describe your method of operation…” to “Location(s) of work, including farm name(s), city, and state” and added response line

  • Added another response line for crops and work activities

• Box 10

  • Deleted “Give number, type and seating capacity…”

  • Added “Number of workers, type of vehicle(s) and seating capacity” with a response line next to response “yes”

  • Moved the statement “submit proof of compliance with the insurance….” to language concerning workers compensation

  • Moved the above referenced language to above the response “no”

  • Inserted a line for a response following the statement “explain how workers get to the worksite

  • Bolded the statement “explain how workers get to the worksite.”

  • Deleted “Submit a properly completed….” next to both the Yes and No boxes

  • Next to the “yes” responses, added “Is a properly completed WH-514 Vehicle Mechanical Inspection Report attached for each vehicle?” with spaces for yes and no

  • Next to the “no” response, added “Is a properly completed WH-514a Vehicle Mechanical Inspection Report attached for each vehicle?” with spaces for yes and no

• Box 11

  • Bolded all the language in parenthesis next to both yes and no

Page 5

• Changed “item 2” to “items 2-4”

Changes to Forms WH-514 AND WH-514a

• Changed “name of carrier” to “name of applicant”

• At the end of the first paragraph, bolded the sentence “The inspection must be performed by an independent…not affiliated with the applicant”

• Deleted “vehicle:” in front of “serial or motor no.”

• Moved “registration number”, “state”, and “make” further up on the form

• Added “license plate no.”, “model”, “year”, “color”, and “no. of seats”

• Added the question “This vehicle is used to pull a trailer” with yes and no responses to be checked

• Added “station wagon” and “passenger car” to the types of vehicles identified on the form

• Changed item 14 to “windshield/windows”

• Added “(if applicable)” after “authorized inspection number”

• Added “of inspection number (if applicable)” following “expiration date”

• Changed “address where inspection is performed” to “address of shop (garage)”

• Added to “title”, “of person making inspection”

• Changed “expiration date” to read “expiration date of inspection number (if applicable)”

• Changed “accessory” to “accessories”

Changes to Form WH-515

• Revised the line that currently says “(Signature of Examining Doctor)” to first say “(Name of Examining Doctor)” and then “(Signature of Examining Doctor)”

• Revised the formatting so that the wording in parenthesis below each line is centered below the line

• Added a box at the bottom that says “For Internal Use Only: Medical Certificate Expiration Date”