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MSPA Driver's Doctor's Certificate
Application for a Farm Labor Contractor or Farm Labor Contractor Employee Certificate of Registration
OMB: 1235-0016
IC ID: 202137
OMB.report
DOL/WHD
OMB 1235-0016
ICR 202105-1235-001
IC 202137
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0016 can be found here:
2024-09-10 - No material or nonsubstantive change to a currently approved collection
2024-07-22 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form WH 515
MSPA Driver's Doctor's Certificate
Form and Instruction
Edits to Instruction Page on Website 2.16.21.docx
Instruction
Edits to Instruction Page on Website 2.16.21.docx
Instruction
WH 515 MSPA Doctor's Certificate
wh515_clean_final 030920.docx
www.dol.gov/whd/forms/wh515.pdf
Form and Instruction
WH 515 MSPA Doctor's Certificate
wh515_clean_final 030920.docx
www.dol.gov/whd/forms/wh515.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
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
MSPA Doctor's Certificate
wh515_clean_final 030920.docx
https://www.dol.gov/whd/forms/wh515.pdf
Yes
No
Fillable Printable
Instruction
Edits to Instruction Page on Website 2.16.21.docx
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Labor Rights Management
Privacy Act System of Records
Title:
ESA/DOL-34 and ESA/DOL-35
FR Citation:
67 FR 16818
Number of Respondents:
7,532
Number of Respondents for Small Entity:
7,005
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Farms, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
7,532
0
0
0
0
7,532
Annual IC Time Burden (Hours)
3,264
0
0
0
0
3,264
Annual IC Cost Burden (Dollars)
519,708
0
0
0
0
519,708
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.