Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Special Minimum Wages

Applications to Employ Special Industrial Homeworkers and Workers with Disabilities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0005 can be found here:

Documents and Forms

Document Name Document Type
Form WH-226A Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Special Minimum Wages Form and Instruction
WH-226A Supplemental Data Sheet for Application for Authority to wh226a.pdf www.dol.gov/esa/forms/whd/wh226a.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Special Minimum Wages	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 525

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-226A	Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Special Minimum Wages	wh226a.pdf	http://www.dol.gov/esa/forms/whd/wh226a.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: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	9,000	9,000
Annual IC Time Burden (Hours)	6,750	6,750
Annual IC Cost Burden (Dollars)	0	0

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.