Information Collection

MSPA Driver's Doctor's Certificate

IC 46291 under ICR 201005-1235-001 · OMB 1235-0017.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form WH-515 MSPA Driver's Doctor's Certificate	Form and Instruction
WH-515 MSPA Doctor�s Certificate wh515(exp2010).pdf www.dol.gov/whd/forms/wh515.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 500.105(b)(1)(G) 29 CFR 500.105(b)(1)(I)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-515	MSPA Doctorï¿½s Certificate	wh515(exp2010).pdf	http://www.dol.gov/whd/forms/wh515.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,100

Number of Respondents for Small Entity: 165

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,100	2,100
Annual IC Time Burden (Hours)	735	735
Annual IC Cost Burden (Dollars)	144,900	144,900

Documents for IC

table that charts IC Documents
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.