Information Collection

MSPA Driver's Doctor's Certificate

IC 202137 under ICR 201702-1235-001 · OMB 1235-0016.

⚠️ Notice: This information collection may be referencing outdated material.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

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

IC Title:

MSPA Driver's Doctor's Certificate

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 500.105

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	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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,259	3,259
Annual IC Time Burden (Hours)	1,412	1,412
Annual IC Cost Burden (Dollars)	224,871	224,871

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.