Employment Under Special Certificates of Workers with Disabilities at Special Minimum Wages

Fair Labor Standards Act Special Employment Provisions

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0001 can be found here:

Documents and Forms

Document Name Document Type
Form Website instructions4-1-16.docx www.dol.gov/whd/forms/fts_wh226.htm Instruction
WH-226 Application for Authority to Employ Workers with Disabil WH226 REV 04 04 16 V2.pdf www.dol.gov/whd/forms/fts_wh226.htm Form and Instruction
WH-226A Supplemental Data Sheet for Application for Authority to WH226A REV 04 04 16 V3.pdf www.dol.gov/whd/forms/fts_wh226.htm Form and Instruction
WH-226 and WH-226A Section 14c Certificate Application electronic OMB Screenshots wh-226 and wh-226a.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Employment Under Special Certificates of Workers with Disabilities at Special Minimum Wages	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 525.7-.9 29 CFR 525.11-.13

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Form Website instructions4-1-16.docx	http://www.dol.gov/whd/forms/fts_wh226.htm	Yes	No	Printable Only
Form and Instruction	WH-226	Application for Authority to Employ Workers with Disabilities at Subminimum Wages	WH226 REV 04 04 16 V2.pdf	http://www.dol.gov/whd/forms/fts_wh226.htm	Yes	No	Fillable Printable
Form and Instruction	WH-226A	Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Subminimum Wages	WH226A REV 04 04 16 V3.pdf	http://www.dol.gov/whd/forms/fts_wh226.htm	Yes	No	Fillable Printable
Form and Instruction	WH-226 and WH-226A electronic form	Section 14c Certificate Application electronic	OMB Screenshots wh-226 and wh-226a.pdf		Yes	Yes	Fillable Fileable

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: 2,800

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,500	0	7,500
Annual IC Time Burden (Hours)	13,825	0	13,825
Annual IC Cost Burden (Dollars)	2,030	-1,015	3,045

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.