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⚠️ Notice: This information collection may be referencing outdated material.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
Instructions for Form WH226 wh226a.docx www.dol.gov/agencies/whd/forms/wh226 Instruction
WH-226 Application for Authority to Employ Workers with Disabil wh226.pdf www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh226.pdf Form and Instruction
WH-226A Supplemental Data Sheet for Application for Authority to wh226a.pdf www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh226a.pdf Form and Instruction
WH-226 and WH-226A Section 14(c) certificate application electronic WH-226andWH-226A electronic form screen shots 6-12-20.pdf www.dol.gov/agencies/whd/workers-with-disabilities/section-14c/apply 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 525.11-.13 29 CFR 525.7-.9

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Instructions for Form WH226 wh226a.docx	https://www.dol.gov/agencies/whd/forms/wh226	Yes	No	Printable Only
Form and Instruction	WH-226	Application for Authority to Employ Workers with Disabilities at Subminimum Wages	wh226.pdf	https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh226.pdf	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.pdf	https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh226a.pdf	Yes	No	Fillable Printable
Form and Instruction	WH-226 and WH-226A electronic	Section 14(c) certificate application electronic	WH-226andWH-226A electronic form screen shots 6-12-20.pdf	https://www.dol.gov/agencies/whd/workers-with-disabilities/section-14c/apply	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	Previously Approved
Annual Number of Responses for this IC	7,500	7,500
Annual IC Time Burden (Hours)	13,825	13,825
Annual IC Cost Burden (Dollars)	2,030	2,030

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.