Information Collection

MSPA Driver's Doctor's Certificate

IC 202137 under ICR 202405-1235-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 WH515 MSPA Driver's Doctor's Certificate	Form and Instruction
WH515 DOCTOR’S CERTIFICATE wh515_CLEAN.docx www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh515.pdf	Form and Instruction
WH515 DOCTOR’S CERTIFICATE wh515_CLEAN.docx www.dol.gov/sites/dolgov/files/WHD/legacy/files/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: Modified

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	WH515	DOCTORâS CERTIFICATE	wh515_CLEAN.docx	https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh515.pdf	Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: ESA/DOL-34 and ESA/DOL-35

FR Citation: 67 FR 16818

Number of Respondents: 6,630

Number of Respondents for Small Entity: 6,630

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,630	-902	7,532
Annual IC Time Burden (Hours)	2,873	-391	3,264
Annual IC Cost Burden (Dollars)	577,652	57,944	519,708

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.