MSPA Driver's Doctor's Certificate

Application for a Farm Labor Contractor or Farm Labor Contractor Employee Certificate of Registration

Documents and Forms

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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH515	DOCTOR’S 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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,630	6,630
Annual IC Time Burden (Hours)	2,873	2,873
Annual IC Cost Burden (Dollars)	577,652	577,652

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.