Information Collection

MSPA Driver's Doctor's Certificate

IC 202137 under ICR 202501-1235-001 · OMB 1235-0016.

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
Form WH515 DOCTOR’S CERTIFICATE 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:

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	WH515			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	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

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.

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