Information Collection

MSPA Driver's Doctor's Certificate

IC 46291 under ICR 201005-1235-001 · OMB 1235-0017.

Documents and Forms

Document Name Document Type
Form WH-515 MSPA Driver's Doctor's Certificate Form and Instruction
WH-515 MSPA Doctor�s Certificate wh515(exp2010).pdf www.dol.gov/whd/forms/wh515.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MSPA Driver's Doctor's Certificate	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 500.105(b)(1)(G) 29 CFR 500.105(b)(1)(I)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-515	MSPA Doctorï¿½s Certificate	wh515(exp2010).pdf	http://www.dol.gov/whd/forms/wh515.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,100	Number of Respondents for Small Entity: 165

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,100	2,100
Annual IC Time Burden (Hours)	735	735
Annual IC Cost Burden (Dollars)	144,900	144,900

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.