WH-530
INITIAL OR RENEWAL APPLICATION FOR A FARM LABOR CONTRACTOR CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
Page 1 of 13 WH-530
OMB# 1235-0016
Expiration 09/30/2024
PPlleeaassee rreeaadd iinnssttrruuccttiioonnss bbeeffoorree ccoommpplleettiinngg tthhiiss aapppplliiccaattiioonn.. NNoo FFaarrmm LLaabboorr CCoonnttrraaccttoorr CCeerrttiiffiiccaattee ooff RReeggiissttrraattiioonn mmaayy bbee
iissssuueedd uunnlleessss aa ccoommpplleetteedd ffoorrmm hhaass bbeeeenn rreecceeiivveedd.. PPlleeaassee ddoo nnoott ssttaappllee tthhee ffoorrmm oorr aaccccoommppaannyyiinngg ddooccuummeennttss..
Complete this form if you are a ffaarrmm llaabboorr ccoonnttrraaccttoorr,, meaning that you are:
• a person or business who recruits, solicits, hires, employs, furnishes, or transports migrant or seasonal agricultural
workers for money or other benefit;
• not an agricultural employer, agricultural association, or employee of an agricultural employer or association; and
• not subject to the exemption criteria found in 29 U.S.C. § 213(a)(6)(A) and 29 C.F.R. 500.30.
D
Doo nnoott ccoommpplleettee tthhiiss ffoorrmm iiff yyoouu aarree aa ffaarrmm llaabboorr ccoonnttrraaccttoorr
eemmppllooyyeeee, meaning that you recruit solicit, hire, employ
furnish, or transport migrant or seasonal agricultural workers solely on behalf of a registered farm labor contractor. If you
are a f
faarrmm llaabboorr ccoonnttrraaccttoorr eemmppllooyyeeee please register using form WWHH--553355.
D
Doo nnoott ccoommpplleettee tthhiiss ffoorrmm ii
ff yyoouu aarree sseeeekkiinngg ttoo
aammeenndd aa ccuurrrreenntt ffaarrmm llaabboorr ccoonnttrraaccttoorr oorr ffaarrmm llaabboorr ccoonnttrraaccttoorr CCeerrttiiffiiccaattee
ooff RReeggiissttrraattiioonn. To request an amendment, please use form WWHH--554400..
11.. TTYYPPEE OOFF AAPPPPLLIICCAATTIIOONN FFOORR CCEERRTTIIFFIICCAATTEE OOFF RREEGGIISSTTRR AATTIIOONN:: ((CCHHEECCKK OONNLLYY OONNEE))
☐ Initial ☐ Renewal
Previous/current certificate number (if applicable)
PPrroocceeeedd ttoo SSeeccttiioonn 22
22.. FFIIRREEFFIIGG HHTTEERR SS
Will the applicant engage in firefighting activities? ☐ Yes ☐ No
If yes, specify the firefighting activities:
PPrroocceeeedd ttoo SSeeccttiioonn 33
33.. TTHHEE AAPPPPLLIICCAANNTT IISS AA//AANN :: ((CCHHEECCKK OONNEE))
☐ Individual (with or without “Doing Business As” (DBA) name)
PPrroocceeeedd ttoo SSeeccttiioonn 33BB
☐ Proprietorship
PPrroocceeeedd ttoo SSeeccttiioonn 33BB
☐ Corporation
PPrroocceeeedd ttoo SSeeccttiioonn 33AA
☐ Partnership
PPrroocceeeedd ttoo SSeeccttiioonn 33AA
☐ Limited Liability Company (LLC)
PPrroocceeeedd ttoo SSeeccttiioonn 33AA
☐ Other
PPrroocceeeedd ttoo SSeeccttiioonn 33AA
3
3AA.. CC OOMMPPAA NNYY ,, CCOORRPPOORR AATTIIOONN,, PPAARRTTNNEERRSSHHIIPP,, LLLLCC,, OORR OOTTHHEERR
Company name to appear on certificate
EIN (tax ID)
A
Apppplliiccaanntt RReepprreesseennttaattiivvee IInnffoorrmmaattiioonn
Note that the Applicant Representative is a person with decision-making authority for the company, such as the owner, president, CEO, etc.
First Name Middle Name (optional)
Last Name
SSeeccttiioonn 33AA ccoonnttiinnuueess oonn nneexxtt ppaaggee.. PPlleeaassee ccoommpplleettee aallll ooff SSeeccttiioonn 33AA..
WH-530
INITIAL OR RENEWAL APPLICATION FOR A FARM LABOR CONTRACTOR CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
Page 2 of 13 WH-530
OMB# 1235-0016
Expiration 09/30/2024
33AA.. CC OOMMPPAANNYY,, CCOORR PPOORR AATTIIOONN,, PPAARRTTNNEERRSSHHIIPP,, LLLLCC,, OORR OOTTHHEERR ((
CCOONNTTIINNUUEEDD
))
Has the applicant representative ever been known by any other names (e.g., maiden name)?
Social Security Number Date of Birth (mm/dd/yyyy)
Phone number Email address (optional)
PPrroocceeeedd ttoo SSeeccttiioonn 44
33BB.. IINNDDIIVVIIDDUUAALL OORR PPRROOPPRRIIEETTOORRSSHHIIPP
NNaammee ttoo aappppeeaarr oonn cceerrttiiffiiccaattee::
First Name Middle Name (optional)
Last Name
Social Security Number Date of Birth (mm/dd/yyyy)
DBA Name (If applicable)
DBA EIN (If applicable)
Phone number Email address (optional)
PPrroocceeeedd ttoo SSeeccttiioonn 44
44.. AADDDDRREESSSS
AApppplliiccaanntt oorr AApppplliiccaanntt RReepprreesseennttaattiivvee’’ss ppeerrmmaanneenntt ppllaaccee ooff rreessiiddeennccee ((tthhiiss mmaayy nnoott bbee aa PP..OO.. BBooxx))
Address
City State Zip Code Country
M
Maaiilliinngg oorr bbuussiinneessss aaddddrreessss,, iiff ddiiffffeerreenntt ffrroomm aaddddrreessss aabboovvee
Address
City State Zip Code Country
W
Whhiicchh aaddddrreessss sshhoouulldd aappppeeaarr oonn tthhee cceerrttiiffiiccaattee??
☐ Permanent place of residence ☐ Mailing/business address
PPrroocceeeedd ttoo SSeeccttiioonn 55
WH-530
INITIAL OR RENEWAL APPLICATION FOR A FARM LABOR CONTRACTOR CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
Page 3 of 13 WH-530
OMB# 1235-0016
Expiration 09/30/2024
55.. FFAARRMM LLAABBOORR CCOONN TTRRAACCTTIINNGG AA CCTTIIVVIITTIIEESS TTOO BB EE PPEERR FFOORRMMEEDD
CChheecckk eeaacchh aaccttiivviittyy ttoo bbee ppeerrffoorrmmeedd iinnvvoollvviinngg mmiiggrraanntt aanndd//oorr sseeaassoonnaall aaggrriiccuullttuurraall wwoorrkkeerrss ffoorr aaggrriiccuullttuurraall eemmppllooyymmeenntt
uunnddeerr tthhiiss cceerrttiiffiiccaattee::
☐ Recruit ☐ Hire ☐ Furnish ☐ Transport ☐ Solicit ☐ Employ
Location of work with as much specificity as possible, including state, city, and farm name(s), if known
PPrroocceeeedd ttoo SSeeccttiioonn 66
66.. CCRR IIMMIINNAALL HHIISSTTOORR YY
HHaass tthhee aapppplliiccaanntt oorr,, iinn tthhee ccaassee ooff aa ccoommppaannyy,, tthhee aapppplliiccaanntt’’ss rreepprreesseennttaattiivvee,, bbeeeenn ccoonnvviicctteedd wwiitthhiinn tthhee ppaasstt 55 yyeeaarrss,, uunnddeerr
ssttaattee oorr ffeeddeerraall llaaww,, ooff aannyy ooff tthhee ffoolllloowwiinngg ccrriimmeess??
A. Any crime relating to gambling, or to the sale, distribution, or possession of alcoholic beverages, in connection with or
incident to any farm labor contracting activities. ☐ Yes ☐ No
B. Any felony involving robbery, bribery, extortion, embezzlement, grand larceny, burglary, arson, violation of narcotics
laws, murder, rape, assault with intent to kill, assault which inflicts grievous bodily injury, prostitution, peonage, or
smuggling or harboring individuals who have entered the United States illegally. ☐ Yes ☐ No
I
Iff tthhee aapppplliiccaanntt mmaarrkkeedd
""YYEESS"" ttoo AA oorr BB, attach a copy of the final judgment ☐ Attached
A properly completed form FD-258 fingerprint card must be submitted to WHD at least once every three years. Is form
FD-258 attached to this application?
☐ My completed form FD-258 is attached
PPrroocceeeedd ttoo SSeeccttiioonn 77
☐ I previously submitted a completed form FD-258 within the last three years
PPrroocceeeedd ttoo SSeeccttiioonn 88
77.. FFOORRMM FFDD--225588 FFIINNGG EERRPPRRIINNTT CCAARRDD
RReeaadd aanndd ssiiggnn tthhee ssttaatteemmeenntt bbeellooww
The completed form FD-258 submitted with your application will be used to check the criminal history records of the FBI.
Applicants will have the opportunity to complete or challenge the accuracy of the information in this FBI identification
record. Procedures for obtaining a change, correction, or updating of an FBI identification record are set forth in 28 CFR
16.34. Your signature below acknowledges this agency has informed you of your privacy and redress rights.
SIGNATURE DATE
PPrroocceeeedd ttoo SSeeccttiioonn 88
88.. DDOOEESS TTHHEE AAPPPPLLIICCAANNTT RREEQQUUIIRREE TT
RRAANNSSPPOORR TTAATTIIOONN AA UUTTHHOORR IIZZAATTIIOONN??
WWiillll tthhee aapppplliiccaanntt bbee ttrraannssppoorrttiinngg wwoorrkkeerrss iinn vveehhiicclleess tthhaatt iitt oowwnnss oorr ccoonnttrroollss??
☐ Yes IIff YYEESS,,
pprroocceeeedd ttoo SSeeccttiioonn 99 ttoo aappppllyy ffoorr ttrraannssppoorrttaattiioonn aauutthhoorriizzaattiioonn
☐ No I
Iff NNOO,,
but the applicant will be engaging others to provide transportation, identify the vehicles, companies,
growers, and/or FLCs (including FLC registration numbers) that the applicant will engage to provide transportation:
I
Iff NNOO,,
pprroocceeeedd ttoo SSeeccttiioonn 1100
WH-530
INITIAL OR RENEWAL APPLICATION FOR A FARM LABOR CONTRACTOR CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
Page 4 of 13 WH-530
OMB# 1235-0016
Expiration 09/30/2024
99.. AAPPPPLLIICCAA TTIIOONN FFOORR TTRRAANNSSPPOORR TTAATTIIOONN AAUUTTHHOORRIIZZAA TTIIOONN
SSuubbmmiitt pprrooooff ooff ccoommpplliiaannccee wwiitthh tthhee mmoottoorr vveehhiiccllee ssaaffeettyy aanndd iinnssuurraannccee rreeqquuiirreemmeennttss ffoorr EEAACCHH vveehhiiccllee tthhaatt yyoouu oowwnn oorr
ccoonnttrrooll ttoo ttrraannssppoorrtt mmiiggrraanntt oorr sseeaassoonnaall aaggrriiccuullttuurraall wwoorrkkeerrss
. This proof must be a completed form WH-514, WH-514a, or
other substantially similar report. See instructions for further details. ☐ Attached
HHooww wwiillll tthhee aapppplliiccaanntt ccoommppllyy wwiitthh tthhee iinnssuurraannccee oorr lliiaabbiilliittyy bboonndd rreeqquuiirreemmeennttss?? (Check all that apply)
Attach proof of compliance for each of the vehicle insurance/liability bond options checked. See instructions for acceptable
proof of compliance.
☐ Vehicle liability insurance coverage in the amount of not less than $100,000 for each seat in the vehicle.
☐ Liability bond
☐ State workers’ compensation insurance coverage a
anndd a minimum of $50,000 per accident in motor carrier or other
appropriate insurance covering loss or damage to the property of others (excluding cargo). T
Thhee wwoorrkkeerrss’’ ccoommppeennssaattiioonn
ppoolliiccyy mmuusstt ccoovveerr aallll cciirrccuummssttaanncceess iinn wwhhiicchh tthhee mmiiggrraanntt oorr sseeaassoonnaall aaggrriiccuullttuurraall wwoorrkkeerrss wwiillll bbee ttrraannssppoorrtteedd oorr,, iiff
nneecceessssaarryy,, aaddddiittiioonnaall ccoovveerraaggee tthhrroouugghh aa lliiaabbiilliittyy iinnssuurraannccee ppoolliiccyy oorr lliiaabbiilliittyy bboonndd mmuusstt bbee pprrooccuurreedd ffoorr ttrraannssppoorrttaattiioonn nnoott
ccoovveerreedd bbyy tthhee ssttaattee llaaww.. (
IIff uussiinngg wwoorrkkeerrss’’ ccoommppeennssaattiioonn ccoovveerraaggee iinn lliieeuu ooff vveehhiiccllee iinnssuurraannccee,, tthhee aapppplliiccaanntt mmuusstt ccoommpplleettee
tthhee ffoolllloowwiinngg aaddddiittiioonnaall qquueessttiioonnss aanndd ssiiggnn tthhee aaddddiittiioonnaall aatttteessttaattiioonn..))
In what state(s) will the applicant be transporting workers?
If using state workers’ compensation insurance coverage in lieu of vehicle insurance, check all circumstances in
which the applicant will transport workers and sign below:
☐ Daily transportation between living quarters and worksite
☐ Recurring transportation to run errands (e.g., to the grocery store, laundromat, etc.)
☐ Long distance travel between worksites, or to/from the worker’s permanent residence in a different city, state, or
country
☐ Other (describe)
I affirm that I have truthfully listed all circumstances in which I will transport workers, and that my workers’
compensation policy covers these circumstances under applicable state law. I further affirm that I will not transport
workers in any circumstances not covered under applicable state law by my workers’ compensation policy.
Signature of Applicant or Applicant Representative
SIGNATURE DATE
PPrroocceeeedd ttoo SSeeccttiioonn 1100
1100.. DDOOEESS TTHHEE AA PPPPLLIICCAANNTT RREEQQUUIIRR EE DDRRIIVVIINNGG AAUUTTHHOORRIIZZAATTIIOONN??
IIss tthhee aapppplliiccaanntt aann iinnddiivviidduuaall oorr pprroopprriieettoorrsshhiipp?? (Note that only an individual—with or without a DBA name—or
proprietorship applicant may apply for driving authorization.) ☐ Yes ☐ No I
Iff NNOO,,
pprroocceeeedd ttoo SSeeccttiioonn 1122
Will the applicant drive a vehicle to transport workers?
☐ Yes I
Iff YYEESS
,,
pprroocceeeedd ttoo SSeeccttiioonn 1111 ttoo
aappppllyy ffoorr ddrriivviinngg aauutthhoorriizzaattiioonn
☐ No IIff NNOO,,
pprroocceeeedd ttoo SSeeccttiioonn 1122
WH-530
INITIAL OR RENEWAL APPLICATION FOR A FARM LABOR CONTRACTOR CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
Page 5 of 13 WH-530
OMB# 1235-0016
Expiration 09/30/2024
1111.. AAPPPPLLIICCAATTIIOONN FFOORR DDRRIIVVIINNGG AAUUTTHHOORRIIZZAA TTIIOONN
OOnnllyy ccoommpplleettee iiff tthhee aapppplliiccaanntt iiss aann iinnddiivviidduuaall ((wwiitthh oorr wwiitthhoouutt aa DDBBAA nnaammee)) oorr pprroopprriieettoorrsshhiipp..
In what state(s) will the applicant be driving workers?
Attach a copy of the applicant’s driver’s license (front & back) ☐ Attached
Attach a copy of the applicant’s doctor’s certificate (WH-515 or applicable Department of Transportation form).
☐ Attached ☐ Not applicable (the applicant has a currently valid doctor’s certificate on file with WHD)
PPrroocceeeedd ttoo SSeeccttiioonn 1122
1122.. DDOOEESS TTHHEE AA PPPPLLIICCAA
NNTT RR EEQQUU IIRR EE HHOOUU SSIINNGG AA
UUTTHHOORRIIZZAATTIIOONN??
WWiillll tthhee aapppplliiccaanntt oowwnn oorr ccoonnttrrooll aannyy ffaacciilliittyy oorr rreeaall pprrooppeerrttyy tthhaatt wwiillll bbee uusseedd ffoorr hhoouussiinngg bbyy mmiiggrraanntt aaggrriiccuullttuurraall wwoorrkkeerrss iinn
tthhee aapppplliiccaanntt’’ss ccrreeww((ss)) aatt aannyy ttiimmee??
☐ Yes IIff YYEESS,,
pprroocceeeedd ttoo SSeeccttiioonn 1133 ttoo aappppllyy ffoorr hhoouussiinngg aauutthhoorriizzaattiioonn
☐ No I
Iff NNOO,,
bbuutt tthhee aapppplliiccaanntt wwiillll bbee eemmppllooyyiinngg mmiiggrraanntt wwoorrkkeerrss,, iiddeennttiiffyy aallll ffaacciilliittiieess oorr rreeaall pprrooppeerrttyy oowwnneedd aanndd//oorr
ccoonnttrroolllleedd bbyy ootthheerrss wwhheerree
mmiiggrraanntt wwoorrkkeerrss wwiillll bbee hhoouusseedd,, tthheenn
pprroocceeeedd ttoo SSeeccttii
oonn 1144
☐ Not Applicable (The applicant will only employ seasonal workers able to return to their permanent residences each
day.)
IIff NNOOTT AAPPPPLLIICCAABBLLEE,, pprroocceeeedd ttoo SSeeccttiioonn 1144
1133.. AAPPPPLLIICCAATTIIOONN FFOORR HHOOUUSSIINNGG AAUUTTHHOORRIIZZAA TTIIOONN
CChheecckk tthhee aapppplliiccaabbllee bbooxx bbeellooww, and attach the corresponding document indicating that the housing that is owned or
controlled by the applicant and that will be used to house migrant agricultural workers meets all applicable federal and
state safety and health standards. Such proof must be submitted for each facility or real property and must identify the
specific housing (i.e., address).
☐ MSPA form WH-520, Housing Occupancy Certificate issued by a state or local health authority or other appropriate
agency
☐ Occupancy certificate or permit issued by a state or local government agency.
☐ A signed and dated written request for the inspection of a facility or real property made to the appropriate state or
local agency at least forty-five (45) days prior to the date on which it is to be occupied by migrant agricultural workers.
RReeaa dd aanndd ssiiggnn tthhee ffoolllloowwiinngg ssttaatteemmeenntt::
SSTTAATTEEMMEENNTT OOFF IINNTTEENNTTIIOONN TTOO CCOOMMPPLLYY WWIITTHH HHOOUUSSIINNGG RREEQQUUIIRREEMMEENNTTSS OOFF TTHHEE MMIIGGRRAANNTT AANNDD SSEEAASSOONNAALL
AAGGRRIICCUULLTTUURRAALL WWOORRKKEERR PPRROOTTEECCTTIIOONN AACCTT ((MMSSPPAA))
Section 102(3) of the MSPA requires that an applicant for a certificate of registration with authorization to house migrant
agricultural workers shall file a statement identifying each facility or real property to be used by the applicant to house
any migrant agricultural worker during the period for which registration is sought. 29 U.S.C. § 1812(3); 29 C.F.R. §
500.45(c). If the facility or real property is or will be owned or controlled by the applicant, such statement shall provide
documentation showing that the applicant is in compliance with all substantive federal and state safety and health
standards with respect to each such facility or real property. I hereby declare that I will not house migrant agricultural
workers in any facility or real property I own or control until I have submitted all necessary written evidence and have
been issued a Certificate of Registration with housing authorized. I understand that I may then house migrant agricultural
workers only in facilities or real property that has been authorized by the Secretary of Labor.
SIGNATURE DATE
PPrroocceeeedd ttoo SSeeccttiioonn 1144
WH-530
INITIAL OR RENEWAL APPLICATION FOR A FARM LABOR CONTRACTOR CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
Page 6 of 13 WH-530
OMB# 1235-0016
Expiration 09/30/2024
1144.. CCEERRTTIIFFIICCAA TTIIOONNSS AANN DD AAUU TTHHOORRIIZZAATTIIOONN SS
AAllll aapppplliiccaannttss mmuusstt rreeaadd aanndd ssiiggnn aallll cceerrttiiffiiccaattiioonnss aanndd aauutthhoorriizzaattiioonnss iinn tthhiiss sseeccttiioonn..
CCeerrttiiffiiccaattiioonn ooff TTrruutthhffuullnneessss iinn AApppplliiccaattiioonn
I certify that compensation is to be received for the intended farm labor contractor activities and that all representations
made by me in this application are true to the best of my knowledge and belief.
SIGNATURE DATE
S
Sttaatteemmeenntt ooff IInntteennttiioonn
ttoo CCoommppllyy
wwiitthh TTrraannssppoorrttaattiioonn RReeqquuiirreemmeennttss ooff tthhee MMiiggrraanntt aanndd SSeeaassoonnaall AAggrriiccuullttuurraall WWoorrkkeerr
PPrrootteeccttiioonn AAcctt ((MMSSPPAA))
When using, or causing to be used, any vehicle for providing transportation to migrant and/or seasonal agricultural
workers, I declare that I will ensure that each vehicle conforms to applicable federal and state safety regulations, that it
has an insurance policy or liability bond in effect which insures me against liability for damage to persons or property
arising from transporting any migrant or seasonal agricultural workers in that vehicle, and that each driver has a valid and
appropriate license, as provided by state law, to operate the vehicle. I further declare that I will not transport migrant or
seasonal agricultural workers in any vehicle I own or control until I have submitted all necessary written evidence and
have been issued a Certificate of Registration with transportation authorized, and that I will maintain the vehicle(s) in
accordance with applicable federal and state safety regulations, maintain insurance at the required levels, and transport
only in circumstances that are covered by my insurance.
SIGNATURE DATE
A
Auutthhoorriizzaattiioonn ooff tthhee SSeeccrreettaarryy ttoo AAcccceepptt LLeeggaall PPrroocceessss
The following authorization is executed pursuant to section 102(5) of the MSPA. 29 U.S.C. § 1812(5); 29 C.F.R. § 500.45(e).
“I do hereby designate and appoint the Secretary of Labor, United States Department of Labor, as my lawful agent to
accept service of summons in any action against me at any and all times during which I have departed from the
jurisdiction in which such action is commenced or otherwise have become unavailable to accept service, and under such
terms and conditions as are set by the court in which such action has been commenced.”
SIGNATURE DATE
WH-530 INSTRUCTIONS
APPLICATION FOR A FA
RM LABOR CONTRACTOR
CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
PURPOSE OF FORM WH-530
The Migrant and Seasonal Agricultural Worker Protection Act (MSPA) protects migrant and seasonal agricultural workers
by establishing employment standards related to wages, housing, transportation, disclosures and recordkeeping.
Generally, the MSPA applies to any person (or business) who recruits, solicits, hires, employs, furnishes, or transports
migrant or seasonal agricultural workers (the MSPA refers to these activities as "farm labor contracting activities"). In
order to legally operate as a farm labor contractor (FLC) or farm labor contractor employee (FLCE), individuals and
companies must apply to the U.S. Department of Labor for a Certificate of Registration authorizing the applicant to
engage in farm labor contracting activities. During the period for which the Certificate of Registration is in effect, each FLC
and FLCE must notify the Department of Labor to amend the certificate to reflect important changes, such as a change in
address.
Certain persons and organizations, such as small businesses meeting the exemption criteria of 29 U.S.C. § 213(a)(6)(A),
are exempt from the MSPA and are not required to register as farm labor contractors. In addition, establishments meeting
the MSPA definition of an "agricultural association" or "agricultural employer," are not required to register as farm labor
contractors.
The Wage and Hour Division of the U.S. Department of Labor administers and enforces the MSPA. For more information,
contact the Wage and Hour Division through its website at https://www.dol.gov/agencies/whd/contact or by telephone at
1-866-4US-WAGE (1-866-487-9243), TTY: 1-877-889-5627. The federal regulations implementing MSPA appear in 29
C.F.R. Part 500. The regulations are available here: https://www.dol.gov/agencies/whd/laws-and-regulations/laws/mspa
WHO MAY S
UBMIT A FORM
WH-530?
This form is used to apply to the U.S. Department of Labor’s Wage and Hour Division (WHD) for an initial or renewal
Certificate of Registration, authorizing the applicant to engage in “farm labor contr
acting activities” as a farm labor
contractor (FLC).
If you are the employee of a FLC and will be performing farm labor contracting activities solely on behalf of such FLC,
complete form WH-535.
If you are seeking to amend an existing certificate, complete form WH-540.
GENERAL WH-530 INSTRUCTIONS
IMPORTANT: Submitting the application form does not authorize you to engage in farm labor contracting activities. If the
application is approved, you will be issued a Farm Labor Contractor (FLC) Certificate of Registration, at which time you
may begin to engage in the authorized activities. No Farm Labor Contractor Certificate of Registration may be issued unless
a completed form has been received (
see
29 U.S.C. 1811). The application will be returned without processing if it is
incomplete, and the applicant will be required to resubmit.
In addition, depending upon the specific activities for which you are seeking authorization (i.e., housing, transporting, or
driving covered workers), additional forms/documentation must be submitted with your application. Each section of this
application requiring additional form(s) or documentation will include the name and location of the form(s) and/or a
description of the specific documentation needed.
Note: The terms APPLICANT and APPLICANT REPRESENTATIVE are both used in this application. The APPLICANT is the
entity requesting certification, and may be a corporation, partnership, limited liability company (LLC), proprietorship, or
an individual. If the APPLICANT is any entity other than a proprietorship or individual, the APPLICANT REPRESENTATIVE
must be a person with decision-making authority for the entity, such as the owner, president, CEO, etc.
Page 7 of 13 WH-530
OMB# 1235-0016
Expiration 09/30/2024
WH-530 INSTRUCTIONS
APPLICATION FOR A FA
RM LABOR CONTRACTOR
CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
1. TYPE OF APPLICATION FOR CERTIFICATE OF REGISTRATION
Check one box to indicate whether the applicant is submitting an initial or renewal application.
Check INITIAL if:
• no certificate of registration has ever been issued to the applicant;
• a certificate was previously issued to the applicant, and it is now expired; or
• a certificate was previously issued to the applicant, and it is due to expire in
less than 30 days. (For example, if today is
January 1
st
, and the current certificate is due to expire on January 15
th
.)
Check RENEWAL if:
• a certificate of registration was previously issued to the applicant, and it is not yet expired; and
• the certificate is due to expire in 30 days or more.
Identify the current or previous certificate number, if applicable, regardless if the application is an initial or renewal.
Note: A MSPA certificate may be temporarily extended by the timely filing of a properly completed and signed application
for renewal at least
30 days before the expiration of your current certificate. If the application for renewal i
s filed by
regular mail or delivered in person, it must be received by the Department at least 30 days prior to the expiration date on
the current certificate. If the application for renewal is filed by certified mail, it must be mailed at least 30 days prior to
the expiration date on the current certificate.
2. FIREFIGHTERS
Check YES if the applicant will be engaged in performing any firefighting activities.
If checking
YES, provide specific
examples of firefighting activities the applicant will perform.
3. THE APPLICANT IS A/AN:
Check one box to indicate if the applicant is
AN INDIVIDUAL, PROPRIETORSHIP, CORPORATION, PARTNERSHIP, LIMITED
LIABILITY COMPANY, or other.
If the applicant is an INDIVIDUAL (with or without DBA name) or PROPRIETORSHIP, skip Section 3A and proceed to Section
3B.
If the applicant is a CORPORATION, PARTNERSHIP, LIMITED LIABILITY COMPANY, or OTHER, complete Section 3A, and skip
Section 3B.
3A. COMPANY, CORPORATION, PARTNERSHIP, LLC, OR OTHER
Complete this section (and skip Section 3B) if your company is operating as a CORPORATION, PARTNERSHIP, LIMITED
LIABILITY COMPANY, or OTHER.
Identify the COMPANY NAME and EIN (TAX ID) NUMBER that should appear on the certificate.
Identify the FIRST NAME, MIDDLE NAME (OPTIONAL), and LAST NAME of the APPLICANT REPRESENTATIVE submitting the
application. The APPLICANT REPRESENTATIVE must be an individual who has authority to make significant decisions for the
company, e.g., the owner, president, C.E.O., etc. Provide the applicant representative’s social security number and date of
birth. If attaching an
FD-258
to this application, the information on both forms must be for the same APPLICANT
REPRESENTATIVE.
Identify if the applicant representative ever been known by other names, such as a maiden name or alias.
Enter the PHONE NUMBER and EMAIL ADDRESS (optional) to be used to contact the applicant regarding the application.
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APPLICATION FOR A FA
RM LABOR CONTRACTOR
CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
3B. INDIVIDUAL OR PROPRIETORSHIP
Complete this section (and skip Section 3A)
if you are operating as an INDIVIDUAL (WITH OR
WITHOUT DBA NAME)
or
PROPRIETORSHIP and are applying to engage in farm labor contracting activities as a FLC.
Provide the FIRST NAME, MIDDLE NAME, and LAST NAME to appear on the certificate.
Provide the applicant’s SOCIAL SECURITY NUMBER and DATE OF BIRTH.
If the applicant operates the business under a different name, identify the DBA NAME and EIN (TAX ID) NUMBER (if
applicable).
Identify if the applicant ever been known by other names, such as a maiden name or alias.
Enter the PHONE NUMBER and EMAIL ADDRESS (optional) to be used to contact the applicant regarding the application.
4. ADDRESS
Provide the
APPLICANT REPRESENTA
TIVE’S (named in Section 3A) or
APPLICANT’
s (named in Section 3B) permanent
address. This address must be for a physical location where the individual resides; it may not be a P.O. Box.
If the applicant has a different MAILING OR BUSINESS ADDRESS from its permanent address, list this address. Check one
box to indicate which address should appear on the certificate. If no box is checked, the certificate will list the
PERMANENT PLACE OF RESIDENCE.
5. FARM LABOR CONTRACTING ACTIVITIES TO BE PERFORMED
Check the box for each activity to be performed for purposes of this certificate.
At least one box must be checked.
The
MSPA regulations at 29 CFR 500.20(h) provide a definition of “employ.” All other terms have their common meaning.
Provide the location of work with as much specificity as possible, including city, state, and farm name(s), if known.
If the
exact location is unknown, provide as much detail as possible.
6. CRIMINAL HISTORY
Identify if the APPLICANT REPRESENTATIVE or APPLICANT has been convicted of any of the listed crimes in the previous
five year period.
Check
YES to part A
if he/she was convicted
of any crime described in this part that was associated with any farm labor
contracting activities.
Check YES to part B if he/she was convicted of any crime described in this part REGARDLESS
of whether the crime was
committed in connection with any farm labor contracting activities.
If checking yes to part A and/or B, attach a copy of the final judgment to this application. A final judgment is a court
document that contains the final disposition of the case (e.g., convicted, acquitted, dropped, etc.).
Form FD-258 Fingerprint Card must be fully completed by the APPLICANT or APPLICANT REPRESENTATIVE (if the APPLICANT
is a company) if applying for an INITIAL certificate, or if applying for a certificate RENEWAL and the last FD-258 was
submitted to WHD more than three years ago. Identify whether the form FD-258 is attached or has previously been
provided within the preceding three-year period.
7. FORM FD-258 FINGERPRINT CARD
If attaching form FD-258, read and sign the statement regarding privacy and redress rights.
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WH-530 INSTRUCTIONS
APPLICATION FOR A FA
RM LABOR CONTRACTOR
CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
8. DOES THE APPLICANT REQUIRE TRANSPORTATION AUTHORIZATION?
If providing transportation to workers in vehicles that you own or control, complete Section 9, Application for
Transportation Authorization, below.
If you will not be transporting workers in vehicles that you own or control, but you will be engaging others to provide such
transportation, identify the vehicles, companies, growers, and/or FLCs that the applicant will engage to provide
transportation.
9. APPLICATION FOR T
RANSPORTATION AUTHOR
IZATION
You must attach proof of compliance with the motor vehicle safety and insurance requirements for EACH vehicle that you
own or control to transport migrant or seasonal workers to this application.
Acceptable proof of compliance is listed
below.
Acceptable Proof of Compliance–Motor Vehicle Safety
Each vehicle must be inspected and approved each year by a federal or state
Inspector or by a licensed, third
-party garage
or mechanic to ensure that it is in compliance with applicable federal and state safety standards. Proof of compliance
must be demonstrated by submitting a completed form WH-514
(https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh514.pdf) or form
WH-514a
(https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh514a.pdf), Vehicle Identification and Mechanical Inspection
Report, or other substantially similar report.
Such pr
oof must be submitted EACH year for EACH vehicle used to transport
workers.
Acceptable Proof of Compliance
–Insurance or Financial Responsibility
The MSPA regulations at 29 CFR 500.120-.128 outline the insurance or financial responsibility requirements with regard to
migrant and seasonal agricultural workers.
These requirements are also summarized in WHD’s Fact Sheet 50 found at
https://www.dol.gov/agencies/whd/fact-sheets/50
-mspa-transportation. A FLC may not transport workers in any vehicle
without an insurance policy or liability bond in effect. Attach proof of compliance of vehicle insurance OR liability bond
requirements for EACH vehicle to this application.
The applicant must check the box for the type(s) of insurance or liability
bond attached to the application. The options and specific proof required are described below.
• Vehicle liability insurance coverage in the amount of not less than $100,000 for each seat in the vehicle, up to a
maximum of $5,000,000 per vehicle. If checking this box, attach the certificate of insurance (and other information, as
necessary) demonstrating the following information:
• coverage limits for the insurance policy;
• auto schedule or copies of separate ID cards listing the VINs for the vehicles covered. The VINs on the auto
schedule and/or ID cards must match the VINs on the vehicle inspection forms; and
• listing the “Department of Labor” and the address listed in item 15 of the instructions, below, as the certificate
holder.
• Liability bond from a U.S. Department of Treasury approved “surety” assuring payment for any liability up to $500,000
for damages to persons or property arising out of transporting workers in connection with the business, activities, or
operations of the person doing the transporting. If checking this box, mail the original bond to the address listed in
item 15 of the instructions, below.
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APPLICATION FOR A FA
RM LABOR CONTRACTOR
CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
• State workers’ compensation insurance coverage and a minimum of $50,000 per accident in motor carrier or other
appropriate insurance covering loss or damage to the property of others (excluding cargo). The workers’ compensation
policy must cover all circumstances in which the migrant or seasonal agricultural workers will be transported or, if
necessary, additional coverage through a liability insurance policy or liability bond must be procured for
transportation not covered by the state law. Applicants are responsible for consulting with their insurance companies,
state workers’ compensation specialists, and/or legal counsel to ensure that all circumstances of transportation will
be covered. Note that workers’ compensation provides specific coverage and may not cover out-of-state travel or
non-work related travel. Also note that if transportation authorization is issued based on a workers’ compensation
insurance policy pro
vided by a specific employer, the insurance coverage is limited to such times as the applicant is
actually working for that employer.
If checking this box, attach the certificate of insurance demonstrating the workers’ compensation policy, $50,000 in
insurance covering loss or damage to the property of others, and listing the “Department of Labor” and the address
listed in item 15 of the instructions, below, as the certificate holder. If using workers’ compensation coverage in lieu
of vehicle insurance, the applicant must also complete the following additional fields on the form:
• States in which the applicant will be transporting workers. Workers’ compensation laws vary from state to state.
The applicant must ensure that it transports workers only in circumstances for which there is coverage under
state law.
• List of all circumstances in which the applicant will transport workers. Some workers’ compensation policies may
not cover all circumstances of transportation. The applicant is responsible for knowing what circumstances are
covered by the workers’ compensation policy and
transporting workers in only those circumstances
.
• Affirmation that the applicant will only transport workers in circumstances covered under applicable state law. If an
investigation reveal
s that the applicant knowingly misrepresented the circumstances in which it would transport
workers, or knowingly misrepresented that such circumstances are covered under applicable state law, the Wage
and Hour Division may pursue certificate revocation pursuant to MSPA Section 103(a)(1) and 29 CFR 500.51(a).
10. DOES THE APPLICANT REQUIRE DRIVING A UTHORIZATION?
Only an individual or proprietorship may apply for driving authorization. Check NO, skip Section 11, and proceed to Section
12 if you do not need driving authorization. If you are an applicant representative applying for a corporation, partnership,
LLC, or other business, and require driving authorization, you must register as a Farm Labor Contractor Employee (FLCE)
and obtain driving authorization using your FLCE certificate
If seeking driving authorization, complete Section 11, Application for Driving Authorization.
11. APPLICATION FOR DRIVING AUTHORIZATION
If applying for driving authorization, attach:
• A clear photocopy of the applicant’s current and valid driver’s license, both front and back; and
• A completed doctor’s certificate (completed by a doctor of medicine or osteopathy) for the applicant, WH-515
(https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh515.pdf) or applicable Department of Transportation
form, if WHD does not have a currently valid doctor’s certificate on file.
The applicant must also list the state(s) where he or she will be driving. Note that some states have restrictions on driver’s
licenses issued by foreign countries. Driving authorization will not be issued to an applicant holding only a foreign driver’s
license if, at the time of filing the application, any of the listed state(s) do not accept a foreign driver’s license.
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APPLICATION FOR A FA
RM LABOR CONTRACTOR
CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
12. DOES THE APPLICANT REQUIRE HOUSING AUTHORIZATION?
The applicant should check YES
if it will be housing migrant workers in a facility or real property that it owns or controls.
The applicant is an owner if it has le
gal or equitable interest in facilities or real property that will be used as housing by
migrant agricultural workers. The applicant controls a facility or real property if it has the power or authority to oversee,
manage, superintend, or administer the property.
If owning or controlling a facility or real property to house workers, complete Section 13, Application for Housing
Authorization, below.
13. APPLICATION FOR
HOUSING AUTHORIZATIO
N
Skip this section if the applicant does not own or control any facilities or real property to be used by migrant workers, or if
all workers will return to their permanent residences each workday.
For EACH facility or real property that the applicant owns or controls and that will be used to house migrant agricultural
workers, check the applicable box and attach the corresponding document indicating compliance with applicable federal
and state safety and health standards. The proof may be any of the completed documents listed below, and must identify
the housing (i.e., list
the address).
• MSPA form WH
-
520, Housing Occupancy Certificate
(https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh520.pdf) issued by a state or local health authority or
other appropriate agency.
• Occupancy certificate or permit issued by a state or local government agency.
• A dated and signed written request for the inspection of a facility or real property made to the appropriate state or
local agency at least forty-five (45) days prior to the date on which it is to be occupied by migrant agricultural workers.
The request should list the following items:
• Property address
• Intended dates of occupancy
• Intended number of occupants
• Number of
units (if applicable)
•
Owner of property
• Printed name and signature of requesting FLC
Sign the statement to affirm that the applicant intends to comply with the MSPA housing requirements.
14. CERTIFICATIONS AND AUTHORIZATIONS
All applicants must sign the statement to affirm that the information in the application is true. A false answer or
misrepresentation to any question may be punishable by fine or imprisonment. See 18 U.S.C. § 1001, 29 U.S.C. §§ 1851-
1853; 29 C.F.R. § 500.6.
All applicants must also sig
n the statement to affirm their intention to comply with all MSPA transportation requirements.
Finally, the applicant must sign agreeing that, if you become unavailable to accept service on a summons regarding any
action taken against you, the Secretary of
Labor may act as your agent and accept service on your behalf. See 29 U.S.C. §
1812(5); 29 C.F.R. § 500.45(e).
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WH-530 INSTRUCTIONS
APPLICATION FOR A FA
RM LABOR CONTRACTOR
CERTIFICATE OF REGISTRATION
(APPLICATION FOR “ORANGE CARD”)
SUBMISSION OF APPLICATION
Send first class mail, certified mail, or USPS Express Mail to:
U.S. Department of Labor
Wage and Hour Division
Farm Labor Certificate Processing
90 Seventh Street Suite 11-100
San Francisco, CA 94103
You may contact the certificate processing office by email at mspaflc@dol.gov or by phone at 415-241-3505 for in
quiries
during the hours of 8 AM-12 PM and 1 PM-4:30 PM Pacific Time, Monday through Friday, excluding federal holidays.
PRIVACY ACT AND PAPERWORK REDUCTION ACT
PUBLIC BURDEN STATEM
ENT
• The purpose of this form is to provide the Department of Labor with sufficient information to identify and determine
the qualifications of the applicant for the requested certificate to serve as a FLC or FLCE.
• In addition to the Department of Labor using this collection of information in the FLC/FLCE registration process,
information from this form may be used in the course of presenting evidence to a court of administrative tribunal or
in the course of settlement negotiations.
• Failure to provide the information precludes the issuance of necessary documents required under the law. Your social
security number is used for identification purposes; its submission is authorized by 29 C.F.R. Part 500.
• Information collected in response to this request may be disclosed in accordance with the provisions of the Freedom
of Information Act, 5 U.S.C. § 552(a); and related regulations, 29 C.F.R. Parts 70, 71. The Department of Labor makes
no express assurances of confidentiality regarding this collection of information.
• Submission of this information is required under the MSPA in order to obtain the
benefit of an FLC or FLCE Certificate
of Registration. 29 U.S.C. §§ 1811
-1812; 29 C.F.R. § 500.44
-.47. Unlawfully engaging in FLC activities without valid
FLC/FLCE Certificate of Registration may subject you to civil or criminal penalties. See 29 U.S.C. §§ 1851-1853; 29
C.F.R. 500 Subpart E.
• Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control
Number.
• The Department of Labor estimates that it will take an average of 30 minutes to complete this collection of
information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed and completing and reviewing the collection of information. If you have any suggestions for reducing
this burden, send them to the Administrator, Wage and Hour Division, Room S-3502,
200 Constitution Avenue NW,
Washington, DC, 20210.
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