Information Collection

Worker Information - Terms and Conditions of Employment

IC 13905 under ICR 201003-1235-002 · OMB 1235-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0002 can be found here:

Documents and Forms

Document Name Document Type
Form WH-516-ENGLISH Worker Information - Terms and Conditions of Employment Form
WH-516-ENGLISH Worker Information-Terms and Conditions of Employment Form_WH-516_English.pdf www.dol.gov/esa/forms/whd/Form_WH-516_English.PDF Form
WH-516-ESPANOL Informacion Sobre el Trabajador-Terminos y Condiciones d WH-516_Spanish.pdf www.dol.gov/esa/forms/whd/WH-516_Spanish.PDF Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Worker Information - Terms and Conditions of Employment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 500.75 29 CFR 500.76

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	WH-516-ENGLISH	Worker Information-Terms and Conditions of Employment	Form_WH-516_English.pdf	http://www.dol.gov/esa/forms/whd/Form_WH-516_English.PDF	Yes	No	Fillable Printable
Form	WH-516-ESPANOL	Informacion Sobre el Trabajador-Terminos y Condiciones de Empleo	WH-516_Spanish.pdf	http://www.dol.gov/esa/forms/whd/WH-516_Spanish.PDF	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 129,250	Number of Respondents for Small Entity: 100,000

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,102,000	1,507,200	1,594,800
Annual IC Time Burden (Hours)	77,550	8,750	68,800
Annual IC Cost Burden (Dollars)	93,060	50,060	43,000

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.